- Apex Health Solutions (Houston, TX)
- Summary: The UM Reviewer serves as a contact...utilization review (UR) of healthcare services. The UM Reviewer will be responsible for complying ... or UR questions or issues arise. To support care management initiatives, the UM Reviewer should also identify enrollees in need of case/disease management… more
- Elevance Health (Houston, TX)
- …clinical reviews with attending physicians or other providers to discuss review determinations, and patients office visits with providers and external physicians. ... with attending physicians or other ordering providers to discuss review determinations. + Serves as a resource and consultant...or territory of the United States when conducting utilization review or an appeals consideration and cannot be located… more
- Apex Health Solutions (Houston, TX)
- …of care. Provides medication management support, including comprehensive medication review and adherence education Communicates, collaborates and cooperates with ... internal and external stakeholders. Collaborates effectively with Utilization Management, Case Management, Population Management, Quality Management, Pharmacy, Provider relations and other health plan departments Adheres to all Compliance/Program Integrity… more
- Molina Healthcare (Houston, TX)
- …(RN) Registered Nurse with previous experience in Hospital Acute Care, Concurrent Review / Utilization Review / Utilization Management and knowledge of Interqual ... Collaborates with multidisciplinary teams to promote Molina Care Model. + Adheres to UM policies and procedures. + Occasional travel to other Molina offices or… more
- Elevance Health (Houston, TX)
- …40 hrs a week** . The **Medical Director Associate - Oral Health ( UM )** is responsible for providing day-to-day guidance, support, and leadership for clinical and/or ... in ensuring clinical integrity of broad and significant clinical programs. May perform clinical review focused on oral health. **How you will make an impact:** + May… more
- The City of Houston (Houston, TX)
- …/ SKILLS TESTS REQUIRED The selection process will involve application review and/or interview. Department may administer skills assessment test. Bilingual ... NOT an acceptable answer and may delay your application review ) 10 Please indicate your level of proficiency in...notes while speaking, refrains from using fillers such as " Um ". + Expert - Attended toast masters course, makes… more