- 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
- Molina Healthcare (Houston, TX)
- …730pm Central Standard Time** . + This role will be working in the UM Pharmacy reviewing incoming Prior Auth requests for Medicaid and Marketplace members through ... clinical pharmacy services (such as, therapeutic drug monitoring, drug regimen review , patient education, and medical staff interaction), and oversight (establishing… more
- Molina Healthcare (Houston, TX)
- …Collaborates with multidisciplinary teams to promote Molina Care Model. + Adheres to UM policies and procedures. + Occasional travel to other Molina offices or ... experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. **Preferred… more
- Molina Healthcare (Houston, TX)
- …Collaborates with multidisciplinary teams to promote Molina Care Model + Adheres to UM policies and procedures. + Occasional travel to other Molina offices or ... hospitals as requested, may be required. This can vary based on the individual State Plan. + Must be able to travel within applicable state or locality with reliable transportation as required for internal meetings. **JOB QUALIFICATIONS** **Required… more
- Molina Healthcare (Houston, TX)
- …Collaborates with multidisciplinary teams to promote Molina Care Model. + Adheres to UM policies and procedures. + Occasional travel to other Molina offices or ... hospitals as requested, may be required. This can vary based on the individual State Plan. **JOB QUALIFICATIONS** **Required Education** Graduate from an Accredited School of Nursing. **Required Experience** 3+ years hospital acute care/medical experience.… more
- Houston Methodist (Houston, TX)
- …other areas according to department specifications. + Manages utilization management ( UM ) programs including Medical Claims Review , Precertification and ... competent and engaged employee group by conducting regular department meetings to review policies and procedures and operational matters, rounding on all employees,… more
- Molina Healthcare (Houston, TX)
- …auditing of registered nurse and other clinical functions in Utilization Management ( UM ), Case Management (CM), Member Assessment Team (MAT), Health Management (HM), ... Nursing. Michigan unrestricted license preferred. **Required Experience** + Minimum two years UM , CM, MAT, HM, DM, and/or managed care experience. + Proficient… more
- Molina Healthcare (Houston, TX)
- …appropriate care at the most effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under-utilization. Assumes a leadership ... requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care and services… 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
- Molina Healthcare (Houston, TX)
- …and results across Molina Health Plans & Segments. **KNOWLEDGE/SKILLS/ABILITIES** + Review existing case management standards and processes and establishes new ... model concept design. + Collaborate with other COE leaders across the enterprise UM , LTSS, BH, Quality, Office of the CMO, Network, Government Contracts, Growth and… more
- Molina Healthcare (Houston, TX)
- …and results across Molina Health Plans & Segments. **KNOWLEDGE/SKILLS/ABILITIES** + Review existing standards and processes and establish new standards and processes ... all lines of business. + Collaborate with other COE leaders across the enterprise UM , LTSS, BH, Quality, Office of the CMO, Network, Government Contracts, Growth and… more