- Centene Corporation (Austin, TX)
- …needed to discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member ... approve medical determinations or provide recommendations based on requested services and concurrent review findings + Assists with providing education to… more
- Centene Corporation (Austin, TX)
- …in California or Texas.** **Hours are 9:30am-6pm PST.** **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance ... medical appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine… more
- CVS Health (Austin, TX)
- …needed as well as outreach calls to physician offices. -Conducts prospective, concurrent , and/or retrospective review of cases using health plan/employer agreed ... requirements. -Facilitation of documentation of program agreement with client. * Review complex clinical criteria-based prior authorizations in accordance with… more
- Molina Healthcare (Austin, TX)
- …requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care ... state, and local laws and regulatory requirements affecting the medical and clinical staff. **Job Duties** + Provides medical oversight and expertise in… more