- Elevance Health (Grand Prairie, TX)
- …within 50 miles of one of our Elevance Health locations.** The Medical Director is responsible for the administration of physical and/or behavioral health medical ... cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program. How you will… more
- Apex Health Solutions (Houston, TX)
- Summary: The UM Reviewer serves as a contact and resource person to Health Solutions' members for the utilization review (UR) of healthcare services. The UM ... pending cases for a review determination with Health Solutions Medical Director , coordinate pre-authorization activities with affiliated health plans and interface… more
- Magellan Health Services (Dallas, TX)
- …of care. Provides day to day physician oversight to an assigned interdisciplinary UM team, including regular involvement in the case management of at-risk cases and ... care at the most cost-effective setting. Evaluates the effectiveness of UM practices and criteria. Actively monitors for over- and under-utilization. Assumes… more
- Baylor Scott & White Health (Temple, TX)
- …accountable to provide professional leadership and direction in the utilization/cost management ( UM ) and clinical quality improvement (QI) of the Health Plan, as ... measured by benchmarked UM and QI goals. Works collaboratively as a clinical...care performance. + Partner with Provider Networks and Medical Director team in creating and maintaining programs that incentivize… more
- CVS Health (Austin, TX)
- …have a TX License without encumbrances. PM&R Specialty desired. In the Medical Director role you will provide oversight for medical policy implementation. You will ... timely and consistent responses to members and providers. As a Medical Director you will focus primarily on overseeing utilization review / quality assurance… more
- Houston Methodist (Nassau Bay, TX)
- …and quality improvement processes related to admission, concurrent and retrospective UM and medical claims programs. Collaborates with medical and clinical ... areas according to department specifications. + Manages utilization management ( UM ) programs including Medical Claims Review, Precertification and Reconsiderations… more
- Tarleton State University (Stephenville, TX)
- …priorities. This position will be located in Stephenville and report to the SON's Director of Curriculum and Instruction. Work hours: Mon-Fri; 8 AM-5 PM or as work ... funding availability and candidate experience/skillset in relation to the mini m um requirements of this position. Tarleton State University offers a career filled… more
- Highmark Health (Austin, TX)
- …in the capacity as a clinical pharmacist the incumbent may also review UM requests; provide consultation into the case and disease management identification process, ... overall efficiencies. + Manage individual projects for timely review with the Director , Clinical Pharmacy. + Participate in Medicare Stars performance measures to… more