- CVS Health (Dallas, TX)
- …PBM clinical programs, including formulary development, Pharmacy & Therapeutics Committee, utilization management , and accreditation (eg, URAC, NCQA). ... personal, convenient and affordable. **Position Summary** The VP & Senior Legal Counsel for CVS Caremark is responsible for...clinical programs and Aetna pharmacy benefit. The VP & Senior Legal Counsel will act as a subject matter… more
- Houston Methodist (Cypress, TX)
- …and trends in the areas of care coordination, evidence- based practice, utilization management , and service excellence. Disseminates information and focuses the ... for appropriate utilization of resources to avoid denials and resource management as it pertains to delivery of care. **GROWTH/INNOVATION ESSENTIAL FUNCTIONS** +… more
- CVS Health (Austin, TX)
- … in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and appeals) and responds to ... programs and commercial client program support. Will share in reviews of utilization management (PA) criteria and clinical policy revisions/reviews. - Directors… more
- Magellan Health Services (Dallas, TX)
- …appropriate for complex case management and timely completion of all utilization management activities. Involvement in the development of case management ... plans. + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a high quality of patient care,… more
- HCA Healthcare (Cypress, TX)
- …will assemble regional physician advisory panels to provide ongoing feedback to HCA senior management , and serves as a liaison between committees and ... review/ management + You will consult with facility-level staff regarding delegated utilization management and disease management operations under managed… more
- Houston Methodist (Houston, TX)
- …compliance with ethical and legal business practices and accreditation /regulatory/government regulations. **PEOPLE ESSENTIAL FUNCTIONS** + Directs, develops and ... teams to enable the effective and efficient completion of objectives. + Oversees management of and ensures development for staff to meet overall objectives in terms… more
- Evolent Health (Austin, TX)
- …selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. ... Reviewer you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Houston Methodist (Houston, TX)
- …compliance with ethical and legal business practices and accreditation /regulatory/government regulations. **PEOPLE ESSENTIAL FUNCTIONS** + Directs, develops and ... teams to enable the effective and efficient completion of objectives. + Oversees management of and ensures development for staff to meet overall objectives in terms… more
- Houston Methodist (Nassau Bay, TX)
- At Houston Methodist, the Director Nursing position is responsible for the 24/7 management of the assigned nursing units and departments in terms of the quality of ... in cooperation with the Medical Staff to ensure regulations and accreditation standards are maintained. The Director position responsibilities include overseeing the… more
- Houston Methodist (Houston, TX)
- …the Director Physician Recruitment position is responsible for the comprehensive management of strategic Physician Recruitment for the Physician Organization, which ... secure compliance with ethical and legal business practices and accreditation /regulatory/government regulations. **PEOPLE ESSENTIAL FUNCTIONS** + Directs, develops and… more
- HCA Healthcare (Austin, TX)
- …standards for ACGME simulation requirements. This positions also coordinates the utilization of simulation resources to ensure fidelity of curricula and assessments ... pedagogy to faculty and staff across all programs. + Work closely with senior leadership to prepare supporting documentation as required for ACGME accreditation … more
- Evolent Health (Austin, TX)
- …Be Doing:** As a Physician Clinical Reviewer you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- Houston Methodist (Houston, TX)
- …compliance with ethical and legal business practices and accreditation /regulatory/government regulations. **PEOPLE ESSENTIAL FUNCTIONS** + Directs, develops and ... teams to enable the effective and efficient completion of objectives + Oversees management of and ensures development for staff to meet overall objectives in terms… more
- Houston Methodist (Nassau Bay, TX)
- …compliance with ethical and legal business practices and accreditation /regulatory/government regulations. **PEOPLE ESSENTIAL FUNCTIONS** + Directs, develops and ... teams to enable the effective and efficient completion of objectives. + Oversees management of and ensures development for staff to meet overall objectives in terms… more
- Houston Methodist (Houston, TX)
- …/regulatory/ government regulations. **PEOPLE ESSENTIAL FUNCTIONS** + Performs management responsibilities of selection, scheduling, supervision, retention, and ... At Houston Methodist, the Senior Practice Manager position is responsible for independently managing and/or coordinating complex delivery of care within a large,… more
- HCA Healthcare (Austin, TX)
- …and/or revise the department safety plan and/or any specific accreditation /regulatory required safety guidelines. Responsible for staff maintenance of credentials ... and monitor budget reports and variances, evaluate human and material resource utilization , and make necessary adjustments. Analyze and interpret complex data sets… more
- HCA Healthcare (North Richland Hills, TX)
- …preferred. **Experience:** + Five years in quality, performance improvement, risk management , medical staff peer review, and regulatory/ accreditation standards ... improvement of quality and safety of patient care, enhance appropriate utilization of resources, and the reduction/elimination of unnecessary risks and medical… more
- Houston Methodist (Cypress, TX)
- At Houston Methodist, the Senior Exercise Physiologist position effectively evaluates patients referred to the Cardiac Rehabilitation program, develops and ... implements effective, efficient, management /treatment plans. This position assumes additional responsibilities, which support the growth and professional development… more
- Elevance Health (Grand Prairie, TX)
- …problem solving with providers, claims or service issues. Assists with development of utilization /care management policies and procedures. + Within the medical ... **The Transplant Nurse II** is responsible for providing case management and/or medical management (UM/UR) for members...on the team in preparation for advancement to the senior level. Primary duties may include, but are not… more
- Catholic Health Initiatives (Lufkin, TX)
- …information, including variance reports, financial projections and other statistical reports; keeps senior management apprised of all issues with potential for ... human relations and continuous quality improvement in the overall management , coordination, and refinement of inpatient pharmaceutical care. **Responsibilities**… more