- Humana (Austin, TX)
- …a part of our caring community and help us put health first** The UM Administration Coordinator 2 provides clerical support for the department. We are the beginning, ... members. **Achieve your best at Humana. Join Us!** The UM Administration Coordinator 2 provides non-clinical support for the...the nursing team + Builds and pends authorizations for review + Responsible for inbound and outbound calls to… more
- Textron (Fort Worth, TX)
- **Electromagnetic Effects Engineer - HIRF Lightning UM ** **Description** _We're more than aviation experts, we're pioneers\. We challenge what's possible\. From ... \. **And we want you\.** **Electromagnetic Effects Engineer - HIRF Lightning UM ** Responsible for representing Bell aircraft commercial programs as a subject matter… more
- CVS Health (Austin, TX)
- …Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and appeals) and responds to prescriber inquiries ... related to UM transactions and more generally related to CVS Health...when appropriate. - Medical Directors will participate in inter-rater review activities and other quality oversight processes for internal… 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 (Grand Prairie, TX)
- …The **Medical Policy Analyst Sr.** is primarily responsible for the development, review , and maintenance of new and existing Elevance Health medical policies and ... clinical UM guidelines. Primary duties may include, but are not...support analysis of potential new medical policies and clinical UM guidelines + Investigates and develops analysis of potential… more
- Elevance Health (Houston, TX)
- …prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer . + Responsible for the identification ... responsible for coordinating cases for precertification and prior authorization review . **How you will make an impact :** +...and data entry of referral requests into the UM system in accordance with the plan certificate. +… more
- ERP International (Corpus Christi, TX)
- …Program (UMP) and ensure that the UMP meets established Utilization Management ( UM ) standards of care. Assist in coordinating a multidisciplinary team to meet ... of utilization management services including referrals, care coordination, utilization review , discharge planning, continued stay reviews, and appeal reviews. *… more
- Prime Therapeutics (Austin, TX)
- …development and process support for Prime National and Client Utilization Management ( UM ) programs, review of regulatory requirements and adherence for processes ... of Prime's functional areas: Clinical Program Management, Utilization Management ( UM ), Formulary, GuidedHealth, Pharmaceutical Trade Relations, Pharmacy Audit, Provider… more
- Magellan Health Services (Dallas, TX)
- This is a part time position doing case review , remote work from home, and the work schedule is M-F, 1-5pm CST. TX license required. This position supports the ... 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… more
- Evolent Health (Austin, TX)
- …Initial Clinical Reviewers. **What you'll be doing:** + Supports pre-admission review , utilization management, and concurrent and retrospective review process. ... risk management, claim adjudication, pharmacy utilization management, catastrophic case review , outreach programs, + Assists with execution of Evolent's benchmarked… more
- Evolent Health (Austin, TX)
- …business. + Provides oversight of the use of appropriate correspondence and review requests for new or modifications to existing correspondence templates. + Oversees ... minimum standards for National Committee for Quality Assurance + Utilization Review Accreditation Commission (URAC), Employee Retirement Income Security Act of 1974… more
- Tarleton State University (Stephenville, TX)
- …Kaplan), + Orders appropriate materials for such sessions + Arranges onsite board review sessions with external organizations (eg, Kaplan Review ), + Collects and ... 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
- Baylor Scott & White Health (Temple, TX)
- …communication with from providers and facilities related to utilization review requests and inquiries. Processes phone and electronic authorization requests ... the request to appropriate clinical personnel to allow for a clinical review for authorization determinations. + Completes return memoranda when requests are missing… more
- Molina Healthcare (Dallas, 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
- MTC (Raymondville, TX)
- …clinical impressions. + Inspect, complete and analyze medical records, assign review and update medical classifications; complete admission notes, progress notes, ... responses to detainee lawsuits. + Attend regularly scheduled staff meetings, QI, UM , P&T, and other meetings as required. + Facilitate, where applicable, NCCHC/ACA… more
- USAA (San Antonio, TX)
- …attempts **What sets you apart:** + At least 4 years of experience handling UM /UIM injury claims + 3+ years of catastrophic injury experience + Injury Experience in ... or other status protected by law. California applicants, please review our HR CCPA - Notice at Collection (https://statmcstg.usaa.com/mcontent/static\_assets/Media/enterprise\_hr\_cpra\_notice\_at\_collection.pdf)… more