- 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
- Evolent (Austin, TX)
- …of direct clinical patient care + **Minimum one year of experience with Utilization Review ( UM ) in a managed care environment** + Cardiology and Oncology ... better health outcomes. **Collaboration Opportunities:** + Works with the physician reviewer to monitor the adverse determination process and ensure notification… more
- Humana (Austin, TX)
- …part of our caring community and help us put health first** The UM Administration Coordinator 2 provides non-clinical support for the policies and procedures ... and most appropriate treatment, care or services for members. UM Administration Coordinator 2 + Support the UM...+ 1 or more years of experience with Utilization Review and/or Prior Authorization + 1 or more years… more
- L3Harris (Greenville, TX)
- …in the interest of national security. Job Title: Lead, Aerodynamics Engineer / ODA UM Job Code: 21347 Job Location: Greenville or Plano, TX (100% On-site) Job ... Engineering (ASE) team as an aerodynamics engineer and ODA UM with delegation in Structures/Aerodynamics Loads. In this role,...Write analytical reports, test plans, and test reports. + Review and approve flight test procedures and loads reports… 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
- Molina Healthcare (San Antonio, TX)
- …clinical pharmacy services (such as, therapeutic drug monitoring, drug regimen review , patient education, and medical staff interaction), and oversight (establishing ... and medication use policies). **KNOWLEDGE/SKILLS/ABILITIES** The Lead Pharmacist, Utilization Management ( UM ) will serve as a team lead to support the pharmacy… more
- USAA (Dallas, TX)
- …special and impactful. **The Opportunity** We are seeking a dedicated Trial Attorney (BI/ UM ) for our Dallas, Texas staff counsel law office. As a dedicated personal ... 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
- Molina Healthcare (TX)
- **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States who has a compact, multi-state license. This team reviews the prior ... the ideal candidate will have experience either in utilization review or case management for transplants. Preference will be...for transplants. Preference will be given to those whose UM experience is within another MCO like Molina; experience… more
- Molina Healthcare (San Antonio, TX)
- …topics using clinical expertise gained through previous experience in either UM or CM. Applies critical thinking skills, clinical/professional judgement, and breaks ... proper clinical judgment and approaches to decision making. Draws upon previous CM/ UM experience to direct trainees and provide them with best practices for… more
- Molina Healthcare (Fort Worth, TX)
- **EMERGENCY ROOM ADMISSIONS REVIEW NURSE** **_2 openings for 12 hour NIGHT SHIFT: 7:30PM (in the evening) - 08:30AM (in the morning) PACIFIC HOURS NON EXEMPT, 3 days ... Collaborates with multidisciplinary teams to promote Molina Care Model. + Adheres to UM policies and procedures. + Occasional travel to other Molina offices or… more
- Molina Healthcare (San Antonio, TX)
- …with multidisciplinary teams to promote Molina Care Model. + Adheres to UM policies and procedures. **JOB QUALIFICATIONS** **Required Education** Graduate from an ... Accredited School of Nursing. **Required Experience** 3+ years hospital acute care/medical experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing (RN) license in good standing. Must have valid driver's… more
- Molina Healthcare (Fort Worth, 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
- 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
- Kelsey-Seybold Clinic (Pearland, TX)
- …Services is accountable for activities and personnel related to Utilization Management ( UM ) and Claims auditors to manage both delegated commercial and Medicare ... Benefit products. Manage all aspects of utilization review and claims in accordance with regulatory and accreditation...to monitoring performance and reporting compliance issues to maintain UM and Claims delegation. Primary contact for UM… more
- Evolent (Austin, TX)
- …value creation. + Provide **clinical** **expertise** **in** **utilization** **management ( UM ),** ensuring high-value care aligned with national guidelines. + Process ... rationale for standard and expedited appeals,** ensuring compliance with UM policies and regulatory requirements. + Collaborate with cross-functional teams,… more
- Humana (Austin, TX)
- …for overseeing and managing risks associated with Medicaid utilization management ( UM ) programs to ensure compliance with MHPAEA regulations. This role involves ... Humana is seeking a seasoned expert in Utilization Management to join the UM Risk Management team and help support Medicaid MHPAEA (Mental Health Parity and… more
- Molina Healthcare (Austin, TX)
- …The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM delegates are compliant all applicable State, CMS, and NCQA requirements, as ... Assists with preparation of delegation summary reports submitted to the EQIC and/or UM Committees. + Participates as needed in Joint Operation Committees (JOC's) for… more
- L3Harris (Greenville, TX)
- …with the ODA/AWCR Unit Members. + Control Account Manager CAM input on which UM disciplines are needed and when for reviews, guidance, coordinate meetings with the ... ODA to review the requirements, the architecture, the design, and the...full set of Requirements. + Work with the ODA UM team to ensure Compliance Artifacts are identified and… more
- Fujifilm (College Station, TX)
- …for the outsourced testing and laboratory supplies. + Develop and enhance the Company EM/ UM program, an author/ review trend report for all FDBT facilities. + ... not limited to staff hiring, supervision, coaching, discipline and performing annual review assessments. Duties include reviewing data and problem solving in support… more
- USAA (San Antonio, TX)
- …claims with significant injuries (eg traumatic brain injury, disfigurement, fatality) and UM /UIM, and small business claims, as well as some auto physical damage ... within 90 days and 3 attempts. **What sets you apart:** + Experience handling UM /UIM injury claims. + 2+ years of catastrophic injury experience. + College Degree… more