- Kelsey-Seybold Clinic (Pearland, TX)
- **Responsibilities** The Utilization Review Specialist ( LVN ) is responsible for conducting medical reviews, benefit verification, and applying criteria ... care services requiring authorization prior to services being rendered for members. The Utilization Review Specialist ( LVN ) serves as a liaison in… more
- The Cigna Group (Harlingen, TX)
- …skills * Typing and computer knowledge- able to type 35WPM * Knowledge of utilization review requirements and procedures * Knowledge of current health care ... up calls which may include primary care physician and specialist appointment scheduling * Collaborates with the attending physician...Duties as assigned. **Experience:** * Current Licensure as a LPN/ LVN or RN, in the state of Texas in… more
- Apex Health Solutions (Houston, TX)
- Position Summary: The Practice Transformation Specialist (PTS) is responsible for all value-based care initiatives, interventions to support the implementation and ... and analyzing quality data and measurements. The Practice Transformation Specialist is committed to leveraging Health Information Technology for analytics,… more
- Select Medical (Frisco, TX)
- …licenses, if candidate also has extensive experience with prior authorizations and/or utilization review + Previous Experience within a physical rehabilitation ... Medical & Baylor Scott & White Health **Prior Authorization Specialist -** **onsite only** **This position must work** **onsite**...**Minimum Qualifications** + Licensure as a Registered Nurse or LVN /LPN is required + 2 years of of direct… more
- Guardian Life (Plano, TX)
- Guardian has an opportunity in the role of **Medical Specialist ** where you will be knowledgeable in a variety of medical and behavioral health conditions. This ... individual may also be required to help with coordinating and overseeing vendor utilization and assist in determining overall function as needed to facilitate timely… more
- Molina Healthcare (TX)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + Identifies and… more