- Elevance Health (Grand Prairie, TX)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... assessment within 48 hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of… more
- Elevance Health (Grand Prairie, TX)
- …(ABA) services only, and there is licensed staff supervision. Previous experience in case management/ utilization management with a broad range of experience with ... Behavioral Health Care Manager I- BH Care Manager I...outpatient professional treatment health benefits through telephonic or written review . **How you will make an impact:** + Uses… more
- Elevance Health (Grand Prairie, TX)
- …supervision. **Preferred Skills, Capabilities and Experiences:** + Previous experience in case management/ utilization management with a broad range of experience ... **Behavioral Health Care Manager I (3rd Shift - After Hours)** **Virtual:**...outpatient professional treatment health benefits through telephonic or written review . **How you will make an impact** **Primary duties… more
- Elevance Health (Grand Prairie, TX)
- …services only, and there is licensed staff supervision. + Previous experience in case management/ utilization management with a broad range of experience with ... **Behavioral Health - Care Manager II** **Location:** _Virtual:_ This role enables associate...outpatient professional treatment health benefits through telephonic or written review . **How you will make an impact:** + Uses… more
- Molina Healthcare (Fort Worth, TX)
- …At least 2 years clinical nursing experience, including at least 1 year of utilization review , medical claims review , long-term services and supports (LTSS), ... Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM),… more
- Molina Healthcare (Fort Worth, TX)
- …in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership ... Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of… more
- Molina Healthcare (Fort Worth, TX)
- …Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of ... oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and chemical… more
- Texas Health Resources (Arlington, TX)
- …Upon Hire Required And CPR - Cardiopulmonary Resuscitation Upon Hire Required And ACM - Accredited Case Manager Upon Hire Preferred Or CCM - Certified Case ... Manager Upon Hire Preferred Or CPUM - Certified Professional Utilization Manager Upon Hire Preferred Or Other ANCC Upon Hire Preferred Skills Knowledge of… more
- Elevance Health (Grand Prairie, TX)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... for clinical operational aspects of a program. + Conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss … more
- CenterWell (Arlington, TX)
- …performance in patient experience, quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts to identify opportunities ... precise + Identify critical issues for high-risk patients during case reviews & other forums, and modeling and driving...of health (SDOH) efforts, improving clinical outcomes and avoidable utilization + Monitor and manage daily patient care and… more
- Elevance Health (Grand Prairie, TX)
- …Medical Director** **Carelon Medical Benefits Management** **Radiology Benefit Management/ Utilization Review ** **Virtual:** This role enables associates ... necessity decisions. + Brings to their supervisors attention, any case review decisions that require + Medical...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Grand Prairie, TX)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... clinical reviews with attending physicians or other providers to discuss review determinations, and patients' office visits with providers and external physicians.… more