Utilization Review Jobs in Houston, GA

The Manager Stars and Quality Improvement Programs plays a critical leadership role in advancing quality performance for the Medicare Advantage population with a specialized focus on medication-related quality measures. This includes driving improvements in Part D Star Ratings particu More...

The Manager Stars and Quality Improvement Programs plays a critical leadership role in advancing quality performance for the Medicare Advantage population with a specialized focus on medication-related quality measures. This includes driving improvements in Part D Star Ratings particu More...

Formulary Strategy & Utilization Review PharmacistShape the drug benefit landscapeanalyze and optimize medication use.Key Responsibilities:Review prescribing trends and propose cost-saving alternatives.Maintain evidence-based formularies across multiple payers.Conduct retrospectiv More...

Job SummaryProvides administrative oversight for the outreach implementation and management functions for the Houston Reconnect Program district-wide. Collaborate with College Student Services staff to ensure students of the program receive the appropriate support and warp around serv More...

OverviewAt Houston Methodist the Senior Residency Program Coordinator is responsible for working closely with Methodists Graduate Medical Education (GME) office and attending physicians. This position supports the program directors the faculty and the residents by coordinating adminis More...

DescriptionWe are searching for a Care Coordinator someone utilizing a collaborative approach to assess plan implement monitor and evaluate the options and services required to meet an individuals health needs. Provides comprehensive on-going case management services to patients by c More...

OverviewAt Houston Methodist the Director Case Management & Social Services RN position is responsible for strategy function and operations of the Case Management & Social Work department. This position is an integrated interprofessional role which supports caregivers to provi More...

    Conducts training for staff members pertaining to Utilization Review process clinical rules/guidelines client/module/modality-specific workflows and software enhancements     Creates educational material for review tiers by collaborating with key More...

Job TitleProgram Coordinator IIAgencyTexas A&M UniversityDepartmentSchool of Engineering MedicineProposed Minimum Salary$4812.00 monthlyJob LocationHouston TexasJob TypeStaffJob DescriptionOur CommitmentTexas A&M University is committed to enriching the learning and working en More...

The LVN/LPN will provide patient care and assist in the collection of data during the assessment process within their scope of practice under the direction of an RN mid-level practitioner licensed physician or supervisor at all times.ResponsibilitiesAdheres to all DBH Policy and Proce More...

OverviewAt Houston Methodist the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent medical record review for medical necessity and level of care using nationally recognized acute care indicators and c More...

    Conducts training for staff members pertaining to Utilization Review process clinical rules/guidelines client/module/modality-specific workflows and software enhancements     Creates educational material for review tiers by collaborating with key More...

DescriptionWe are searching for a Care Coordinator (RN) Value Based Care someone utilizing a collaborative approach to assess plan implement monitor and evaluate the options and services required to meet an individuals health needs and support our Value-Based Care initiatives. Provi More...

DescriptionWe are searching for a Clinical Program Coordinator-- someone who works well in a fast-paced setting. In this position you will coordinate all activities related to the clinical program. This includes but is not limited to: coordination of all activities related to evaluati More...

ABOUT US: Ethos is a leading insurance claims investigation and medical management company committed to providing better data that translates into better decision-making for our clients. We are at the forefront of innovation in our space and our success is driven by a dynamic team pas More...

OverviewAre you an accomplished Board Certified PM&R physician Candidates must have a TX license.Are you passionate about your work/life balance We are seeking flexible and experienced physicians for our medical reviewstream division. This telecommute role provides the ability for More...

OverviewAre you an accomplished Board Certified physician in one of the below specialties Preferred candidates will have a TX license.General SurgeryNeurologistOrthopedic Surgery with hand or spine specialtyPhysical Medicine & RehabilitationPlastic SurgeryPodiatristPain MedicineNe More...

The Associate Therapist works in a dynamic multidisciplinary team providing treatment services according to the Discovery Clinical Model. Therapist responsibilities include ensuring patient safety providing milieu interventions leading psychoeducational and process-oriented therapy gr More...

Utilization Review Nurse RN or LVN (Remote $43/hr Temp-to-Hire)Join one of the nations leading managed care organizations committed to transforming health care for underserved communities. Our client is a mission-driven health plan known for delivering accessible high-quality care to More...

We are actively recruiting for an CAL RNs to join our rapidly growing Population Health team.  The primary role of the Care Manager will be to provide our patients with on-demand telephone-based care management services through a 24/7 Nurse Advice Line (i.e. telephone triage). &# More...