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637 Ed Utilization Review Case Manager jobs in Houston,TX

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Senior Analyst, Risk & Quality Reporting (Remote)

Molina Healthcare

Houston, TX 77001

$63,435-$123,699/yr

Remote

Bachelor's Degree or equivalent combination of education and work experience
3-5 years of experience in Analysis related to HEDIS and/or Risk Adjustment
3-5 years of experience in working with data mapping, scrubbing, scrapping, and cleaning of data
3-5 years of experience in working with complex data to include quantifying, measuring, and analyzing financial/performance management and utilization metrics
1-3 years of experience with Microsoft Azure, AWS, or Hadoop
3-5 years of experience in Managed Care Organization executing similar techno functional role that involves writing complex SQL Queries, Functions, Procedures and Data design
3-5 years of experience working with Microsoft T-SQL, Databricks SQL and PowerBI

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Program Manager

Texas Children's Hospital

Houston, TX 77086

Onsite

Bachelor's Degree required
RN - Lic-Registered Nurses Texas Board of Nursing or Nurse Licensure Compact required
3 years' Experience in a health plan and utilization management required

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Social Work Case Manager

UVA Health

Houston, TX 77084

Onsite

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Medical Records Director Non Nurse/HIM

Garden Terrace Alzheimer's Center of Excellence (Houston)

Houston, TX 77054

Onsite

Maintains confidentiality of all proprietary and/or confidential information
Make independent decisions when circumstances warrant such action
Promotes a culture of integrity, maintains an “open door” policy, and does not participate in or allow retaliation against those who report good faith concerns
Actively implements the compliance program and Code of Conduct and ensures 100% participation by department staff
Read, write, speak, and understand the English language
Training in post-acute care health information management
Demonstrate knowledge of State and Federal legal requirements relating to documentation, confidentiality, and legal issues pertaining to health information
Sit, stand, bend, lift, push, pull, stoop, walk, reach, and move intermittently during working hours
Must be able to lift 35 lbs floor to waist, lift 35 lbs waist to shoulder, lift and carry 35 lbs, and push/pull 35 lbs
Functional knowledge in field of practice
Knowledgeable of medical records practices and procedures as well as the laws, regulations, and guidelines governing medical records functions in the post-acute care facility
Understand and follow company policies including harassment and compliance procedures
Bachelor's degree OR an equivalent combination of education and experience
Credentialed as a Registered Health Information Administrator (RHIA) OR as a Registered Health Information Technician (RHIT) OR have a degree in a health related field with extensive training and demonstrated competence in the HIM field
Perform proficiently in all competency areas including but not limited to: medical coding, auditing, clinical records, privacy official responsibilities, supervisory responsibilities, patient rights, and safety and sanitation
Demonstrate efficient usage of complex computer software systems
Displays integrity and professionalism by adhering to Life Care's Code of Conduct and completes mandatory Code of Conduct and other appropriate compliance training
Implement and interpret the programs, goals, objectives, policies, and procedures of the medical records department

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Home Care Service Coordinator

Girling Personal Care – an Addus family company

Bellaire, TX 77401

~ 9 min OnsiteHealth InsurancePaid Time OffRetirement Benefit

Must have high school diploma or equivalent.
6 months of Industry experience required.
Must have reliable transportation.

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In Home Sales Representative

Erie Home

Pasadena, TX 77504

$125,000-$250,000/yr

~ 33 min OnsiteHealth InsuranceRetirement Benefit

Valid driver's license, reliable transportation with auto insurance, and the ability to travel to and from in-home appointments.
No sales or construction experience needed
Midday, evening, & weekend availability

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Evaluator/Reviewer - Teaching Assistants, Postsecondary

Sepal

Houston, TX 77246

$35-$60/hr

Remote

Advanced degree, professional certification, or equivalent experience in the relevant occupation or field
Evaluation, review, auditing, or supervisory responsibilities
Strong understanding of professional boundaries, risk, and compliance considerations
Excellent written communication skills suitable for formal feedback
5+ years of professional experience practicing in that domain
Teaching, mentoring, training, or assessing professional work

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New, Posted 1 day ago

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Clinical Account Executive - Home Health Sales - Elite Home Health - Remote

Optum

Houston, TX 77001

$71,200-$127,200/yr

RemoteRetirement Benefit

Current Driver's License, vehicle insurance, and access to a dependable vehicle or public transportation
Formalized clinical training from an accredited institution
Home Health experience
Solid computer skills, including Microsoft Outlook and CRM software
Licensed in the state of practice
Proven excellent presentation, negotiation, and relationship-building skills
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

SmartExplore AI is experimental.

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