Top 36 Utilization management Jobs in Beaumont, Tx

LTSS Service Coordinator (Hardin and Polk County)
Elevance Health —Beaumont, TX
- Monday to Friday
- Experience working with individuals with developmental disabilities
- Spanish
- Bachelor of Science
- Employee stock purchase plan
- Paid holidays
5d
Provider Relations – Market Performance Lead
Astrana Health, Inc. —Beaumont, TX
- $80,000 - $90,000 a year
- Email
- Private practice
- Nursing
- Microsoft Excel
Quick Apply
QMHP/Case Manager
Houston Circle of Hope Services, Inc. —Beaumont, TX
- $24 - $27 an hour
- Full-time
- Mid-level
- Office
- Master's degree
Quick Apply
Certified Occupational Therapist Assistant - Physical Therapy - Full Time
Christus Health —Beaumont, TX
- 8 hour shift
- BLS Certification
- Mid-level
- Associate's degree
13d
Director, Clinical Operations
Astrana Health, Inc. —Beaumont, TX
- $90,000 - $130,000 a year
- Full-time
- Hybrid work
- SQL
- Clinic
- Analysis skills
Quick Apply
Cancer Center Program Administrator
Riceland Healthcare —Beaumont, TX
- $100,000 - $130,000 a year
- Full-time
- Nursing
- 5 years
- Clinic
- Health insurance
- Dental insurance
Quick Apply
4d
QMHP - Bilingual (Beaumont, Texas)
Houston Circle of Hope Services, Inc. —Beaumont, TX
- $26 - $28 an hour
- Full-time
- Bilingual
- Mid-level
- Office
Quick Apply
Longshore IME & Peer Review - Audiology
Dane Street, LLC —Beaumont, TX
- Contract
- Mid-level
- Analysis skills
Quick Apply
Certified Medication Aide (CMA) - Gist Unit
UTMB Health —Beaumont, TX
- Full-time
- Mid-level
- Ability to lift 50 pounds
- Military encouraged
MDS Nurse - LVN
Jefferson Nursing and Rehabilitation Center —Beaumont, TX
- Full-time
- Nursing
- Skilled nursing facility
- LVN
Quick Apply
Longshore IME & Peer Review - Psychiatry
Dane Street, LLC —Beaumont, TX
- Contract
- Psychiatry
- Analysis skills
- Senior level
Quick Apply
Licensed Professional Counselor-Associate Salary Range: $51,614 / Annually
SPINDLETOP CENTER —Beaumont, TX
- $51,614 a year
- Weekends as needed
- LMFT
- Pass drug screening
- Licensed Clinical Social Worker
Longshore IME & Peer Review - Otolaryngology
Dane Street, LLC —Beaumont, TX
- Contract
- BC/BE
- Analysis skills
- Senior level
Quick Apply
RN
Optum —Nederland, TX
- $75,450 - $87,000 a year
- Full-time
- CPR Certification
- RN License
- Writing skills
Quick Apply
Advanced Practice Provider
NAUTILUS MEDICAL GROUP INC —Beaumont, TX
- Contract
- Nursing
- Doctoral degree
- Clinic experience
Quick Apply
Hospital - Clinical Pharmacist Specialist (Bone Marrow Transplant)
UT Health Science Center at San Antonio —United States
- Hospital
- Outpatient experience
- 3 years
Quick Apply
Remote Physician (MD/DO), PMR or Neurology, Outpatient Prior Authorizations (REMOTE/FT) (IC to FTE)
Virtix Health —United States
- $125 an hour
- 8 hour shift
- Remote
- Background check
- Medicine
- Doctoral degree
- Work from home
Quick Apply
Complex Care Manager RN-Western MA (Hybrid)
WellSense Health Plan —United States
- $74,000 - $107,000 a year
- Full-time
- Hybrid work
- Background check
- School experience
- Nursing
- Health insurance
- Dental insurance
Family Medicine Medical Director Utilization Management
Amerihealth Caritas —United States
- Weekends as needed
- Hybrid work
- Medicine
- Physical & Rehabilitation Medicine
- 3 years
- Paid holidays
- Health insurance

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Bachelor’s Degree in Social Work, Psychology, or related field, required. Conducts utilization reviews of behavioral health cases to determine medical necessity…
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Utilization Management Specialist
ST VINCENT FAMILY SERVICES —Columbus, OH
Associate's Degree required; Bachelor's Degree preferred in Healthcare Administration, Business Administration, Social Work, Public Health, or related field.
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LTSS Service Coordinator (Hardin and Polk County)

Elevance Health -
Beaumont, TX

Apply Now

Job Details

5 days ago

Benefits

Employee stock purchase plan
Paid holidays
Disability insurance
Health insurance
Dental insurance
Paid time off
Vision insurance
401(k) matching
Life insurance

Qualifications

Health insurance authorizations
Appeals
Personal service client interaction documentation
Experience working with individuals with developmental disabilities
Spanish
Abuse and neglect policy adherence
Chronic disease management
Interdisciplinary collaboration in health services social work
Health risk assessments
Bachelor of Science
Experience working with individuals with chronic illnesses
Process improvement
English
Mid-level
Formal training programs
Elder abuse reporting
Care planning in social services
Overseeing care coordination
Case appeal in utilization management
Professional development support
Bachelor's degree
Utilization management
Motivational interviewing
Clinical staff mentoring
Managing patients as a health services social worker
Intellectual disabilities support
Client management
Clinical documentation
Resource utilization in healthcare
Multidisciplinary team collaboration for treatment planning

Full Job Description

LTSS Service Coordinator

Schedule: Monday-Friday 8am-5pm CST

Location: This is primarily a field based position. Candidate would need to reside in one of the following counties: Hardin and Polk County

Field: This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement. Alternate locations may be considered if candidates reside within a commuting distance from an office

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

The LTSS Service Coordinator is responsible for conducting service coordination functions for a defined caseload of individuals in specialized programs. In collaboration with the person supported, facilitates the Person Centered Planning process that documents the member's preferences, needs and self-identified goals, including but not limited to conducting assessments, development of a comprehensive Person Centered Support Plan (PCSP) and backup plan, interfacing with Medical Directors and participating in interdisciplinary care rounds to support development of a fully integrated care plan, engaging the member's circle of support and overall management of the individuals physical health (PH)/behavioral health (BH)/LTSS needs, as required by applicable state law and contract, and federal requirements.

How you will make an impact:

Responsible for performing face to face program assessments (using various tools with pre-defined questions) for identification, applying motivational interviewing techniques for evaluations, coordination, and management of an individual's waiver (such as LTSS/IDD), and BH or PH needs.
Uses tools and pre-defined identification process, identifies members with potential clinical health care needs (including, but not limited to, potential for high-risk complications, addresses gaps in care) and coordinates those member's cases (serving as the single point of contact) with the clinical healthcare management and interdisciplinary team in order to provide care coordination support.
Manages non-clinical needs of members with chronic illnesses, co-morbidities, and/or disabilities, to ensure cost effective and efficient utilization of long-term services and supports.
At the direction of the member, documents their short and long-term service and support goals in collaboration with the member's chosen care team that may include, caregivers, family, natural supports, service providers, and physicians.
Identifies members that would benefit from an alternative level of service or other waiver programs.
May also serve as mentor, subject matter expert or preceptor for new staff, assisting in the formal training of associates, and may be involved in process improvement initiatives.
Submits utilization/authorization requests to utilization management with documentation supporting and aligning with the individual's care plan.
Responsible for reporting critical incidents to appropriate internal and external parties such as state and county agencies (Adult Protective Services, Law Enforcement).
Assists and participates in appeal or fair hearings, member grievances, appeals, and state audits.

Minimum Requirements:

Requires BA/BS degree and a minimum of 2 years of experience working with a social work agency; or any combination of education and experience which would provide an equivalent background.
Specific education, years, and type of experience may be required based upon state law and contract requirements.

Preferred Skills, Capabilities and Experiences:

BA/BS degree field of study in health care related field preferred.
Bilingual in English/ Spanish strongly preferred.
LTSS, case management, social work or hospital discharge planning experience preferred.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact [email protected] assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act

Apply Now

Refine Your Search

utilization management jobs in beaumont, tx

LTSS Service Coordinator (Hardin and Polk County)

Provider Relations – Market Performance Lead

QMHP/Case Manager

Certified Occupational Therapist Assistant - Physical Therapy - Full Time

Director, Clinical Operations

Cancer Center Program Administrator

QMHP - Bilingual (Beaumont, Texas)

Longshore IME & Peer Review - Audiology

Certified Medication Aide (CMA) - Gist Unit

MDS Nurse - LVN

Longshore IME & Peer Review - Psychiatry

Licensed Professional Counselor-Associate Salary Range: $51,614 / Annually

Longshore IME & Peer Review - Otolaryngology

RN

Advanced Practice Provider

Hospital - Clinical Pharmacist Specialist (Bone Marrow Transplant)

Remote Physician (MD/DO), PMR or Neurology, Outpatient Prior Authorizations (REMOTE/FT) (IC to FTE)

Complex Care Manager RN-Western MA (Hybrid)

Family Medicine Medical Director Utilization Management

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