Top 745 Utilization management Jobs in Houston Tx

IPA Provider Network Specialist [HOUSTON]
Nutex Health —Houston, TX
- $78,000 - $88,000 a year
- Full-time
- Microsoft Word
- Microsoft Access
- Marketing
- Health insurance
- Dental insurance
Quick Apply
LTSS Nursing Facility Service Coordinator, RN
Community Health Choice —Texas
- $37.24 - $44.85 an hour
- Full-time
- Remote
- Nursing
- Clean driving record
- Microsoft Excel
- Disability insurance
- Health insurance
Quick Apply
4d
Case Manager
Houston Methodist Sugar Land Hospital —Sugar Land, TX
- Full-time
- Acute care
- Nursing
- Microsoft Excel
Case Manager
Houston Methodist Sugar Land Hospital —Sugar Land, TX
- Full-time
- Acute care
- Nursing
- Microsoft Excel
Point of Entry Nurse
Houston Methodist Hospital —Houston, TX
- Full-time
- Acute care
- Nursing
- Microsoft Excel
10d
Utilization Management Assistant
Texas Children's Hospital —Bellaire, TX
- Full-time
- Mid-level
- High school diploma or GED
10d
Corporate Director of Care Management
Stark Lane, Inc. —Houston, TX
- Nursing
- 7 years
- RN License
- Health insurance
- Dental insurance
Quick Apply
14d
Utilization Review RN
Houston Methodist Cypress Hospital —Cypress, TX
- Full-time
- Nursing
- RN License
- Hospital
Sterile Processing Liaison
Houston Methodist Hospital —Houston, TX
- Full-time
- Acute care
- Surgery
- English
Remote Intake Coordinator
SUN Behavioral Houston —Houston, TX
- PRN
- Remote
- Nursing
- RN License
- Writing skills
Utilization Management Review Nurse
Harris Health —Bellaire, TX
- $98,529.60 - $120,224.00 a year
- 8 hour shift
- Bilingual
- Microsoft Word
- Nursing
Utilization Management Specialist I
SUN Behavioral Houston —Houston, TX
- PRN
- CPR Certification
- Writing skills
- BLS Certification
- Employee assistance program
- 401(k) matching
Clinical Team Lead - Utilization Management
The Harris Center for Mental Health and IDD —Houston, TX
- From $84,903 a year
- Full-time
- LMFT
- Word processing
- Writing skills
- Paid time off
- Gym membership
Block Utilization Lead OR Coordinator
Memorial Hermann Health System —Houston, TX
- Full-time
- Hospital
- Writing skills
- English
14d
Quality and Population Health Analyst
HEALTHCARE FOR THE HOMELESS - HOUSTON —Houston, TX
- Mid-level
- SQL
- Analysis skills
Quick Apply
20h
UTILIZATION REVIEW NURSE - RN
Nexus Health Systems Ltd —Houston, TX
- Full-time
- Nursing
- Microsoft Excel
- Microsoft Outlook
Quick Apply
Director Care Management
Baylor St Luke's Medical Center —Houston, TX
- $52.15 - $77.58 an hour
- Full-time
- Nursing
- RN License
- 5 years
PRN OR Coordinator, OR Scheduling Call Center
Memorial Hermann Health System —Houston, TX
- Part-time
- Surgery
- Medical office experience
- Mid-level
14d
Lead Patient Access Services
Houston Methodist —Houston, TX
- Full-time
- Word processing
- Writing skills
- English
8h
Registered Nurse - Utilization Review
St. Josephs Medical Center —Houston, TX
- Full-time
- Bilingual
- Nursing
- RN License
Quick Apply
6d

I want to receive the latest job alert for utilization management in houston tx

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

utilization management jobs near houston tx

IPA Provider Network Specialist [HOUSTON]

Nutex Health -
Houston, TX

Quick Apply

Job Details

Full-time
$78,000 - $88,000 a year

Benefits

Health insurance
Dental insurance
Flexible spending account
Paid time off
Vision insurance
401(k) matching
Life insurance

Qualifications

Vendor relationship building
Managed care organization experience
Contract management experience in healthcare
Bachelor's degree
Direct contracting
Vendor relationship management
Recruiting
Relationship management
Contracts
Managed physicians
Value-based negotiation
Training & development

Full Job Description

JOB SUMMARY

The IPA Provider Network Specialist manages the physician network by developing and maintaining the assigned IPA/Medical Group. This individual provides service and education to network physicians/providers and achieves company targets by implementing network improvement plans. The representative offers professional work and is responsible for performing activities pertaining to IPA Provider Network Specialist. This job includes traveling to provider offices and working under general supervision. Positions at this level are assigned a broad range of duties in the occupation. The representative uses judgment in selecting appropriate guidelines and applying general policies and procedures.

RESPONSIBILITIES

Completes new provider orientation for all applicable product lines.
Conducts provider group meetings to review monthly/quarterly data and outcomes.
Responsible for meeting minutes and follow-up on 'TO DO' items identified at meetings.
Conduct site visits to service providers, resolve issues, educate staff and providers on policies, and collect credentialing information.
Conduct site visits to service providers and educate staff and providers on submitting Risk Adjustment Factor Data and HEDIS information.
Maintains relationships with contracted HMOs to implement amendments to DOFR, delegation, policy, and procedures.
Returns all routine calls from providers within 24 hours to establish consistent and robust relationships with provider offices.
Provide oversight on inquiries and claims issues and follow up with providers to ensure problems have been resolved.
Maintains provider office tools, including provider manual.
Supports regional Network Improvement Plan targets by providing utilization reports, ER contingencies, Frequent Flier Reports, and other analytics available to improve /maintain regions.
Identifies network gaps and completes contracts for PCP, Specialist, and Ancillary networks with in-depth knowledge of different fee schedules (Medicare/Medical/ASP/AWP).
Identifies new cost-saving possibilities through working with various committees, such as UM and Claims.
Understands and explains risk contracts (shared risk/entire risk).
Strategizes for membership growth and retention.
Provide training, mentoring, and guidance to new representatives.
Works on special projects as assigned or directed.

QUALIFICATIONS

Knowledge of MS Office: Word, Excel, PowerPoint, Access Database.
Knowledge of MS Provider relations/customer service strategies.
Knowledge of MSO-VL and MMSE programs and services: Authorizations, Claims, Credentialing encounters, RAF, Star Ratings, IS/IR, etc.
Knowledge of Network development strategies and Provider Relations experience or similar background.
Knowledge of current MSO-VL and MMSE geo-access requirements.
Effective and efficient oral and written communication skills.
Knowledge of County provider demographics.
Skills in negotiating contract language and rate structures.
Skills to provide training and technical assistance to contracted providers.
Skills to evaluate and assess provider network to determine gaps and services needed.
Skills to identify and develop new providers to ensure accessibility.
Skills to monitor contract performance through site visits and data analysis.
Skills to facilitate contracted provider meetings.
Ability to represent the department or division professionally.
Ability to establish and maintain effective working relationships with contracted and potential providers.
Ability to resolve provider inquiries or requests promptly.

REQUIREMENTS

Bachelor's Degree in Marketing or Business Administration
Minimum of 2 years experience in Network Management within a managed care environment, health plan, or significant medical group administration.

Job Type: Full-time

Pay: $78,000.00 - $88,000.00 per year

Benefits:

401(k) matching
Dental insurance
Flexible spending account
Health insurance
Life insurance
Paid time off
Vision insurance

Application Question(s):

This role requires being based in the Houston area and traveling regularly between multiple provider locations across the city. Are you currently located in the Houston metro area and able to meet this multi-site travel requirement?

Education:

Bachelor's (Required)

Experience:

IPA Physician Network: 2 years (Required)
Physician Recruiting/Contracting: 2 years (Required)
Regional Network Improvement Plan: 2 years (Required)

Work Location: On the road

Quick Apply

Refine Your Search

utilization management jobs in houston tx

IPA Provider Network Specialist [HOUSTON]

LTSS Nursing Facility Service Coordinator, RN

Case Manager

Case Manager

Point of Entry Nurse

Utilization Management Assistant

Corporate Director of Care Management

Utilization Review RN

Sterile Processing Liaison

Remote Intake Coordinator

Utilization Management Review Nurse

Utilization Management Specialist I

Clinical Team Lead - Utilization Management

Block Utilization Lead OR Coordinator

Quality and Population Health Analyst

UTILIZATION REVIEW NURSE - RN

Director Care Management

PRN OR Coordinator, OR Scheduling Call Center

Lead Patient Access Services

Registered Nurse - Utilization Review

I want to receive the latest job alert for utilization management in houston tx

Related Searches

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected