Top 39 Utilization management Jobs in Orange Tx

Physician Advisor
Christus Health —Beaumont, TX
- Full-time
- Medicine
- Hospital
- 5 years
- Relocation assistance
1d
Certified Occupational Therapist Assistant - Physical Therapy - Full Time
Christus Health —Beaumont, TX
- 8 hour shift
- BLS Certification
- Mid-level
- Associate's degree
(CEM) - Psychiatrist
Loyal Source —Texas
- $225.83 an hour
- Full-time
- Medicine
- Microsoft Excel
- Microsoft Outlook
Quick Apply
Provider Relations – Market Performance Lead
Astrana Health, Inc. —Beaumont, TX
- $80,000 - $90,000 a year
- Email
- Private practice
- Nursing
- Microsoft Excel
Quick Apply
Decision Support Coordinator - Care Management - Days
Baptist Hospitals of Southeast Texas —Beaumont, TX
- Hospital
- High school diploma or GED
- Entry level
- Health insurance
- Dental insurance
QMHP/Case Manager
Houston Circle of Hope Services, Inc. —Beaumont, TX
- $20.00 - $24.50 an hour
- Part-time
- Mid-level
- Office
- Master's degree
Quick Apply
Utilization Management Nurse II - Case Management - Full Time
Christus Health —Beaumont, TX
- Overtime
- Nursing
- LVN
- RN License
1d
Advanced Practice Provider
NAUTILUS MEDICAL GROUP INC —Beaumont, TX
- Contract
- Nursing
- Doctoral degree
- Clinic experience
Quick Apply
Certified Medication Aide (CMA) - Gist Unit
UTMB Health —Beaumont, TX
- Full-time
- Mid-level
- Ability to lift 50 pounds
- Military encouraged
Longshore IME & Peer Review - Audiology
Dane Street, LLC —Beaumont, TX
- Contract
- Mid-level
- Analysis skills
Quick Apply
7d
Longshore IME & Peer Review - Otolaryngology
Dane Street, LLC —Beaumont, TX
- Contract
- BC/BE
- Analysis skills
- Senior level
Quick Apply
7d
Longshore IME & Peer Review - Psychiatry
Dane Street, LLC —Beaumont, TX
- Contract
- Psychiatry
- Analysis skills
- Senior level
Quick Apply
7d
Licensed Professional Counselor-Associate Salary Range: $51,614
SPINDLETOP CENTER —Beaumont, TX
- $51,614 a year
- Weekends as needed
- LMFT
- Pass drug screening
- Licensed Clinical Social Worker
Registered Nurse
Optum —Nederland, TX
- $75,450 - $87,000 a year
- Full-time
- CPR Certification
- RN License
- Writing skills
Quick Apply
9d
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
Physician Assistant/Nurse Practitioner (D), CVOR - Regional
Corewell Health —United States
- Weekends as needed
- Acute care
- Nursing
- Surgery
- Free parking
- Paid holidays
Advanced Practice Provider Lead (NP or PA) – NJ Palliative Care
NJ Palliative Care Solutions —United States
- $160,000 - $190,000 a year
- Full-time
- Bilingual
- 5 years
- Outpatient
Quick Apply
9d
Medicare Medical Review RN (Medical Reviewer III)
CoventBridge Group —United States
- $65,000 - $75,000 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- RN License
- Paid holidays
- Disability insurance
6d

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Certified Occupational Therapist Assistant - Physical Therapy - Full Time
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The information collected and used by medical information management staff is interconnected with the clinical and business systems of the health system and is…
14d

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utilization management jobs near orange tx

Physician Advisor

Christus Health -
Beaumont, TX

Apply Now

Job Details

Full-time
1 day ago

Benefits

Relocation assistance

Qualifications

Utilization management
Resource utilization in healthcare
Medical License

Full Job Description

Description

Recruiter Contact Information:

Keely Peirce

[email protected]

CHRISTUS Health St. Elizabeth is seeking a full time, in-person Physician Advisor to join the team in Beaumont, TX!

Roles and Responsibilities Overview

The Physician Advisor is an administrative physician role serving CHRISTUS St. Elizabeth hospital and its affiliates through teaching, consulting, and advising both the Care Management Department and the medical staff on matters regarding physician practice patterns, documentation, over- and under-utilization of resources, medical necessity, compliance rules and regulations, collaboration and relationships with payers, and the community. The PA also ensures physician support and execution for the Care Management and CDI Departments' initiatives by promoting effective and efficient physician documentation to support the patient's Level of Care (LOC), billing status, and appropriateness of Medicare Severity-Diagnosis Related Group (MS-DRG)/DRG assignment. The PA will submit monthly time records documenting time actually spent in the provision of the responsibilities outlined below. M-F, no call responsibilities!

Location: On Site - Beaumont, TX

Reporting Relationship
The PA reports directly to the Chief Medical Officer of CHRISTUS St. Elizabeth hospital.

Professional Qualifications
The Physician Advisor-Care Management and Clinical Documentation Improvement role should be staffed by a physician with the following qualifications:

5 years of clinical experience

Licensed physician in state of residence

Board certified in a clinical specialty

Certified by the American Board of Quality Assurance and Utilization Review Physicians, Inc (ABQUARP) - preferred

Experienced in clinical practice with an understanding of utilization review

Served on or chaired a Utilization Management Committee

Demonstrated cost-efficient practice

Physician Advisor - Care Management & CDI Duties and Responsibilities

Utilization Management Plan: 20%

In collaboration with the Director of CM, lead the Utilization Review Committee

Conduct secondary status reviews for appropriate level of care determination

Conduct peer-to-peer consults with the payor medical directors for the denied cases, to resolve medical necessity issues prior to claims submission.

In collaboration with the CMO and Director of CM, monitor key metrics for UM and participate in action steps to achieve targets. Metrics include (but not limited to):

Denial trends, appeals & recoveries

Length of stay- inpatient and observation

Condition Code 44

Physician & Staff Education: 15%

Provide education to physicians and other clinicians related to regulatory requirements, appropriate billing status and utilization of alternate levels of care, community resources, and end of life care.

Work with physicians to facilitate referrals to the continuum of care

Facilitate, mentor, and educate other physicians regarding payer requirements

Provide mentoring/coaching to UR Case Managers to increase knowledge in care progression

Educate physicians on the benefits and importance of a clinical documentation program and how to work with CDI specialists

Care Management: 50%

Participate in daily IDRs takes action to expedite testing and treatment to promote efficient patient care and appropriate LOC

Provides guidance/assistance to the Emergency Department Physicians and CM staff to ensure correct LOC designation at intake

Act as a liaison with payers to facilitate approvals and prevent denials or carved-out days when appropriate

Participate in review of long-stay patients escalated from Care Management to facilitate the use of the most appropriate LOC

Review cases that indicate a need for issuance of a hospital notice of non-coverage determination. Discuss the case with the attending physician and if additional clinical information is not available, discuss the process for issuance and appeal with the physician.

Document patient care reviews, decisions, and other pertinent information per hospital policy

Possess foundational knowledge of InterQual and MCG criteria

Participate in Care Management Leadership & staff meetings to help identify and progress toward departmental goals

Notify the Care Manager of any conflict of interest in reviewing a particular patient record. Assist with identifying a physician to review such record.

Clinical Documentation Integrity 15%

CDI query facilitation as needed

Partner with CDI leadership to provide staff education on CDI and appropriate documentation

Provide feedback to physicians in each service on clinical documentation using specific case examples

Highlights/ Benefits:

Balanced professional and personal lifestyle

Competitive compensation and benefits

No state income tax

Relocation assistance

Community Description:

Easy drive to Houston

Enjoy the lush green countryside, pine tree-covered hills and lakes.

Year-round outdoor activities include golfing, hunting, fishing, camping, hiking, and boating.

Excellent public and private schools

EEO is the law - click below for more information:

https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12ScreenRdr.pdf

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact us at (844) 257-6925.

Apply Now

Refine Your Search

utilization management jobs in orange tx

Physician Advisor

Certified Occupational Therapist Assistant - Physical Therapy - Full Time

(CEM) - Psychiatrist

Provider Relations – Market Performance Lead

Decision Support Coordinator - Care Management - Days

QMHP/Case Manager

Utilization Management Nurse II - Case Management - Full Time

Advanced Practice Provider

Certified Medication Aide (CMA) - Gist Unit

Longshore IME & Peer Review - Audiology

Longshore IME & Peer Review - Otolaryngology

Longshore IME & Peer Review - Psychiatry

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

Registered Nurse

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

Physician Assistant/Nurse Practitioner (D), CVOR - Regional

Advanced Practice Provider Lead (NP or PA) – NJ Palliative Care

Medicare Medical Review RN (Medical Reviewer III)

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