12 Medical Director And Reviewer Positions jobs in Houston.

Hiring now: Care Review Clinician Inp @ Molina Hea, Clinical Reviewer @ Healthhelp, Nurse Reviewer Associate @ Elevance H, Relief Veterinarian Centr @ Thrive Pet, Medical Dir @ Transameri, Provider Reimburse Admin @ Elevation .Explore more at jobswithgpt.com.

🔥 Skills

medical necessity (5) utilization management (3) clinical service requests (2) evidence-based clinical guidelines (2) cost-effective (2) financial responsibility (2) prior authorization (2) compliance (2) patient outcomes (2) utilization review (2)

đź“Ť Locations

Houston (12)
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Molina Healthcare

Care Review Clinician, Inpatient Review (RN) Houston
Skills & Focus: inpatient reviews, clinical service requests, evidence-based clinical guidelines, medically appropriate care, cost-effective, financial responsibility, prior authorization, multidisciplinary team collaboration, Utilization Management Certification, hospital acute care
About the Company: Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance.
Experience: 3+ years hospital acute care/medical experience.
Salary: $23.76 - $51.49 / HOURLY
Benefits: Molina Healthcare offers a competitive benefits and compensation package.
Care Review Clinician, Prior Authorization Nurse Houston
Skills & Focus: prior authorization, clinical service requests, evidence-based clinical guidelines, financial responsibility, multidisciplinary teams, utilization management, compliance, cost-effectiveness, referrals, patient outcomes
About the Company: Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance.
Experience: 1-3 years of hospital or medical clinic experience.
Salary: $19.64 - $42.55 / HOURLY
Type: Full Time
Benefits: Molina Healthcare offers a competitive benefits and compensation package.

Healthhelp

Clinical Reviewer Houston
Skills & Focus: utilization review, medical necessity, clinical reviews, customer service, HIPAA, quality issues, compliance, teamwork, NCQA standards, project prioritization

Molina Healthcare

Specialist, Appeals & Grievances Houston
Skills & Focus: appeals, grievances, member complaints, provider complaints, research, resolution, medical records, claims processing, communication, regulatory guidelines
About the Company: Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance.
Experience: Min. 2 years operational managed care experience (call center, appeals or claims environment).
Salary: $21.16 - $38.37 / HOURLY
Type: Full Time
Benefits: Molina Healthcare offers a competitive benefits and compensation package.

Elevance Health

Nurse Reviewer Associate Houston
Skills & Focus: preauthorization, clinical screening, medical necessity, diagnostic imaging, collaboration, healthcare providers, confidentiality, patient outcomes, managed health care, ICD-9 and CPT coding
About the Company: Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstandi…
Experience: AS in nursing; Current unrestricted RN license in applicable state(s) required.
Salary: $27.47 to $52.06 (hourly)
Type: Full-time
Benefits: comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution.

Thrive Pet Healthcare

Relief Veterinarian - Central Region Houston
Skills & Focus: Veterinarian, Relief, Emergency medicine, Doctor of Veterinary Medicine, Board certification, Community, Medical excellence, Professional development, Mental health support, Diversity
About the Company: We are looking for Relief Veterinarians to join our team as part of the Thrive Pet Healthcare community. At Thrive Pet Healthcare, you will have the support, t…
Experience: Doctor of Veterinary Medicine (DVM / VMD) degree, State Veterinary Board License: Active and in good standing for the state of intended employment
Benefits: customizable professional development opportunities, a supportive work environment that values work-life rhythms, menta…

Healthhelp

Clinical Reviewer Houston
Skills & Focus: utilization review, medical necessity, clinical reviews, documentation policy, HIPAA, customer service, quality management, regulatory requirements, independent work, project prioritization

Molina Healthcare

Care Review Clinician, Inpatient Review (RN) Houston
Skills & Focus: inpatient, review, clinical guidelines, authorization, utilization management, collaboration, multidisciplinary, cost-effective, treatments, encounter
About the Company: Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are s…
Experience: 3+ years hospital acute care/medical experience.
Salary: $23.76 - $51.49 / HOURLY
Type: Full-time
Benefits: Molina Healthcare offers a competitive benefits and compensation package.

Elevance Health

Nurse Reviewer I Houston
Skills & Focus: preauthorization, medical necessity, diagnostic imaging, clinical guidelines, provider communication, quality management, utilization management, ICD-9, CPT-4 coding, healthcare
About the Company: Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstandi…
Experience: Minimum of 3 years of clinical nursing experience in an ambulatory or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management, and/or call center experience.
Salary: $29.96 to $56.77 (hourly)
Type: Hybrid
Benefits: Comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution.

Transamerica

Medical Director Houston
Skills & Focus: mortality risk assessment, medical underwriting, EKG interpretation, clinical experience, data analytics, insurance medicine, strategic direction, medical impairments, technical training, interpersonal skills
About the Company: Transamerica is part of an international holding company, with millions of customers and thousands of employees worldwide, providing insurance, retirement, and…
Experience: 5 years of clinical experience; Minimum 3 – 5 years’ experience in clinical medical practice
Salary: $183-235K
Type: Full-time
Benefits: Competitive Pay, Bonus for Eligible Employees, Pension Plan, 401k Match, Employee Stock Purchase Plan, Tuition Reimburs…

Elevation Health

Provider Reimburse Admin Sr Houston
Skills & Focus: reimbursement policies, claims adjudication, subject matter expert, medical policies, editing policies, vendor collaboration, business process improvements, provider reimbursement activities, mentorship, coding conventions
About the Company: Elevation Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstand…
Experience: 4 years related experience; or any combination of education and experience.
Salary: $76,296 to $124,848
Type: Hybrid (1-2 days in the office)
Benefits: comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution

Elevance Health

Medical Director, Cardiology Houston
Skills & Focus: Medical Director, Cardiology, clinical case reviews, medical necessity, peer-to-peer consultations, healthcare, vascular surgery, evidence-based guidelines, clinical criteria, treatments
About the Company: Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstandi…
Experience: Minimum of 1 year of experience with clinical case reviews for medical necessity.
Salary: $205,470.72 - $337,559.04
Type: Hybrid
Benefits: Comprehensive benefits package, incentive and recognition programs, equity stock purchase, 401k contribution.