San Antonio, Texas, United States · On-site
Job DetailsJob Location: 933 Pleasanton Rd - San Antonio, TX 78214Position Type: Full TimeJob Category: Managed CareGeneral Summary: UM Nurse focuses on the Gonzaba Medical Group UM Review Process. Supervisory Responsibi…
Skills: Utilization Management, Medical Necessity Review, Clinical Documentation, HIPAA Compliance, Case Management
San Antonio, Texas, United States · On-site
Job DetailsJob Location: 933 Pleasanton Rd - San Antonio, TX 78214Position Type: Full TimeJob Category: Managed CareGeneral Summary: The Hospital Case Manager (HCM) focuses on concurrent review of GMG MC patients (member…
Skills: Concurrent Review, Discharge Planning, Utilization Management, Care Coordination, Patient Advocacy
San Antonio, Texas, United States · On-site
Job DetailsJob Location: 933 Pleasanton Rd - San Antonio, TX 78214Position Type: Full TimeJob Category: Managed CareGeneral Summary: The Hospital Case Manager (HCM) focuses on concurrent review of GMG MC patients (member…
Skills: Concurrent Review, Discharge Planning, Utilization Management, Care Coordination, Patient Advocacy
San Antonio, Texas, United States · On-site
Job DetailsJob Location: 933 Pleasanton Rd - San Antonio, TX 78214Position Type: Full TimeJob Category: Managed CareGeneral Summary: UM Nurse focuses on the Gonzaba Medical Group UM Review Process. Supervisory Responsibi…
Skills: Utilization Management, Medical Necessity Review, Clinical Documentation, HIPAA Compliance, Case Management
San Antonio, Texas, United States · On-site
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Skills: Project Management, Construction Scheduling, Budget Management, Blueprint Reading, Sub-contractor Management
Austin, Texas, United States · On-site
Job Summary: The Social Media and Content Manager will assist in the development and implementation of marketing and communications campaigns through utilization of various digital and social media platforms. The role wi…
Skills: Social Media Management, Content Creation, Digital Marketing, Content Strategy, Analytics
San Antonio, Texas, United States · On-site
POSITION SUMMARY: Under the supervision of the Group Sales or Department Manager, the Team Leader gives daily direction to the associates in one of the departments within the store, to include: merchandise presentation, …
Skills: Retail Sales, Supervisory Leadership, Inventory Control, Merchandising, Customer Service
San Antonio, Texas, United States · On-site
$60k–$65k/yr
The Operations Manager is responsible for overseeing the day-to-day operations functions of the facility to make sure all departments are organized, efficient, and effective in their daily tasks and responsibilities are …
Skills: Operations Management, Logistics, Transportation, Payroll Processing, Recruiting
San Juan, Puerto Rico, United States · On-site
Come join NRP’s A+ team! We’ve been recognized as a “Top Workplace” because we promote a culture where our team can build long-term careers and connections. As we grow as a company, our goal is that you will grow in your…
Skills: Property Management, Customer Service, Yardi, Leasing, Financial Reporting
San Antonio, Texas, United States · On-site
Welcome to Whataburger Careers! Your Recipe for Impact — What You’ll Do As a Restaurant Manager, you’ll oversee a high‑volume restaurant with average annual sales of $4M+ and an average team size of more than fifty Famil…
Skills: Restaurant Operations, Team Leadership, Guest Service, Staff Coaching, Profitability Management
San Antonio, Texas, United States · On-site
Company:Take 5 Oil Change We invite you to join us at Take 5! Take 5 Oil Change is your neighborhood go-to oil change spot. We've been doing this for over 35 years now and we pride ourselves in our friendly technicians, …
Skills: Leadership, Recruiting, Interviewing, Onboarding, Employee Training
San Antonio, Texas, United States · On-site
Job DetailsJob Location: Skilled Nursing at Coronado at Stone Oak - San Antonio, TX 78258Position Type: Full TimeJob Category: Housekeeping & Maintenance #MP Diversity, Equity, and Inclusion are at the heart of Cantex. W…
Skills: Electrical Repair, Plumbing, Carpentry, HVAC, Refrigeration
San Antonio, Texas, United States · On-site
Clinical Therapy Director Job Overview Duties and Responsibilities Office Responsibilities Implements policies and procedures for therapy division, models and maintains standards of best practiceEnsures compliance with a…
Skills: Clinical Leadership, Staff Supervision, Regulatory Compliance, Pediatric Care, Home Health Management
Corpus Christi, Texas, United States · On-site
Area Construction Manager We are Lennar Lennar is one of the nation's leading homebuilders, dedicated to making an impact and creating an extraordinary experience for their Homeowners, Communities, and Associates by buil…
Skills: Construction Management, Team Leadership, Budgeting, Scheduling, Quality Control
San Antonio, Texas, United States · On-site
$17/hr–$19/hr
Overview Aquatics Coordinator Job Type: Part-Time with benefits Pay Rate:$17- $19/hr. Category: Aquatics Location: Six Flags Fiesta Texas in San Antonio, Texas WHAT WE PROVIDE: This is a part-time position with benefits …
Skills: Leadership, Team Motivation, Safety Compliance, Risk Prevention, Lifeguarding Practices
San Antonio, Texas, United States · On-site
$14/hr–$16/hr
Job DetailsJob Location: TXSA02 SW Military - San Antonio, TX 78224Salary Range: $14.00 - $16.00 HourlyGet ready to jumpstart your career journey at Bluewave Express Wash – where we're not just washing cars, we're …
Skills: Leadership, Team Management, Customer Relations, Training, Problem Solving
San Antonio, Texas, United States · On-site
Store 2742001: 3033 Goliad Rd, San Antonio, Texas 78223 Shift AvailabilityFlexible (Days, Evenings, Overnights + Weekends) Time Type Full time Assistant Manager We want you to join our team as an Assistant Manager. If yo…
Skills: Team Leadership, Recruiting, Interviewing, Hiring, Delegation
San Antonio, Texas, United States · On-site
Store 2742293: 3603 SE Military Dr, San Antonio, Texas 78223 Shift AvailabilityFlexible (Days, Evenings, Overnights + Weekends) Time Type Full time Assistant Manager We want you to join our team as an Assistant Manager. …
Skills: Team Leadership, Recruiting, Interviewing, Hiring, Delegation
San Antonio, Texas, United States · On-site
Division: San Antonio Main Project Location(s): San Antonio, TX 78212 USA Minimum Years Experience: Travel Involved: Job Type: Regular Job Classification: Experienced Education: Job Family: Construction Compensation: Sal…
Skills: MEP Coordination, Project Scheduling, Quality Control, Site Safety Management, Budget Management
San Antonio, Texas, United States · Hybrid
$77k–$147k/yr
Why USAA? At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community a…
Skills: Capital Markets, Asset Securitization, Debt Issuance, Cash Flow Modeling, Financial Analysis
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The UM Nurse manages the utilization review process, including medical necessity reviews and the composition of denial letters according to CMS standards. They are responsible for authorization oversight, submitting regulatory reports, and collaborating with providers to ensure clinical compliance.
Candidates must be an active Registered Nurse with at least an associate degree or a licensed practical nurse with clinic experience. A minimum of 5 years of experience in Managed Care and Utilization Management is required.
Job DetailsJob Location: 933 Pleasanton Rd - San Antonio, TX 78214Position Type: Full TimeJob Category: Managed CareGeneral Summary: UM Nurse focuses on the Gonzaba Medical Group UM Review Process.
Supervisory Responsibilities: This position has no supervisory responsibilities.
General Requirements: All duties performed will be done accurately and in a timely manner.
Carries out GMG UM Program activities and UM Operations.
Exercise tact and courtesy when dealing with patients, visitors, providers, and co-workers.
Participates in educational programs as needed.
Maintains strict confidentiality practicing HIPAA rules and regulations.
Other duties as assigned.
Bilingual English/ Spanish fluency preferred.
Must always adhere to customer service expectations including in-person and virtual (via telephone, or telehealth applications) communication.
Assumes responsibility for maintaining clinical competencies according to Gonzaba Medical Group policy.
Provides clinical perspective/input to Review team, UM team and Referral Specialists.
Summarizes medical records documentation for physician medical necessity review.
Composes Denial letters according to CMS defined standards and according to UM delegation rules.
Applies evidenced-based criteria to medical necessity reviews and documents appropriately in review summary.
Performs daily authorization oversight to insure proper completion of referral documentation in EZ Cap and EMR, timeliness of determinations and compliance with UM Delegation requirements in daily operations.
Pulls, validates, and submits ODAG reports, Part C reports and other UM reports to health plans upon request, meeting submission deadlines.
Successfully performs live ODAG reviews with health plan auditors; successfully responds to “desk review” requests, by submitting screenshots and documents within defined timeline.
Contributes to delegation audits and fulfilling certain requirements for UM delegation related to making UM criteria available to requesting providers upon request, non-contracted providers are consistently identified appropriate State, OIG, MCR opt out screenings are carried out prior to approving the referral service. Ensure use of Board-Certified Specialists in making referral decisions. Other UM requirements for training, monitoring performance measures, etc.
Ensures GMG UM team responds timely to inquiry from claims vendor where an authorization has NOT been obtained previously.
Identifies opportunities for operational improvement, and works collaboratively with UM team, Provider PODS, and other GMG departments.
Communicates effectively regarding UM issues with patients, GMG staff/providers and external staff/providers.
Participates in the annual review of Managed Care, UM policies and procedures, and other periodic reviews as needed.
Promotes the Contracted Network Providers to GMG patients and staff.
Work Environment: Office environment. Exposure to communicable diseases, bodily fluids, toxic substances, ionizing radiation, medicinal preparations, and other conditions common to a clinic environment.
Mental / Physical Requirements: Requires manual dexterity, sitting, standing, stooping, reaching, kneeling, crouching, bending, walking, lifting up to 40 lbs. without assistance. Close vision and ability to adjust focus. Must be able to work efficiently under pressure.
Additional Information: Gonzaba Medical Group is seeking team members who contribute as A-Players, demonstrate a strong work ethic, are committed to the culture and our core values.
Other Duties As Assigned: The above job description is not intended to be an all-inclusive list of duties and standards of the position. Team members will follow any other instructions, and perform any other related duties, as assigned by their supervisor. Responsibilities, knowledge, skills, abilities, and work environments may change as needs evolve.
QualificationsEducation and Training: Active, unencumbered Registered Nurse with an associate degree or must be state-licensed practical nurse with one year of LVN and clinic experience. Prefer BS in Nursing. Must keep all licenses and certifications current and in good standing as initial and continued employment is contingent up these credentials.
Experience: Requires at least 5 years’ experience in Managed Care, and Utilization Management. Experience in a clinic, doctor’s office or hospital with a minimum of one-year acute care experience preferred.
Other Requirements: Computer Skills: Skilled in use of computer/EMR systems. Knowledge of Word processing software, spreadsheet software, Internet, and database software.
Gonzaba Medical Group is dedicated to serving the San Antonio community through innovative healthcare with integrity.
Gonzaba Medical Group’s founder, William Gonzaba, M.D., started his family practice in 1960 on South Flores Street, not far from the neighborhood where he was born and raised. In the early 1980s, he brought in additional doctors to help him with a growing patient population. Soon, the doctors outgrew the South Flores clinic. Dr. Bill Gonzaba looked a few blocks down the street to the old Pan American Restaurant building and decided to give the landmark building a new life in the healthcare industry. After nine months of planning and renovation, Gonzaba Medical Group reopened in 1986 as a state-of-the-art medical complex. Today, Gonzaba Medical Group includes an outstanding team of physicians who share the same commitment to quality care and customer service as the group’s founder. Led by Dr. David Padilla, the group includes a team of more than 80 physicians, hospitalists, physician assistants and nurse practitioners serving in seven locations throughout the city. With a support staff of hundreds of individuals, expanded and updated facilities as well as the latest diagnostic capabilities, Gonzaba Medical Group continues to change the way healthcare is delivered while staying true to its core principle: “the patient always comes first.” Purpose To serve our patients Como Familia - Like Family Mission To provide an innovative system of medical care that delivers with integrity every day. Vision To be a physician-led, patient centered, high performing medical group that provides value-driven answers to the high cost of health care. Core Values • Purpose – We are called to serve our patients como familia • Action – We deliver highest quality care at the lowest cost with compassion and respect • Superior Service – We work responsibly as a team to earn your trust • Integrity – We do the right thing every day • Obligation – We embrace transparency, accountability and measurable results • New Ideas – We lead innovation in the practice of medicine
Offices: 720 Pleasanton Road, San Antonio, Texas 78214, US · 902 Bandera Road, San Antonio, Texas 78228, US · 3520 S. New Braunfels, San Antonio, Texas 78223, US · 7616 Culebra Road, Suite 111, San Antonio, Texas 78251, US · 1423 Guadalupe Street, San Antonio, Texas 78207, US
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