• Senior Director Case Management

    Houston Methodist (Houston, TX)
    …leading multi-site or enterprise-level programs preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... analytics and real-time dashboards to proactively manage authorization workflows, appeals , and peer reviews. **GROWTH/INNOVATION ESSENTIAL FUNCTIONS** + Identifies,… more
    Houston Methodist (10/16/25)
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  • PRN UR Coordinator

    San Antonio Behavioral Health (San Antonio, TX)
    …May consult with staff as needed. Essential Duties: + Collaborate and set standards with registered nurse ( RN ) case managers (CMs) and outcome managers to ... of potential denials and respond appropriately; ie facilitate Physician to Physician appeals when appropriate and assist with construction of appeal letters. +… more
    San Antonio Behavioral Health (08/27/25)
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  • Advanced Practice Nurse Practitioner

    Molina Healthcare (TX)
    …or equivalent combination of relevant education and experience. * Advanced Practice Registered Nurse (APRN) license. License must be active and unrestricted ... and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends… more
    Molina Healthcare (11/01/25)
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