- Houston Methodist (The Woodlands, TX)
- …of current state, federal, and CMS regulations, DNV requirements, and guidelines on case management , utilization review , and clinical documentation. ... is a key member and leader of the hospital's utilization review / management committee, which is...decisions, and other pertinent information per hospital/ case management and clinical documentation policies policy. + Review… more
- Houston Methodist (The Woodlands, TX)
- …and eligibility for state, local, and federal programs + Progressive knowledge of utilization management , case management , performance improvement, and ... At Houston Methodist, the Utilization Review Nurse (URN) PRN position...coverage determinations (LCDs & NCDs). This position collaborates with case management in the development and implementation… more
- UTMB Health (Friendswood, TX)
- …and a safe and efficient work environment. + Monitors the work performance of the Utilization Review Case Management staff and provides guidance as ... area and/or general nursing. + Provides assistance with clinical issues for non-nursing Utilization Review Case Management staff. + Contributes to the… more
- HCA Healthcare (Live Oak, TX)
- …Offers clinical support for appeals and denials process, discharge planning, case management , and utilization review / management + You will consult ... of quality and cost improvement, and develops systems to review utilization of resources and objectively measure...the denial and appeals process, as requested by the Case Management Department and Patient Accounting Services… more
- Sedgwick (Austin, TX)
- …:: To ensure efficient, cost effective, and high quality delivery of case management and utilization review services to clients for multiple business ... locations; to provide expertise in client specific case management and utilization review requirements; and to ensure customer satisfaction through… more
- Insight Global (Houston, TX)
- …AVPs reporting to the CMOs. Lead Epic build efforts related to case management and utilization review , including updates driven by Medicare guidelines. ... an Epic Clinical Application Analyst with a focus on Inpatient ClinDoc and Clinical Case Management to join our dynamic care coordination team. This role is… more
- AdventHealth (Burleson, TX)
- …(BSN) RN License **_EDUCATION AND EXPERIENCE PREFERRED:_** 2-3 years in hospital quality, case management , utilization review , or performance ... winning facility and departments including Great Place to Work by Beckers Hospital Review and Gallup. + Work with the latest technology and top experts including… more
- Actalent (Houston, TX)
- …Experience in utilization management , concurrent review , prior authorization, utilization review , case management , and discharge planning. + ... a team of nurses and communicate with doctors and case managers to make informed decisions and gather additional...Proficiency with InterQual. + Active Compact RN License. + Utilization Management /Concurrent Review experience. +… more
- Houston Methodist (Sugar Land, TX)
- …and eligibility for state, local, and federal programs + Comprehensive knowledge of utilization management , case management , performance improvement, and ... At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position...coverage determinations (LCDs & NCDs). This position collaborates with case management in the development and implementation… more
- Houston Methodist (Sugar Land, TX)
- …+ Seven years clinical nursing/patient care experience which includes three years in utilization review , case management or equivalent revenue ... Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management… more