- HCA Healthcare (Tomball, TX)
- …and continue to learn! **Job Summary and Qualifications** The Employee Health nurse completes physicals according to the Employee Health Plan and written standards. ... the EH & S Program to include: reporting, processing claims , tracking and documentation. What qualifications you will need:...Nursing. + 2 years recent experience as a licensed nurse . + Current Texas licenses as a Registered … more
- Ascension Health (Cedar Park, TX)
- …safety information. Collect, evaluate, and maintain data concerning injuries, complaints, claims , and/or other patient safety-related data. + Educate and train the ... with legal counsel to coordinate the investigation, processing, and defense of claims against the organization. + Enhance the organization's and the larger… more
- HCA Healthcare (Conroe, TX)
- …for benefits may vary by location._** It is an exciting time to be a nurse at HCA Healthcare! Come unlock your career potential and see how rewarding it can ... will work with defense legal counsel to coordinate claim investigations; Process claims against the facility, including the preparation of records, documents, and… more
- Public Consulting Group (Austin, TX)
- …Third Party Administrator Services + Enhance Health and Public Safety Services + Claims Processing Services and Solutions + Consulting and Advisory Services + Cost ... and client-centered + Handles case assignments, draft service plans, review case progress and determine case closure + Travels...Proven working experience in case management, including as a nurse , medical, mental health care manager or a related… more
- Humana (Austin, TX)
- …in day-to-day UM activities and discussions with UM leaders. 20% 2. Review and monitor Contract Change Orders and evaluate impact on Utilization Management ... **Use your skills to make an impact** **Required Qualifications** + **Registered Nurse (RN)** **with current, unrestricted licensure** + BSN or degree in related… more
- Elevance Health (Grand Prairie, TX)
- …Finder and follows up with provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. + ... make an impact:** + Managing incoming calls or incoming post services claims work. + Determines contract and benefit eligibility; provides authorization for… more
- Elevance Health (Grand Prairie, TX)
- …prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification ... I** is responsible for coordinating cases for precertification and prior authorization review . **How will you make an impact:** + Managing incoming calls or… more
- Molina Healthcare (Austin, TX)
- …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... focused reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care.… more
- HCA Healthcare (Houston, TX)
- …will work with defense legal counsel to coordinate claim investigations; Process claims against the facility, including the preparation of records, documents, and ... and actions on all regulatory/insurance survey report recommendations/deficiencies;** + You will review and follow up with RM Notification reports for timeliness and… more