- Molina Healthcare (San Antonio, TX)
- JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals ... regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Assesses appropriateness of services, length of stay and… more
- Elevance Health (Houston, TX)
- ** Nurse Appeals - Litigation & Legal...Review requests. + Acts as a resource for both clinical and non- clinical teams, by managing and ... will be necessary and is dependent on court hearing schedules. The ** Nurse Appeals - Litigation & Legal Support** is responsible for investigating and processing… more
- Evolent (Austin, TX)
- …to Standard processing, documenting accordingly. + Works closely with the appeals -dedicated Clinical Reviewers to ensure timely adjudication of processed ... for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a...be able to exercise independent and sound judgment in clinical decision making. - **Preferred** + Able to navigate… more
- Centene Corporation (Austin, TX)
- …of all appeals requests + Partners with interdepartmental teams to improve clinical appeals processes and procedures to prevent recurrences based on industry ... CST either Tuesday - Saturday or Sunday - Thursday** **Position Purpose:** Performs clinical reviews needed to resolve and process appeals by reviewing medical… more
- Elevance Health (Houston, TX)
- ** Clinical Operations Medical Director** **Medical Oncology** **Carelon Medical Benefit Management** **Virtual** : This role enables associates to work virtually ... Our platform delivers significant cost-of-care savings across an expanding set of clinical domains, including radiology, cardiology and oncology._ The ** Clinical … more
- Texas Health Resources (Arlington, TX)
- …* Master's Degree Counseling or Social Work Required Experience * 3 Years Clinical psychiatric or chemical dependency experience Required and * 6 Months in case ... Worker Upon Hire Required Or * LCSW - Licensed Clinical Social Worker Upon Hire Required Or * LPC...Maintain ongoing contact with the attending physician, program manager, nurse manager, and various members of the treatment team.… more
- Molina Healthcare (TX)
- …medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse ... and consultation for NCQA standards/guidelines for the plan including compliant clinical quality improvement activity (QIA) in collaboration with clinical … more
- Molina Healthcare (TX)
- For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity of high ... (Team will work on set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. JOB DESCRIPTION Job SummaryProvides support for … more
- Texas Health Resources (Arlington, TX)
- …the following: Compliance with program expectations Mitigation activities with all clinical partners / payors as needed. Compliance requirements: Code 44 ... days, etc. Medical necessity criteria, patient status, and discharge criteria. All clinical and transition documentation Clinical Review staff requirements and… more
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