- 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 Support** **In Office Expectation:** This role is **Virtual** ; This role enables associates to work virtually full-time, ... necessary and is dependent on court hearing schedules. The ** Nurse Appeals - Litigation & Legal Support**...including ensuring accurate entry, investigation, and analysis of state appeals ; summarizing medical information for review by… 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...work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators… more
- Cognizant (Austin, TX)
- …, and retro-authorization as well as timely filing deadlines and processes. + Review clinical denials including but not limited to referral, preauthorization, ... cycle or clinic operations + Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and concurrent reviews +… more
- Houston Methodist (Sugar Land, TX)
- …responsible for performing utilization review activities, and monitoring the clinical denial management and appeals process, as applicable, in collaboration ... management or equivalent revenue cycle clinical role + Experience includes writing clinical appeals for medical necessity compliance or level of care for… more
- Molina Healthcare (TX)
- …(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 this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...for clinical member services review assessment processes. Responsible… more
- Elevance Health (Houston, TX)
- …members and providers. **How you will make an impact:** + Perform physician-level case review , following initial nurse review , of Medical Oncology regimens ... ** Clinical Operations Medical Director** **Medical Oncology** **Carelon Medical...and supportive care. + Perform physician-level case review , following initial nurse review ,… 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 ... management or utilization review Required * Prior experience with EPIC EMR Licenses...Worker Upon Hire Required Or * LCSW - Licensed Clinical Social Worker Upon Hire Required Or * LPC… more
- Molina Healthcare (TX)
- …the chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the ... medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse… more
- Texas Health Resources (Arlington, TX)
- …days, etc. Medical necessity criteria, patient status, and discharge criteria. All clinical and transition documentation Clinical Review staff requirements ... the following: Compliance with program expectations Mitigation activities with all clinical partners / payors as needed. Compliance requirements: Code 44… more