- Datavant (Austin, TX)
- …evolve the product vision, strategy, and roadmap for the Prospective Suspecting and Concurrent Review solutions within Datavant's Clinical Insights Platform ... government agencies, and those who deliver and pay for care . By joining Datavant today, you're stepping onto a...Background in working with provider documentation teams, coders, or concurrent review vendors. + Clinical … more
- Intermountain Health (Austin, TX)
- …extensive knowledge and expertise to work alongside and collaborates with Clinical Documentation Integrity (CDI) Registered Nurses (RN) and Intermountain Physician ... Advisors to review complex facility encounters and assign International Classification of...appropriate codes in support of the provision of value-based care by Intermountain Healthcare to appropriate populations. It ensures… more
- Actalent (Dallas, TX)
- …Responsibilities + Perform concurrent reviews to assess member's overall health. + Review the type of care being delivered and evaluate medical necessity. + ... Clinical Review Nurse (Utilization Management)100% Remote...and utilization review expertise. + Experience in concurrent review and prior authorization. + Knowledge… more
- Houston Methodist (Houston, TX)
- …(RN) who comprehensively conducts point of entry and concurrent medical record review for medical necessity and level of care using nationally recognized ... regarding any claim issues or concerns that may require clinical review during the pre-bill, audit, or...that operate at the system level to help enable clinical departments to provide high quality patient care… more
- HCA Healthcare (Pasadena, TX)
- …criteria + Proficient in application and use of InterQual + Analyze documentation of clinical care from the electronic medical record + Exhibit determined and ... Come join our team as a Behavioral Health Utilization Review RN MSW. We care for our...On base + Communicate with physicians regarding patient status, clinical documentation, and concurrent denial mitigation strategies… more
- Houston Methodist (Houston, TX)
- …utilization review functions through point of entry, observation progression of care management, concurrent review and denials reviews. Additionally, the ... point of entry and concurrent medical record review for medical necessity and level of care...regarding any claim issues or concern that may require clinical review during the pre-bill, audit, or… more
- Texas Health Resources (Arlington, TX)
- …and all identified potentially compensable events (consumers and product). Concurrent review of medical records against pre-established criteria/quality ... Patient Safety/Grievance Program Manager - TH Urgent Care (Breeze), Full-time, Days _Bring your passion to Texas Health so we are Better + Together_ Work location:… more
- Cardinal Health (Austin, TX)
- …to rethink the reach and impact of their products. **_What Individualized Care contributes to Cardinal Health_** Clinical Operations is responsible for ... (TM) Access and Patient Support helps specialty pharmaceutical manufacturers remove barriers to care so that patients can access, afford and remain on the therapy… more
- Houston Methodist (The Woodlands, TX)
- … reviews, decisions, and other pertinent information per hospital/case management and clinical documentation policies policy. + Review issues identified by case ... and CMS regulations, DNV requirements, and guidelines on case management, utilization review , and clinical documentation. + Provide ongoing education to… more
- CVS Health (Austin, TX)
- …timely and consistent responses to members and providers related to precertification, concurrent review , and appeal request. This position is primarily ... Management, including prior authorization and precertification as well as concurrent review . Cases could focus on inpatient...- Five or more years of experience in Health Care Delivery System eg, Clinical Practice and… more