- Centene Corporation (Austin, TX)
- …excellent opportunity to apply your clinical expertise in a **non-direct care, remote role** , supporting quality care and improved outcomes for the Medicaid ... the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified,… more
- CVS Health (Austin, TX)
- …Management. - Refer all cases that do not meet applicable criteria or have a potential quality of care issue to a physician reviewer . - Identify and address ... with heart, each and every day. **This is a remote work from home role anywhere in the US...AHH delivers flexible medical management services that support cost-effective quality care for members. - This position consists of… more
- UTMB Health (Galveston, TX)
- Clinical Documentation Specialist ( Remote -Texas Resident) - Clinical Data **Galveston, Texas, United States** Medical Administrative UTMB Health Requisition ... nurse (or medical school graduate) with a minimum of 3 years inpatient clinical experience, advanced clinical expertise and an extensive knowledge of complex… more
- UTMB Health (Galveston, TX)
- QAPI Clinical Service Ln Mgr (RN) Partial Remote (Sealy Heart & Vasc. Inst. - Galveston) **Galveston, Texas, United States** Nursing & Care Management UTMB ... + Sound working knowledge of concepts, practices, and procedures related to quality improvement functions specific to clinical program supporting. + Demonstrated… more
- Molina Healthcare (Austin, TX)
- …are highly preferred Work hours: Monday- Friday 8:00am - 5:00pm Central time Remote position **Essential Job Duties** * Performs clinical /medical reviews of ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal...provided to members. Contributes to overarching strategy to provide quality and cost-effective member care. Candidates with UM and… more
- UTMB Health (Webster, TX)
- …to maintain and manage all changes to clinical systems. + Participates in quality assurance review and the evaluation of new and existing products. + Directs ... EHR Clinical Solutions Specialist (Epic Beaker/LIS), Partial Remote - ITS - ClinDoc-Rad **Webster, Texas, United States** Information Technology UTMB Health… more
- Texas Health Resources (Arlington, TX)
- Clinical Coding Educator _Are you looking for a rewarding career with an award-winning company? We're looking for a qualified_ Clinical Coding Educator _like you ... to join our Texas Health family._ Work location: Remote Work hours: Monday through Friday (full time hours) HIMS/CCDI Department Highlights: + 100% remote work +… more
- Evolent (Austin, TX)
- …when available, within the regulatory timeframe of the request. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the ... clinical professionals. + A role that values innovation, continuous improvement, and clinical excellence. + **This position is 100% Remote and can be… more
- Molina Healthcare (Austin, TX)
- JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for ... verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired… more
- Providence (Lubbock, TX)
- …a Coding Quality Auditor, HEDIS who will:** + Be responsible for conducting clinical quality audits/overreads for the Quality Department + Identify and ... reports issues related to clinical audits to determine potential areas for ...Information Set (HEDIS) program + Conduct Audits inclusive of review of outpatient medical records, hospital records, clinical… more