- Cognizant (Austin, TX)
- …and retro-authorization as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral, preauthorization, ... determinations to the Health Plan/Medical Director based on the review of clinical documentation in accordance with...have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical … more
- HCA Healthcare (Austin, TX)
- …(ie Core Measures, Stroke, STS, and CathPCI) . You will perform daily concurrent review and retrospective reviews as needed to ensure compliance with ... implement standardized, evidence-based processes/protocols . You will coordinate OPPE/FPPE Process, including clinical chart review as it pertains to peer … more
- HCA Healthcare (Weatherford, TX)
- …Systems & Operations Committee and Peer Review meetings. + 3 years of Clinical experience as a Registered Professional Nurse Caring for the Trauma Patient. ... adequate documentation as required by regulatory agencies. + Complete concurrent review of cases to identify quality,...you to apply for our Trauma Coordinator - Registered Nurse opening. We promptly review all applications.… more
- HCA Healthcare (Tomball, TX)
- …Tomball we support our colleagues in their positions. Join our Team as a Nurse Manager RN Women's Services and access programs to assist with every stage of ... and more affordable to gain certifications and job skills. Apply today for our Nurse Manager RN Women's Services opening and continue to learn! **Job Summary and… more
- Humana (Austin, TX)
- …include timely data entry in MSR. * Perform accurate and timely assessment and concurrent review of outlier admissions using InterQual criteria and document ... of our caring community and help us put health first** The Pre-Authorization Nurse 2 reviews prior authorization requests for appropriate care and setting, following… more
- HCA Healthcare (Houston, TX)
- …to you, we encourage you to apply for our Registered Nurse Clinical Reviewer opening. Our team will promptly review your application. Highly qualified ... in their positions. Join our Team as a(an) Registered Nurse Clinical Reviewer and access programs to...resource to Hospital and Medical Staff + Responsible for concurrent audits of patient charts. Inputs data for tracking,… more
- Texas Health Resources (Plano, TX)
- …patient populations in terms of operation, services and patient care * Concurrent review of medical records against pre-established criteria/quality initiatives ... Quality Improvement Coordinator, Registered Nurse - Neuro Administration _We're looking for a...a health related field preferred * 3 years of clinical nursing experience in an acute care setting required… more
- UTMB Health (Galveston, TX)
- …mechanism for the review of quality of care issues arising during concurrent review , identifies area of potential medical liability and communicates to ... Utilization Review Case Mgr - Galv. Campus Utilization Mgt...and current Texas Nursing licensure as a professional registered nurse . Minimum of three years of full time wage… more
- Banner Health (TX)
- …thoroughly completes documentation required for claims payment of services approved through concurrent review 2. Supervises the team to ensure internal/external ... clinical denials. Collaborates with Care Coordination, physician, Utilization Review , and other internal/external departments to overturn and/or reduction of… more
- Molina Healthcare (San Antonio, TX)
- …requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care ... state, and local laws and regulatory requirements affecting the medical and clinical staff. **Job Duties** + Provides medical oversight and expertise in… more