- Actalent (Dallas, TX)
- Clinical Review Nurse (Utilization...and utilization review expertise. + Experience in concurrent review and prior authorization. + Knowledge ... Remote Job Description The role of the Utilization Management Nurse involves performing concurrent reviews, determining the...concurrent reviews to assess member's overall health. + Review the type of care being delivered and evaluate… more
- Houston Methodist (Houston, TX)
- … functions through point of entry, observation progression of care management, concurrent review and denials reviews. Additionally, the URSN will prospectively ... At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is...regarding any claim issues or concern that may require clinical review during the pre-bill, audit, or… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... concurrent medical record review for medical necessity...regarding any claim issues or concerns that may require clinical review during the pre-bill, audit, or… 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
- 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
- AdventHealth (Burleson, TX)
- …winning facility and departments including Great Place to Work by Beckers Hospital Review and Gallup. + Work with the latest technology and top experts including ... Patient Safety (PIPS) Program which include patient care coordination, improvement of clinical process through active participation in the evaluation of patient care… more
- UTMB Health (Friendswood, TX)
- …a mechanism for the review of quality of care issues arising during concurrent review , and identifies areas of potential medical liability. + Educates the ... quality, cost, and service/outcomes. Supports and actualizes the UTMB Utilization Review /Case Management program by utilizing clinical knowledge, expertise,… 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 ... RN - Registered Nurse RN - Registered Nurse Upon Hire required Or + Other Clinical...to address identified risk. + Ability to acquire and review multiple data sources and provide detailed analysis to… more
- Molina Healthcare (Fort Worth, 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
- BrightSpring Health Services (Harlingen, TX)
- …Registered Professional Nurse + Excellent communicator with ability to handle concurrent tasks and responsibilities + Ability to travel within assigned area + ... monitoring both skilled and non-skilled healthcare services + Directly supervises clinical personnel + Providing clinical teaching and conducting performance… more