- Houston Methodist (Sugar Land, TX)
- …care for government and nongovernmental payers preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... At Houston Methodist, the Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical… more
- Texas Health Resources (Arlington, TX)
- …of Milliman or InterQual criteria required + Case management experience preferred + Denials and Appeals experience preferred + RN license to practice in the ... Clinical Reviews, Denial and Appeals RN Bring your passion to THR so we...ancillary departments to proactively address patient care issues and denials management + Conducts the necessary research… more
- Houston Methodist (Houston, TX)
- …leading multi-site or enterprise-level programs preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... exposure to confidential/sensitive information + Proven expertise in throughput optimization, denials management , and team leadership across diverse care… more
- Houston Methodist (Houston, TX)
- …with HM performance that demonstrates leadership responsibility **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... At Houston Methodist, the Director Case Management & Social Services RN position...of opportunities for appropriate utilization of resources to avoid denials and resource management as it pertains… more
- Cognizant (Austin, TX)
- …expectations. **What you need to have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...by performing advanced level work related to clinical denial management and managing clinical denials from Providers… more
- Datavant (Austin, TX)
- …Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and appeal writing for inpatient admission. ... by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade denials and appeal writing… more
- Houston Methodist (Houston, TX)
- …in utilization review and/or case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact ... Specialist Nurse (URSN) position is a licensed registered nurse ( RN ) who comprehensively...functions through point of entry, observation progression of care management , concurrent review and denials reviews. Additionally,… more
- MD Anderson Cancer Center (Houston, TX)
- …reviews and audits of patient accounts to complete Defense Audits. *Ideal Candidate:* A * Registered Nurse ( RN )* with experience in *appeals* and * nurse ... knowledge, insurance expertise, and critical thinking to resolve complex denials and audits-making a direct impact on patient outcomes...remote. Prefer Houston/local area. *LICENSES AND CERTIFICATIONS* * Required: RN - Registered Nurse -… more
- AdventHealth (Burleson, TX)
- …qualifications:** + Registered Nurse ( RN ) if Registered Nurse + Certification in Care Management Standards or ACM or CCM This facility is ... provides a low-cost of living. **The role you'll contribute:** The Care Management Market Director has full accountability and oversight for the overall operations… more
- Houston Methodist (The Woodlands, TX)
- …the Case Manager PRN (CM) position is a licensed registered nurse ( RN ) who comprehensively plans for case management of a target patient population on a ... resource utilization, and continued stay. Reviews level of care denials to identify trends and collaborate with team to... management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… more