- Houston Methodist (The Woodlands, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) PRN position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare,...state, local, and federal programs + Progressive knowledge of utilization management , case management , performance… more
- Houston Methodist (Sugar Land, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... this position is able to cover a multitude of utilization review functions through point of entry,...to physicians, nurses, and other health care providers on utilization management topics. + Initiates improvement of… more
- Elevance Health (San Antonio, TX)
- ** Utilization Management Representative III** **Location:** This role requires associates to be in-office 5 days per week, at our San Antonio, TX location. The ... ** Utilization Management Representative III** is responsible for...responsible for coordinating cases for precertification and prior authorization review . **How you will make an impact:** + Responsible… more
- CenterWell (Austin, TX)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- CenterWell (Austin, TX)
- …+ Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Orthopedic procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare… more
- BAYADA Home Health Care (Austin, TX)
- …full time OASIS Review and Coding Manager . The OASIS and Coding Review Manager provides support to all BAYADA Home Health Care Medicare service offices ... and procedures. As a member of the Medicare Case Management (MCM) office, individuals in this role are expected...should be available Monday-Friday from 8:30am-5:00pm. _Medicare, Coder, OASIS Review , Utilization Review , Quality Assurance,… more
- HCA Healthcare (El Paso, TX)
- …Come build your career with us! **Job Summary and Qualifications** The Case Management Manager works in conjunction with other members of the interdisciplinary ... **Description** **Introduction** We are seeking a(an) RN Manager Case Management with Del Sol...as needed + You will complete accurate and timely utilization review of patient charts to insure… more
- HCA Healthcare (Houston, TX)
- … opportunity. **Job Summary and Qualifications** Under the direction of the Case Management Manager and the Director of QRM, reviews admissions and extended ... healthcare provider. We are seeking a(an) Registered Nurse Case Manager to join our healthcare family. **Benefits** The Woman's...in accordance with procedures set forth in the Hospital Utilization Management Plan and the criteria and… more
- Turner & Townsend (Houston, TX)
- …and termination. + Effectively recommends same for direct reports to next level management for review and approval. + Plans and monitors appropriate staffing ... part of Turner & Townsend. It specializes in project and program management for public sector organizations, with industry-leading experts in corporate, cultural,… more
- Molina Healthcare (San Antonio, TX)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years… more