- HCA Healthcare (San Antonio, TX)
- …Do you want to join an organization that invests in you as an Inpatient Authorization Review Services Registered Nurse or Licensed Practical Nurse -NICU ... difference. We are looking for a dedicated Inpatient Authorization Review Services Registered Nurse or...care contracting, experienced preferred. + Currently licensed as a registered nurse ( RN ) in the… more
- Cognizant (Austin, TX)
- …role expectations. **What you need to have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and utilization ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...the medical necessity determinations to the Health Plan/ Medical Director based on the review of… more
- Molina Healthcare (San Antonio, TX)
- …will work on set schedule) Looking for a RN with experience with appeals , claims review , and medical coding. **Job Summary** Utilizing clinical knowledge ... and experience, responsible for review of documentation to ensure medical necessity...state/federal regulations **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:** Active, unrestricted State Registered Nursing ( RN ) license in good standing.… more
- Molina Healthcare (San Antonio, TX)
- JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities. Responsible for ensuring timely ... including diagnosis. Candidates with knowledge of CPT/HCPCS codes, record review , chart audit, provider disputes, appeals , and...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- HCA Healthcare (Plano, TX)
- …worth of each individual is recognized. Submit your application for the opportunity below: Registered Nurse Case Manager IP RehabMedical City Plano **Benefits** ... benefits may vary by location._** We are seeking a(an) Registered Nurse Case Manager IP Rehab for...Nurse Case Manager IP Rehab opening. We promptly review all applications. Highly qualified candidates will be directly… more
- Evolent (Austin, TX)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of...work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators… more
- Houston Methodist (Sugar Land, TX)
- …care for government and nongovernmental payers preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... review , case management or equivalent revenue cycle clinical role + Experience includes writing clinical appeals for medical necessity compliance or level of… more
- Houston Methodist (Houston, TX)
- …leading multi-site or enterprise-level programs preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... oversight for all hospital-based Case Management Directors and the Central Utilization Review Director across the system. This position is responsible for the… more
- San Antonio Behavioral Health (San Antonio, TX)
- …May consult with staff as needed. Essential Duties: + Collaborate and set standards with registered nurse ( RN ) case managers (CMs) and outcome managers to ... The Utilization Review Coordinator conducts utilization reviews to determine if...hospitals stays. Completing data collection of demographics, claim and medical information; non- medical analysis; and outcomes reporting.… more
- Centene Corporation (Austin, TX)
- … records to ensure billing is consistent with medical record for appeals , adjustments and miscellaneous/unlisted code review + Review cases with ... on workplace flexibility. POSITION IS REMOTE **Position Purpose:** Perform clinical/coding medical claim review to ensure compliance with coding practices… more
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