• Diagnosis Related Group Clinical Validation…

    Elevance Health (Grand Prairie, TX)
    …experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing ... the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims...you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles,… more
    Elevance Health (08/09/25)
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  • Employee Health RN PRN

    HCA Healthcare (Tomball, TX)
    …and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low ... health coverage as well as free telemedicine services and free AirMed medical transportation. + Additional options for dental and vision benefits, life and… more
    HCA Healthcare (06/21/25)
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  • Director of Quality and Patient Safetly

    Ascension Health (Cedar Park, TX)
    …+ **Schedule:** Full-time, day shift; Monday through Friday + **Hospital:** Cedar Park Medical Center + **Location:** Cedar Park, TX 78613 + Eligible for an annual ... safety information. Collect, evaluate, and maintain data concerning injuries, complaints, claims , and/or other patient safety-related data. + Educate and train the… more
    Ascension Health (08/19/25)
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  • Process Improvement Lead

    Humana (Austin, TX)
    …of medical coding to include ICD-10, CPT, HCPCS + Knowledge of medical claims processing procedures + Extensive analytical skills + Experience with process ... skills to make an impact** **Required Qualifications** + **Registered Nurse (RN)** **with current, unrestricted licensure** + BSN or... field + Minimum of 5 years experience utilizing medical necessity review criteria (EG MCG, InterQual)… more
    Humana (08/09/25)
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  • Manager Risk Management

    HCA Healthcare (Conroe, TX)
    …and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low ... as well as free telemedicine services and free AirMed medical transportation. + Additional options for dental and vision...location._** It is an exciting time to be a nurse at HCA Healthcare! Come unlock your career potential… more
    HCA Healthcare (07/31/25)
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  • New York RN Case Manager

    Public Consulting Group (Austin, TX)
    …and on a team. + Proven working experience in case management, including as a nurse , medical , mental health care manager or a related job + Excellent knowledge ... Third Party Administrator Services + Enhance Health and Public Safety Services + Claims Processing Services and Solutions + Consulting and Advisory Services + Cost… more
    Public Consulting Group (07/18/25)
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  • Utilization Management Representative I

    Elevance Health (Grand Prairie, TX)
    …prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification ... I** is responsible for coordinating cases for precertification and prior authorization review . **How will you make an impact:** + Managing incoming calls or… more
    Elevance Health (08/15/25)
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  • Manager Patient Safety

    HCA Healthcare (Houston, TX)
    …will work with defense legal counsel to coordinate claim investigations; Process claims against the facility, including the preparation of records, documents, and ... and actions on all regulatory/insurance survey report recommendations/deficiencies;** + You will review and follow up with RM Notification reports for timeliness and… more
    HCA Healthcare (07/30/25)
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