- Molina Healthcare (San Antonio, TX)
- …state/federal guidelines, billing and coding regulations, and Molina policies; validates the medical record and claim submitted support correct coding to ensure ... DESCRIPTION** **Job Summary** Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate… more
- Houston Methodist (Sugar Land, TX)
- …is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent medical record review for medical necessity and level of ... or concurrently determines the appropriateness of inpatient or observation services following review of relevant medical documentation, medical guidelines,… more
- Houston Methodist (Houston, TX)
- …is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent medical record review for medical necessity and level of ... or concurrently determines the appropriateness of inpatient or observation services following review of relevant medical documentation, medical guidelines,… more
- CVS Health (Austin, TX)
- …legal, compliance, or rework projects. + Ensure staff provide detailed written summaries of medical record review findings and ensure the team articulates ... in determining correct coding and appropriate documentation during the review of medical records . This...+ A minimum of 5 years of experience in medical record review for coding… more
- Molina Healthcare (Fort Worth, TX)
- …Access and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/utilization review , and/or other utilization management ... CA, NV, IL, and MI + Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.… more
- Elevance Health (Grand Prairie, TX)
- …+ Serves as a resource and consultant to other areas of the company; particularly the Medical Review and Appeals areas + May be required to represent the company ... ** Medical Director- Medicare Fee for Service** Location: This...fee for service and assisting nurses as needed with review of claims. Works with other Medicare Administrative Contractor… more
- Centene Corporation (Austin, TX)
- …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... review of complex, controversial, or experimental medical services, ensuring timely and quality decision making. +...by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA… more
- Centene Corporation (Austin, TX)
- …+ Provide leadership and expertise in the development, implementation and interpretation of medical review and quality related policies and guidelines. + Provide ... who changes everything for our 28 million members. **Position Purpose:** Provide medical oversight, expertise and leadership to ensure the delivery of cost… more
- Sumitomo Pharma (Austin, TX)
- …Initiated Study and Collaborative Research program. + Provide detailed and compliant medical review and approval of external resources, communications, and ... as appropriate. + Capable of translating brand goals and objectives into actionable medical and scientific strategies. + Proven track record of detailed,… more
- Merck (Austin, TX)
- …Trial Planning, Communication, Decision Making, Empathy, Market Access, Medical Affairs, Medical Research, Medical Review , Medical Writing, Patient ... Skills & Experience:: + At least 5 years Global medical affairs experience with proven track record ...We will consider qualified applicants with arrest and conviction records for employment in compliance with the San Francisco… more