- TEKsystems (West Lake Hills, TX)
- …to support litigation, cost containment, and expert witness services. Job Responsibilities: * Review clinical medical records to validate billed charges. * ... Job Summary: We are seeking a Medical Bill Review Analyst/Expert to join our team and contribute to our mission of delivering accurate, defensible, and… 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
- UTMB Health (Webster, TX)
- …in monitoring patients with complicated treatment plans through multidisciplinary conferences and medical record review . + Facilitates clinical care ... measures to achieve target. + Presents LOS variances for review to Director and Inpatient Medical Director....variances for review to Director and Inpatient Medical Director. Transfer Center (Hospital to Hospital Transfer and… more
- Molina Healthcare (San Antonio, TX)
- …Access and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/utilization review , and/or other utilization management ... + Must have valid driver's license with good driving record and be able to drive within applicable state...Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of InterQual /… 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
- Humana (Austin, TX)
- …will be a key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with a focus on our 5+ ... 48 states. **Key Responsibilities** **:** + Lead an operational team of Medical Directors to review authorizations and ensure clinical decision-making skills… 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
- Humana (Austin, TX)
- …management, provider relations, quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will develop and present ... health topics to the clinical operations team and healthcare organization. The Medical Director's work includes computer based review of moderately complex… more