- CVS Health (Austin, TX)
- … of fraud, waste, and abuse for individual Aetna member cases. **Expectations/Responsibilities:** + Review and prepare cases for medical necessity review of ... disorders. + Make recommendation for enhancements to current managed care, review guidelines, and clinical criteria based on extensive knowledge of health… more
- Molina Healthcare (Austin, TX)
- …with ad hoc projects. **Job Duties** + Performs the role of the HEDIS medical record review overreader/auditor which includes ongoing review of records ... and data entered by the abstraction team during the annual HEDIS medical record review as well as all other HEDIS/HEDIS like project. Mentors entry-level… more
- CoreCivic (Eden, TX)
- …duplication of those services. + Maintain absolute security and confidentiality of all medical records. Review medical files to determine all provided ... physician, provides advanced nursing services and patient care in the facility's medical program to inmates/residents. The successful applicant should be able to… more
- Highmark Health (Austin, TX)
- …action to prevent further improper payments.Forwards case to the Credentialing and/or Medical Review Committee, law enforcement and regulatory agencies. + ... internal and external law enforcement and regulatory agencies, Credentialing or Medical Review Committee. + Engages in delivery of audit results and overpayment… more
- Sedgwick (Houston, TX)
- …clinical review of referred claims; documents decision rationale; and completes medical review of all claims to ensure information substantiates disability. ... consult providers and employees; to provide case direction; and to ensure medical information substantiates the need for absence from work. **ESSENTIAL FUNCTIONS and… more
- Catholic Health Initiatives (Houston, TX)
- …in a correct, businesslike manner. Prepares materials for the multidisciplinary Transplant Medical Review Board, including follow up correspondence to patients, ... and test results, and sorting results which need physician review prior to filing. 7. Obtains and communicates clinical...7. Obtains and communicates clinical information from patients, families, medical record and other members of the health care… more
- Luke Staffing (El Paso, TX)
- …following: . Provide medical examination, care, and treatment to patients. Review medical histories and progress of patients. Examine patients, make ... briefs and an overview of the mobilization and medical stations. Contractor staff shall review a...mobilization and medical stations. Contractor staff shall review a computer-generated, pre-deployment health assessment form with everyone… more
- BP Americas, Inc. (Houston, TX)
- …contingent upon adherence to local policy. This may include pre-placement drug screening, medical review of physical fitness for the role, and background checks. ... the week, and 60% in office. **Key accountabilities** + Work with and review Operational purchases for proper general ledger coding + Manage the capitalization… more
- BrightSpring Health Services (Denton, TX)
- …to identify trends within the IBAMs. + QIDP/PC/LVN weekly IDT meeting to review medical consults/ER visits/hospital discharges. + Ensure monthly info submitted ... to OSS regarding incident management. + Weekly meeting with LVN/RN to review medical appointments, ER visits, hospitalizations. IDT as needed. + Assure that ICF-… more
- TEKsystems (Austin, TX)
- Job Title: Data Entry Specialist - Medical Review Processing Start Date: 10/14 Schedule: Full-time, Monday to Friday, 8:00 AM - 5:00 PM EST Pay Rate: $16/hour ... detail-oriented Data Entry Specialists to support the processing of Independent Medical Reviews. This role involves handling sensitive client information and… more