- Molina Healthcare (Fort Worth, TX)
- …Care Access and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review , and/or other utilization ... clinical and non-clinical team activities to facilitate integrated, proactive utilization management, ensuring compliance with regulatory and accrediting standards.… more
- Public Storage (Plano, TX)
- …+ Oversee reporting of claims and compliance with state filing requirements + Oversee medical utilization + Review and analyze all claims; identify claims ... and claims handling + Approve claims reserves, payments and denials + Compile, review , order or issue any necessary forms for compliance with applicable laws for… more
- Molina Healthcare (San Antonio, TX)
- …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two ... 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)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... concurrent medical record review for medical ...this position is able to cover a multitude of utilization review functions through point of entry,… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent ... medical record review for medical ...work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare,… more
- Medical Center Hospital (Odessa, TX)
- …processes, including the collection and analysis of various computer-based data related to Utilization Review , Care Coordination, and Commercial Insurance. ... + Position Summary: Assists UM Department with utilization reviews… more
- Centene Corporation (Austin, TX)
- … management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , ... with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends... review studies and evaluates adverse trends in utilization of medical services, unusual provider practice… more
- Molina Healthcare (Fort Worth, TX)
- …1-3 years Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and ... for the state they reside This position will support Medical Review for Medicare and Marketplace request...be required. + Serves as a clinical resource for Utilization Management, Chief Medical Officer, Physicians, and… more
- HCA Healthcare (El Paso, TX)
- …**Job Summary and Qualifications** The Case Manager serves as a liaison between medical staff, administration, utilization review , nursing, finance, ... records and other information sources. + Effectively applied data retrieved from the medical record to the review process. Las Palmas Medical Center… more
- Houston Behavioral Healthcare Hospital (Houston, TX)
- …The Lead Utilization Management Coordinator will report to the Director of Utilization Review and will be responsible to provide quality case management ... provided to patients or on behalf of patients in medical record and AIS. + Performs required task/duties accurately...care. + Assist with chart audits and completion of medical records. + Other duties as assigned Knowledge, Skills… more