• Medical Director - OneHome

    Humana (Austin, TX)
    …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health, DME, skilled nursing facility and… more
    Humana (05/31/25)
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  • Director Governmental Reporting

    Houston Methodist (Houston, TX)
    …reviews the filing of Federal and State Charity Report. + Directs the coordination, review and filing of Medicare and Medicaid cost reports and associated audits ... internal and external financial and governmental reporting requirements. Requirements include Medicare cost reports, Federal Tax Returns Health and Human Services… more
    Houston Methodist (03/04/25)
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  • Clinical Coding and OASIS Review Manager

    BAYADA Home Health Care (Austin, TX)
    …while using the Medicare PDGM billing model and CMS guidelines. + Review and communicate OASIS edit recommendations to each clinician to promote OASIS accuracy. ... Utilization Review , Quality Assurance, Remote, Home Health Coding, Coder, Medicare **As an accredited, regulated, certified, and licensed home health care… more
    BAYADA Home Health Care (05/17/25)
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  • Utilization Review RN

    Catholic Health Initiatives (Houston, TX)
    …assist in determination of clinical appropriateness for level of care and Medicare /Medicaid and Managed Care related issues 3. Reviews all patient documentation in ... of 89 JOB DESCRIPTION MASTER TEMPLATE 6. Educates staff with updates in Medicare Medicaid and Managed care initiatives 7. Initiates and Coordinates orientation for… more
    Catholic Health Initiatives (05/11/25)
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  • Medical Director - Medicaid N. Central

    Humana (Austin, TX)
    …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all… more
    Humana (05/14/25)
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  • Revenue Integrity Clin Charge Review

    HCA Healthcare (Pasadena, TX)
    …Do you have the career opportunities as a Revenue Integrity Clinical Charge Review Analyst RN you want with your current employer? We have an exciting ... of colleagues. Do you want to work as a Revenue Integrity Clinical Charge Review Analyst RN where your passion for creating positive patient interactions is valued?… more
    HCA Healthcare (03/22/25)
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  • Revenue Integrity Charge Review Analyst

    HCA Healthcare (Houston, TX)
    …want to join an organization that invests in you as a Revenue Integrity Charge Review Analyst? At Parallon, you come first. HCA Healthcare has committed up to $300 ... opportunity to make a difference. We are looking for a dedicated Revenue Integrity Charge Review Analyst like you to be a part of our team. **Job Summary and… more
    HCA Healthcare (05/29/25)
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  • Case Manager (RN) - Utilization Review

    Houston Methodist (The Woodlands, TX)
    …patient satisfaction and safety measures. **FINANCE ESSENTIAL FUNCTIONS** + Performs review for medical necessity of admission, continued stay and resource use, ... service focus and application of positive language principles + Knowledge of Medicare , Medicaid and Managed Care requirements + Progressive knowledge of community… more
    Houston Methodist (05/30/25)
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  • SR Reimbursement Analyst

    Methodist Health System (Dallas, TX)
    …5 days **Work Shift :** **Job Description :** Your Job: The SR REIMBURSEMENT( MEDICARE ) ANALYST will assist the Manager of Regulatory Compliance, the Manager of ... * CPA Preferred * Position requires extensive knowledge of governmental programs ( Medicare and Medicaid). * Good written and oral communication skills. * Good… more
    Methodist Health System (04/24/25)
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  • Medical Specialist Principal - Life Company…

    USAA (Plano, TX)
    …Minimum of 4 years working with Medicare Supplement claims and/or Medicare -related claims. + Expert Advice: Ability to review complicated medical records ... talented **Medical Specialist Principal** to play a crucial role in advising the Medicare Supplement Claims Department on the morbidity and claims risk of health… more
    USAA (05/22/25)
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