- ChenMed (Houston, TX)
- …approved (when needed). + Schedules patient (Preferred Providers List of Specialist ) and notifies them of appointment information, including, date, time, location, ... and how patient was notified. + Referrals have been sent to specialist office & confirmed receipt. + Prepares and actively participates during physician/clinician… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Sr Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) responsible for promoting the achievement of ... all objectives delineated in the Utilization Review Nurse and Utilization Review Specialist Nurse job roles and is responsible for facilitating appropriate length of… more
- ChenMed (Houston, TX)
- …Checklist. + Communicates alternative/approvals to Referral Coordinator. + Follows up with MMD/ Specialist /MND if no response after 24hours. + Calls and follows up ... entered into HITS prospectively. + Works with tier2/tier 3 specialist to make sure our patients are seen working...the communities served by ChenMed, including the complexities of Medicare programs to patients in the healthcare marketplace +… more
- Molina Healthcare (San Antonio, TX)
- …Ownership** + Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay ... Organization (MCO) or health plan setting, including experience in Medicaid and/or Medicare , or equivalent combination of relevant education and experience + Proven… more
- HCA Healthcare (San Antonio, TX)
- …regarding deficiencies or OASIS corrections (with feedback from Quality Review Specialist ) to ensure the medical records reflect compliance with medical necessity, ... you will need:** Two years of experience within a licensed and certified ( Medicare ) home health agency requiredCompetent in Federal ( Medicare ) and Local… more
- Kelsey-Seybold Clinic (Houston, TX)
- …a family doctor is not necessary to schedule an appointment with a Kelsey-Seybold specialist , but the family doctor is an important part of the multispecialty team. ... and is in-network with major insurance plans. KelseyCare Advantage, a Medicare Advantage plan offered to Houston-area beneficiaries and affiliated with… more
- Texas Health Resources (Arlington, TX)
- …providers to ensure continuity of care plan. Assists in obtaining PCP or specialist physician follow-up. 8. Obtain follow-up PCP appointment prior to discharge when ... for utilization management including but not limited to Joint Commission, TMF, TDI, Medicare , and Milliman Care Guidelines. 2. Applies knowledge of Medicare and… more
- Adecco US, Inc. (Irving, TX)
- …escalations, and appeals. + Deliver payer insights and education on Medicare and commercial insurance coverage. + Collaborate with physician offices, specialty ... 8 years of healthcare reimbursement experience. + Strong knowledge of Medicare , commercial insurance, and specialty pharmacy. + Experience with prior authorizations,… more
- CVS Health (Austin, TX)
- …applicable) to ensure the ICD codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are ... + CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist -Physician) required. + Experience with International Classification of Disease (ICD)… more
- Molina Healthcare (Dallas, TX)
- …and experience. + At least 3 years of Experience with Medicaid and/or Medicare . + Proven experience owning operational projects from concept to execution, especially ... ability to synthesize complex information. **PREFERRED QUALIFICATIONS:** + Experience with Medicare , Medicaid, and Marketplace lines of business. + PMP, Certified… more