- Molina Healthcare (Houston, TX)
- JOB DESCRIPTION **Job Summary** Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal ... nursing experience, including at least 1 year of utilization review , medical claims review , long-term...equivalent combination of relevant education and experience. + Registered Nurse (RN). License must be active and unrestricted in… more
- Actalent (San Antonio, TX)
- Remote Clinical Review Nurse - Prior Authorization Location: Must be located in Central or Eastern time zones Employment Type: Full‑Time About the Role We ... are seeking an experienced Registered Nurse to join our team within a leading Managed...a leading Managed Care Organization. This role is fully remote and focuses on reviewing clinical documentation to determine… more
- Actalent (Fort Worth, TX)
- Immediate Hiring for " Remote Clinical Review Nurses" Job Description: + Review approximately 20 cases a day for medical necessity. + Advocate for and ... complete cases. Qualifications: + 3+ years of utilization management, concurrent review , prior authorization, utilization review , case management, and discharge… more
- Datavant (Austin, TX)
- …+ 3+ years of CDI experience + 3+ years of clinical experience in an academic medical center + Registered Nurse license, Bachelor's degree in Nursing + CCDS or ... you will play a pivotal role in elevating the impact of our medical record documentation. You will conduct daily evaluations and engage in direct communication… more
- TEKsystems (Dallas, TX)
- …8 AM-5 PM CST Quality Assurance Responsibilities: + Perform quality assurance review of peer review reports, correspondences, addendums, or supplemental reviews. ... and specifications are followed and all questions addressed. + Verify each review is supported by current clinical citations and references from reputable … more
- Actalent (Houston, TX)
- "Immediate Hiring for "Utilization Review RN" Job Description: + Perform concurrent reviews to assess member's overall health. + Review the type of care being ... delivered and evaluate medical necessity. + Contribute to discharge planning according to...+ 4+ years experience in utilization management and utilization review /managed care/hospital setting as an RN is Mandatory… more
- Highmark Health (Austin, TX)
- …to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and ... RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) or WV or DE or...Working knowledge of pertinent regulatory and compliance guidelines and medical policies + Ability to multi task and perform… more
- Evolent (Austin, TX)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate,...medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all review … more
- HCA Healthcare (Mcallen, TX)
- …is committed to the growth and development of our future nurses! The **HCA Nurse Residency Program** is a year-long program designed to give you hands-on experience ... help establish valuable clinical and critical thinking skills. As a Resident I Graduate Nurse you will be surrounded by a supportive community of nurse … more
- HCA Healthcare (Mcallen, TX)
- …Hospital we support our colleagues in their positions. Join our Team as a(an) Registered Nurse Cath Lab Neuro IR and access programs to assist with every stage of ... colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no...certifications and job skills. Apply today for our Registered Nurse Cath Lab Neuro IR opening and continue to… more