- Molina Healthcare (Dallas, TX)
- **Job Description** **Job Summary** The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring alignment ... supporting our Appeals and Grievances department. We are seeking a Registered Nurse with previous Appeals experience. The candidate must have strong organizational… more
- Actalent (Austin, TX)
- Clinical Review Nurse - Concurrent Review Location: Remote - Compact Nursing License required; must be able to work CST hours Schedule: Tuesday-Friday, 10:00 ... Business Unit: Medicaid About the Role We are seeking a Clinical Review Nurse to perform concurrent reviews for Medicaid members, ensuring appropriate care,… more
- Actalent (Austin, TX)
- Clinical Review Nurse - Concurrent Review Location: Remote - Candidates can be live anywhere in the US but must be able to work CST hours Schedules ... 6:30 PM CST Position Overview We are seeking Clinical Review Nurses to join our remote team. In this...assess member health, care setting, and medical necessity + Review acuity, resource use, length of stay, and discharge… more
- Houston Methodist (Houston, 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 necessity and level of care using...**LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure -… 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 ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the… more
- Veterans Affairs, Veterans Health Administration (Waco, TX)
- …and record relevant] patient information. Completed work should need only a general review by a registered nurse (RN) or physician (MD/DO) for appropriateness ... by the VHA Education Loan Repayment Services program office after complete review of the EDRP application. Responsibilities VA Careers - Licensed Practical … more
- Veterans Affairs, Veterans Health Administration (El Paso, TX)
- …and record relevant patient information. Completed work should need only a general review by a registered nurse or physician for appropriateness and conformity ... patient information. Completed work should need only a general review by a registered nurse (RN) or physician (MD/DO) for appropriateness and conformity with… more
- Veterans Affairs, Veterans Health Administration (Austin, TX)
- …and record relevant patient information. Completed work should need only a general review by a registered nurse (RN) or physician (MD/DO) for appropriateness ... VHA Education Loan Repayment Services program office after complete review of the EDRP application. Responsibilities Total Rewards of...focused assessment and reports abnormal findings to the Charge Nurse , Nurse Manager and/or RN Team Leader.… more
- Veterans Affairs, Veterans Health Administration (Big Spring, TX)
- …and record relevant patient information. Completed work should need only a general review by a registered nurse (RN) or physician (MD/DO) for appropriateness ... VHA Education Loan Repayment Services program office after complete review of the EDRP application. Responsibilities This vacancy will...assessment and reports abnormal findings to the RN Charge Nurse , and/or Nurse Manager. If acting in… more
- Veterans Affairs, Veterans Health Administration (Kerrville, TX)
- …and record relevant] patient information. Completed work [should need] only a general review by a registered nurse (RN) or physician (MD/DO) for appropriateness ... and unrestricted licensure as a licensed practical or vocational nurse in a State, Territory or Commonwealth (ie, Puerto...practices or procedures may be subject to closer higher-level review . GS-6: Completion of at least 1 year of… more