- Health Advocates Network (Eden, TX)
- …Stipend: Lodging $672 M&I 413=$1,085. Total comp $1769.00.00- blended rate: $49.14** The Registered Nurse ( RN ) plans and provides comprehensive nursing care ... all provided services are documented. *Closely monitor all potential catastrophic illnesses. * Audit pharmacy use for adherence to formulary, as directed or required.… more
- Elevance Health (Grand Prairie, TX)
- …and efficiency recommendations. **Minimum Requirements:** + Requires current, active, unrestricted Registered Nurse license in applicable state(s). + Requires a ... **Diagnosis Related Group Clinical Validation Auditor- RN ** **Virtual:** This role enables associates to work...clinical guidelines, and objectivity in the performance of medical audit activities. + Draws on advanced ICD-10 coding expertise,… more
- Houston Methodist (Sugar Land, TX)
- …Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse ( RN ) who comprehensively conducts point of entry and ... concern that may require clinical review during the pre-bill, audit , or appeal process. + Secures reimbursement for hospital...in case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… more
- Molina Healthcare (Fort Worth, TX)
- **JOB DESCRIPTION** For this position we are seeking a ( RN ) Registered Nurse who must be licensed for the state they reside This position will support ... outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/medical reviews of previously denied… more
- Molina Healthcare (San Antonio, TX)
- …state/federal regulations **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:** Active, unrestricted State Registered Nursing ( RN ) license in good standing. ... to clinical experience + Documents clinical review summaries, bill audit findings and audit details in the database + Provides supporting documentation for… more
- Molina Healthcare (Fort Worth, TX)
- …leadership skills. **Required License, Certification, Association** + Active, unrestricted State Registered Nursing ( RN ) in good standing. + MULTI STATE ... targeted member population, and triage activities. + Completes staff quality audit reviews. Evaluates services provided and outcomes achieved and recommends… more
- Houston Methodist (Houston, TX)
- … processes + Project management experience preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure and/or ... Compact State Licensure within 60 days **OR** + RN -Temp - Registered Nurse -...of hospital or specialty services regulatory reporting, accreditation, and audit processes + Demonstrates knowledge and application of process… more
- Centene Corporation (Austin, TX)
- …Skills:** + One of the following licenses -Licensed Clinical Social Worker (LCSW), Licensed Registered Nurse ( RN ), Licensed Practical Nurse (LPN), and/or ... trainer roles the following are preferred, Licensed Clinical Social Worker (LCSW), Licensed Registered Nurse ( RN ), Licensed Practical Nurse (LPN),… 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 ... concerns that may require clinical review during the pre-bill, audit , or appeal process. **GROWTH/INNOVATION ESSENTIAL FUNCTIONS** + Identifies...in case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… more
- Fresenius Medical Center (Cypress, TX)
- …the PCT I HT are to be performed under the direct supervision of the Home Therapies registered nurse (HT RN ), in compliance with and as permissible per state ... for patients under the direct supervision of a licensed nurse under organization policies, procedures, and training and in...processes and rapport with patients, care partners, the HT RN , direct and non-direct patient care staff, providers, and… more