- Houston Methodist (Houston, TX)
- …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 ...and/or case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… more
- Molina Healthcare (San Antonio, TX)
- For this position we are seeking a ( RN ) Registered Nurse who...for a RN with experience with appeals, claims review , and medical coding. ... authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted… more
- CVS Health (Austin, TX)
- …and every day. **Position Summary** This Case Manager - Registered Nurse ( RN ) position is with Aetna's National Medical Excellence (NME) team and is a ... to apply, however, preference is for candidates in compact Registered Nurse ( RN ) states. This...all case management activities with members to evaluate the medical needs of the member to facilitate the member's… more
- Cognizant (Austin, TX)
- …expectations. **What you need to have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...the medical necessity determinations to the Health Plan/ Medical Director based on the review of… more
- CVS Health (Austin, TX)
- …however, it is subject to change based on business needs.** The RN Case Manager is responsible for telephonically assessing, planning, implementing, and coordinating ... all case management activities with members to evaluate the medical needs of the member and to help facilitate...- Through the use of clinical tools and information/data review , conducts an evaluation of member's needs and benefit… more
- Elevance Health (Grand Prairie, TX)
- …and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare-related questions ... **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon...Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Clinical Fraud Investigator II** is responsible… more
- Molina Healthcare (Austin, TX)
- …managed care experience in the specific programs supported by the plan such as utilization review , medical claims review , long-term services and supports ... likelihood of a formal appeal being submitted. * Reevaluates medical claims and associated records independently by...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- MD Anderson Cancer Center (Houston, TX)
- …reviews and audits of patient accounts to complete Defense Audits. *Ideal Candidate:* A * Registered Nurse ( RN )* with experience in *appeals* and * nurse ... insurance medical directors, case management, and utilization review to request reconsideration and/or appeal of claims...remote. Prefer Houston/local area. *LICENSES AND CERTIFICATIONS* * Required: RN - Registered Nurse -… more
- Molina Healthcare (Dallas, TX)
- …Microsoft Excel (edit/save spreadsheets, sort/filter) **Required License, Certification, Association** Licensed registered nurse ( RN ), Licensed practical ... internal policies, and contract requirements. This position completes a medical review to facilitate a referral to...corresponding medical records to determine accuracy of claims payments. + Review of applicable policies,… more
- Sedgwick (Austin, TX)
- …providers to support the claim request and documents decision rationale. + Completes medical review of all claims by reviewing medical documentation ... clinical evaluations on claims that require additional review based on medical condition, client requirement,... management of claims including comprehension of medical terminology and substantiating claim decisions. **ADDITIONAL… more