- Molina Healthcare (Houston, TX)
- …At least 2 years clinical nursing experience, including at least 1 year of utilization review , medical claims review , long-term services and supports ... DESCRIPTION **Job Summary** Provides support for medical claim and internal appeals review activities -...or equivalent combination of relevant education and experience. + Registered Nurse ( RN ). License must… more
- Houston Methodist (Katy, TX)
- …to department specifications. + Manages utilization management (UM) programs including Medical Claims Review , Precertification and Reconsiderations and ... performance that demonstrates progressive leadership abilities **LICENSES AND CERTIFICATIONS** **Required** + RN - Registered Nurse - Texas State Licensure… more
- CVS Health (Austin, TX)
- …we do it all with heart, each and every day. **Position Summary:** This Case Manager RN position is with Aetna's National Medical Excellence (NME) team and is a ... to apply, however, preference is for candidates in compact RN states. This role is a blended role doing...all case management activities with members to evaluate the medical needs of the member to facilitate the member's… more
- Molina Healthcare (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 can include either a 30 or 60 min unpaid lunch.** 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
- 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
- Elevance Health (Houston, TX)
- …and efficiency recommendations. **Minimum Requirements:** + Requires current, active, unrestricted Registered Nurse license in applicable state(s). + Requires a ... experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing… more
- Highmark Health (Austin, TX)
- …+ 1-3 years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related ... rejection and the proper action to complete the retrospective claim review with the goal of proper...Review process includes a review of medical documentation, itemized bills, and claims data… more
- Houston Methodist (Sugar Land, TX)
- …assigned patient population, under the direct supervision of a Physician, APP and/or Registered Nurse . This position oversees appropriate scope of practice, (ie ... Medical Assistant through AAMA, NAHP, NCCT, NHA or Registered Medical Assistant or EMT **and** +...the clinic under the direct supervision of a Physician, Registered Nurse , or clinic leadership procedures. Complete… more
- Zurich NA (Austin, TX)
- …+ Experience leading operational initiatives and/or work streams Preferred Qualifications: + Licensed Registered Nurse ( RN ) in the state of residence + ... Sr Supplier Medical Process Specialist 128416 Zurich North America is...years of experience in the Nursing areaAND + Licensed registered nurse in state of residence +… more