- Molina Healthcare (San Antonio, TX)
- …work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and ... Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in … 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)
- …Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... of residence.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS...setting. + A Registered Nurse that holds an active, unrestricted… 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
- Houston Methodist (Houston, TX)
- …Sr Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse ( RN ) responsible for promoting the achievement of optimal ... Functions as a resource to department staff in communicating medical information required by external review entities,...in case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… more
- Texas Health Resources (Fort Worth, TX)
- …patient safety/risk exposures affecting the quality of care and outcomes. * Makes medical staff quality review referrals as appropriate. * Utilizes statistical ... Risk Manager RN - Quality Department _Bring your passion to...Actively engages in the Patient Safety Program developing effective medical error reduction strategies and tools. * Works in… more
- CVS Health (Austin, TX)
- …do it all with heart, each and every day. **Position Summary** This Case Manager RN role is with the Costco Team and is fully remote; however, candidates must reside ... or holidays will be required** . The Case Manager RN is responsible for telephonically and/or face to face...all case management activities with members to evaluate the medical needs of the member to facilitate the member's… more
- Sedgwick (Austin, TX)
- … review of referred claims ; documents decision rationale; and completes medical review of all claims to ensure information substantiates disability. ... + Provides clear and appropriate follow-up recommendations for ongoing medical management of claims ; ensures appropriate recommendations are made on claims .… more
- Sedgwick (Austin, TX)
- …Best Workplaces in Financial Services & Insurance Nurse Allocator- RN Medicare Compliance **Prior medical -set-aside experience highly desired for this ... **PRIMARY PURPOSE OF THE ROLE:** To perform provider outreach, specialized document review , and analysis and interpretation of interventions for the preparation of… more
- Houston Methodist (Webster, TX)
- …assigned patient population, under the direct supervision of a Physician, APP and/or Registered Nurse . This position oversees appropriate scope of practice, (ie ... patients visiting the clinic under the direct supervision of a Physician, Registered Nurse , or clinic leadership procedures. Complete pre-visit planning workflow… more