- 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
- 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
- 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
- Houston Methodist (The Woodlands, 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
- Sedgwick (San Antonio, TX)
- …the ADA process for claimants requesting accommodations under the ADAAA; to review complex medical information for temporary and permanent accommodation ... and/or client requirements. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Reviews medical information for ADAAA temporary and permanent accommodation requests. +… more
- San Antonio Behavioral Health (San Antonio, TX)
- …May consult with staff as needed. Essential Duties: + Collaborate and set standards with registered nurse ( RN ) case managers (CMs) and outcome managers to ... The Utilization Review Coordinator conducts utilization reviews to determine if...and extended hospitals stays. Completing data collection of demographics, claim and medical information; non- medical … more
- CVS Health (Austin, TX)
- …+ 3+ years of clinical experience in a healthcare setting. + 2+ years as a Registered Nurse ( RN ) or License Practical Nurse / License Vocational ... Nurse . + Active, current, and unrestricted RN /LVP/LPN license in the state of residence. + Proficiency in Microsoft Office Suite (Outlook, Excel) and ability to… more
- Houston Methodist (Sugar Land, TX)
- …care for government and nongovernmental payers preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management and appeals… more
- Humana (Austin, TX)
- …timeframe **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) Compact license, with no disciplinary action ... us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills to support the...Health Provider Disputes based on the business need + Review and extract information from claims +… more
- Baylor Scott & White Health (College Station, TX)
- …Management, investigates to evaluate patient harm. If organizational risk is found, the Corporate claims manager will review the event further. The CRM will help ... position will support two hospitals; Baylor Scott & White Medical Center - Round Rock and Baylor Scott &...SSOS reports and obtains more detailed information by chart review and interviews as indicated. + When adverse events… more