- 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
- Elevance Health (Grand Prairie, TX)
- …enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims . + Responsible for independently ... Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Investigator Senior** is responsible for the independent… more
- Baylor Scott & White Health (Round Rock, 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