- Molina Healthcare (San Antonio, TX)
- …health, pharmacy, etc.), or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support... licensure, Diagnosis-Related Group (DRG) experience, 2 years of Utilization Review and/or Medical Claims Review… more
- Humana (Austin, TX)
- …contract. We are not able to hire candidates that are currently living in Puerto Rico. + Registered Nurse with current in-state RN license + At least 3 years ... criteria or comparable (such as Interqual, etc.) **Preferred Qualifications** + Utilization Review /Quality Management experience + BA/BSN degree… more
- Children's Home Healthcare (Amarillo, TX)
- …authorizations for Home Health services from insurance company. 7. Attend quarterly Utilization Review meetings as designated by the Director of Professional ... * RN LICENSE REQUIRED, DO NOT APPLY IF YOU...CPR + At least 2 years experience as a Registered Nurse + At least 1 year...skills and willing to travel to patient homes + Utilization Management Experience + Reliable transportation for… more
- HCA Healthcare (San Antonio, TX)
- …DeterminationsSupervisory experience preferredCertifications, Licenses, and other Special RequirementsCurrent/Active Registered Nurse ( RN ) License within ... performance of assigned home health care team(s)Supervises ongoing case management of all patients ensuring an accurate evaluation and...we encourage you to apply for our Clinical Manager RN opening. We promptly review all applications.… more
- Erickson Living (Dallas, TX)
- …of medical practice; insurance benefit structures and related legal/medical issues; and utilization review and quality assurance procedures. Please note that ... by Erickson Senior Living Join our team as a RN Case Manager (also known as Care Coordinator, Erickson...+ Researches and selects care options as appropriate. The nurse care coordinator may utilize a range of alternative,… more
- HCA Healthcare (Irving, TX)
- …degree in Nursing, Health Administration, or Business Administration, preferred + Either Registered Nurse ( RN ) licensure, Licensed Clinical Social Worker ... interdisciplinary teams and external stakeholders. The Director is a registered nurse with responsibility for all operational...we encourage you to apply for our Director Case Management opening. We promptly review all applications.… more
- Centene Corporation (Austin, TX)
- …State Licensure required or + LVN - Licensed Vocational Nurse required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure ... Knowledge of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN -… more
- Baylor Scott & White Health (Dallas, TX)
- …in nursing or Health Information Management or Health Informatics. Must be a Registered Nurse ( RN ) or Registered Health Information Administrator ... Doc Improv Practitioner (CDIP) or Cert Professional Coder (CPC). Reg Health Info Administrator (RHIA), Registered Nurse ( RN ): Must be a Registered … more
- HealthTrust Workforce Solutions (San Antonio, TX)
- …access to more than 200,000 jobs nationwide. **_JOB SUMMARY_** The Interim Leader of Case Management Services is a Registered Nurse who participates as an ... management , cost control, contract compliance, quality improvement, utilization management , denials management and...that the following functions of the role are completed: Utilization Review for medical necessity of admission… more
- Deloitte (Dallas, TX)
- …Bachelor's degree in nursing, medical degree, or physician assistant required + Current Registered Nurse ( RN ) license required + Certified Clinical ... nurse , physician, physician assistant, case manager, clinical documentation specialist, utilization review , informatics RN , Quality, DRG Validation and… more