- Houston Methodist (Houston, TX)
- …with HM performance that demonstrates leadership responsibility **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... At Houston Methodist, the Director Case Management & Social Services RN position...excellent customer/patient service. + Plays a leadership role in utilization review committee which includes identification of… more
- Houston Methodist (Houston, TX)
- …oversight for all hospital-based Case Management Directors and the Central Utilization Review Director across the system. This position is responsible for ... initiatives. + Provides strategic vision and execution for case management and utilization review across...enterprise-level programs preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… more
- Houston Methodist (Houston, TX)
- …the Case Manager (CM) position is a registered nurse ( RN ) responsible for comprehensively planning for case management , which includes care transitions ... experience preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -...and federal programs + Progressive knowledge of discharge planning, utilization management , case management , performance… more
- Elevance Health (Grand Prairie, TX)
- ** Nurse Reviewer I** **Location:** This role...hospital setting or minimum of 1 year of prior utilization management , medical management and/or ... Monday - Friday (9:30 AM -6:00 PM Centeral) The ** Nurse Reviewer I** is responsible for conducting...required. **Preferred Skills, Capabilities and Experiences:** + Familiarity with Utilization Management Guidelines is preferred + ICD-9… more
- Houston Methodist (Sugar Land, TX)
- …Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management ... clinical nursing/patient care experience which includes three years in utilization review , case management or...nongovernmental payers preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… more
- HCA Healthcare (Cypress, TX)
- …to physicians, patients, families and caregivers **What qualifications you will need:** + ( RN ) Registered Nurse + Bachelors Degree, or Associate Degree ... case management scope of services including + Utilization Management supporting medical necessity and denial...encourage you to apply for our Registered Nurse Case Manager PRN opening. We review … more
- CVS Health (Austin, TX)
- …is subject to change based on business needs. **Preferred Qualifications** 6+ months Case Management or Utilization Management experience Case Management ... 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… more
- 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
- MTC (Raymondville, TX)
- …the use of appropriate sanitation methods. + Practice basic cost containment and utilization management for detainee care and facility operations. + Maintain ... Detention Facility in Raymondville, TX** is seeking a dedicated RN to provide compassionate care and support to individuals...of all medical records. Observe applicable HIPAA rules. + Review medical files to determine all provided services are… more
- MTC (Livingston, TX)
- …the use of appropriate sanitation methods. + Practice basic cost containment and utilization management for detainee care and facility operations. + Maintain ... plan **Make a Difference Where It Matters!** Operated by Management & Training Corporation, the **IAH Detention Facility in...has a unique and rewarding challenge for a dedicated nurse . Help us provide essential care where your expertise… more