- Evolent (Austin, TX)
- …and accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to ... and as an RN - **Required** + Minimum of 5 years in Utilization Management , health care Appeals , compliance and/or grievances/complaints in a quality… more
- Molina Healthcare (San Antonio, TX)
- …be required. * Serves as a clinical resource for utilization management , chief medical officer, physicians, and member/provider inquiries/ appeals . * Provides ... JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for internal...officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports… more
- Centene Corporation (Austin, TX)
- …Knowledge of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN - ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Molina Healthcare (TX)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… more
- Texas Health Resources (Arlington, TX)
- …and quality of the services provided by the organization are enhanced. Utilization management issues are identified and addressed by the appropriate ... are reported to supervisor and Administrative leaders as appropriate. Potential utilization management issues are addressed with supervisor and administration… more
- Elevance Health (Houston, TX)
- **Clinical Operations Medical Director** **Medical Oncology** **Carelon Medical Benefit Management ** **Virtual** : This role enables associates to work virtually ... proud member of the Elevance Health family of companies, Carelon Medical Benefits Management , formerly AIM Specialty Health, is a benefit- management leader in… more
- Texas Health Resources (Arlington, TX)
- …and methods necessary for a high-performance culture related to care transition management . Utilizes change management techniques to facilitate leader and staff ... of policies, procedures, and standards that provide structure for care transition management . Participates in the development of new staffing and care coordination… more
- Molina Healthcare (TX)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. JOB DESCRIPTION Job… more