- Fresenius Medical Center (Humble, TX)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Humana (Austin, TX)
- …leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse , with a focus on our 5+ million Medicare ... members. The Director, Physician leadership will lead Medical Directors performing utilization management for inpatient authorizations training medical director… more
- UTMB Health (Friendswood, TX)
- …ensure optimal quality, cost, and service/outcomes. Supports and actualizes the UTMB Utilization Review /Case Management program by utilizing clinical ... manner. **_ESSENTIAL JOB FUNCTIONS_** **:** + Supervises the operational management of the Utilization Review /Case...Nursing + Current Texas Nursing Licensure as a Registered Nurse (RN). + Minimum of five (5) years full-time… more
- Molina Healthcare (Fort Worth, TX)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or medical… more
- Houston Methodist (Houston, TX)
- …while providing excellent customer/patient service. + Plays a leadership role in utilization review committee which includes identification of opportunities for ... and trends in the areas of care coordination, evidence- based practice, utilization management , and service excellence. Disseminates information and focuses the… 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...**LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure -… more
- HCA Healthcare (El Paso, TX)
- …with patients and/or families as needed + You will complete accurate and timely utilization review of patient charts to insure appropriate utilization of ... **Description** **Introduction** We are seeking a(an) RN Manager Case Management with Del Sol Medical Center to promote growth and unlock possibilities. At HCA… more
- Molina Healthcare (Fort Worth, TX)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more
- Houston Methodist (The Woodlands, TX)
- …state, local and federal programs + Comprehensive knowledge of discharge planning, utilization management , case management , performance improvement and ... a registered nurse (RN) responsible for comprehensively planning for case management of a targeted patient population on a designated unit(s) and/or service… more
- Houston Methodist (The Woodlands, TX)
- …state, local and federal programs + Comprehensive knowledge of discharge planning, utilization management , case management , performance improvement and ... At Houston Methodist, the Case Manager PRN (CM) position is a licensed registered nurse (RN) who comprehensively plans for case management of a target patient… more