- Houston Methodist (Sugar Land, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... the URN, this position is able to cover a multitude of utilization review functions through point of entry, observation progression of care management,… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent ... Recent work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare, Medicaid, and Managed Care requirements… more
- Medical Center Hospital (Odessa, TX)
- …processes, including the collection and analysis of various computer-based data related to Utilization Review , Care Coordination, and Commercial Insurance. ... + Position Summary: Assists UM Department with utilization reviews… more
- Houston Behavioral Healthcare Hospital (Houston, TX)
- …The Lead Utilization Management Coordinator will report to the Director of Utilization Review and will be responsible to provide quality case management ... services to all patients and their families, to serve as a member of interdisciplinary team supporting the organization's treatment program and philosophy, and assure the deliverance of quality treatment to patients and their families. Duties: + Assists with… more
- Molina Healthcare (Fort Worth, TX)
- …and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review , and/or other utilization management ... clinical and non-clinical team activities to facilitate integrated, proactive utilization management, ensuring compliance with regulatory and accrediting standards.… more
- Actalent (Dallas, TX)
- …the necessity and appropriate setting of care. Essential Skills + 2+ years of utilization management and utilization review expertise. + Experience in ... Clinical Review Nurse ( Utilization Management)100% Remote Job Description The role of the Utilization Management Nurse involves performing concurrent… more
- Actalent (Houston, TX)
- …of cases. Essential Skills + Experience in utilization management, concurrent review , prior authorization, utilization review , case management, and ... planning. + Proficiency with InterQual. + Active Compact RN License. + Utilization Management/Concurrent Review experience. + ICU/ER experience. + Strong… more
- Molina Healthcare (San Antonio, TX)
- …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... DESCRIPTION** **Job Summary** Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level… more
- Molina Healthcare (TX)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... / MCG guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT LICENSURE**… more
- BAYADA Home Health Care (Austin, TX)
- …+ Candidates should be available Monday-Friday from 8:30am-5:00pm. _Medicare, Coder, OASIS Review , Utilization Review , Quality Assurance, Remote, Home Health ... Home Health Care is hiring a full time OASIS Review and Coding Manager. The OASIS and Coding Review Manager provides support to all BAYADA Home Health Care… more