- Elevance Health (Grand Prairie, TX)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... the assessment within 48 hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of… more
- Elevance Health (Houston, TX)
- **Telephonic Nurse Case Manager Senior** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training ... assessment within 48 hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager Senior** is responsible for care management within the scope of… more
- 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
- Fresenius Medical Center (Houston, TX)
- …all FMS manuals. + Accountable for completion of the Annual Standing Order Review and ICD coding. + Checks correspondence whether electronic, paper or voice mail, ... supporting billing and collection activities. + Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve… more
- MTC (Raymondville, TX)
- …use of appropriate sanitation methods. + Practice basic cost containment and utilization management for detainee care and facility operations. + Maintain absolute ... and confidentiality of all medical records. Observe applicable HIPAA rules. + Review medical files to determine all provided services are documented. + Closely… more
- Molina Healthcare (TX)
- …State Plan. **JOB QUALIFICATIONS** **Required Education** Any of the following: Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program OR a ... field, such as social work or clinical counselor (for Behavioral Health Care Review Clinicians only). **Required Experience** 1-3 years of hospital or medical clinic… more
- Molina Healthcare (Fort Worth, TX)
- …Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or medical… more
- UTMB Health (Friendswood, TX)
- …optimal quality, cost, and service/outcomes. Supports and actualizes the UTMB Utilization Review /Case Management program by utilizing clinical knowledge, ... FUNCTIONS_** **:** + Supervises the operational management of the Utilization Review /Case Management program to ensure high...Nursing + Current Texas Nursing Licensure as a Registered Nurse (RN). + Minimum of five (5) years full-time… more
- Houston Methodist (Sugar Land, TX)
- …the Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management ... Seven years clinical nursing/patient care experience which includes three years in utilization review , case management or equivalent revenue cycle clinical role… more
- Molina Healthcare (Austin, TX)
- …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource… more