- Health Care Service Corporation (Richardson, TX)
- …decision making skills.** **PC and database experience.** **PREFERRED JOB REQUIREMENTS:** ** Utilization review experience.** **3 years clinical experience in ... Summary** This position is responsible for ensuring accurate and timely clinical review of behavioral health cases (Applied Behavior Analysis (ABA)) for medical… more
- Prime Healthcare (Weslaco, TX)
- …a Quality Assurance RN Coordinator , also referred to as a Performance Improvement Nurse Coordinator or Stroke Program Nurse Coordinator . Quality ... COORDINATOR We are seeking...Activities include but are not limited to integrity reliability review , medical chart reviews, data abstraction for CMS Core… more
- Humana (Austin, TX)
- … or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Pre-Transplant Coordinator position a registered nurse , responsible for participating in department initiatives, facilitating, and ... Coordinators and management, benefiting from their practice. The Pre-Transplant Coordinator position interacts with all members of interprofessional transplant team… more
- San Antonio Behavioral Health (San Antonio, TX)
- The Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors ... from insurers. Responsible for monitoring adherence to the hospital's utilization review plan to ensure the effective...Essential Duties: + Collaborate and set standards with registered nurse (RN) case managers (CMs) and outcome managers to… more
- Catholic Health Initiatives (Houston, TX)
- **Job Summary and Responsibilities** As an RN Transplant Coordinator , you will be a pivotal force in transforming lives, orchestrating the intricate journey of ... to patient advocacy, driving both individual success and program excellence. + Review medical information, schedule testing, review results and compile data… more
- Veterans Affairs, Veterans Health Administration (Big Spring, TX)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... period. The duties and responsibilities for the Community Living Center, Registered Nurse include, but are not limited to the following: Provide competent,… more
- MD Anderson Cancer Center (Houston, TX)
- …appeal. * Contact third-party payers, insurance medical directors, case management, and utilization review to request reconsideration and/or appeal of claims ... employee discounts, and more The primary purpose of the * Nurse Defense Audit Coordinator * position within the...Experience in clinical nursing and 1 year Experience in utilization review . * May substitute preferred degree… more
- HCA Healthcare (El Paso, TX)
- …and retrospective review of patient medical records for purposes of utilization review , compliance with requirements of external review agencies ... opportunity to make a real impact. As a(an) Registered Nurse Case Manager you can be a part of...knowledge of case management philosophy/process/role, needs assessment, principles of utilization review /quality assurance, use of InterQual(R) or… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Transplant Recovery Nurse position leads organ procurement services required for transplantation and manages the peri-operative phase of ... as a mentor and resources for team members. The Transplant Recovery Nurse position reviews cadaveric donor organ offers, assesses clinical diagnostics, and evaluates… more