- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of ... this position is able to cover a multitude of utilization review functions through point of entry,...**LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure -… 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 ... **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure -...a hospital or insurance company providing utilization review services + Knowledge of Medicare , Medicaid,… more
- CenterWell (Austin, TX)
- …Physical Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ ... actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that… more
- CenterWell (Austin, TX)
- …or Orthopedic procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ ... actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that… more
- Molina Healthcare (San Antonio, TX)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases… 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
- Humana (Austin, TX)
- …to medical directors and leadership during Medicare and Medicaid LOB - Medicare Clinical Criteria Review (MCCR), Utilization Management Committee (UMC), ... **Desired Qualifications** + Master's degree in health-or business-related field + Utilization management experience (Commercial and/or Medicare ) + Proven… more
- Houston Methodist (Sugar Land, TX)
- At Houston Methodist, the Case Manager (CM) Certified position is a registered nurse (RN) responsible for comprehensively planning for case management of a targeted ... engagement, ie peer-to-peer accountability. **SERVICE ESSENTIAL FUNCTIONS** + Performs review for medical necessity of admission, continued stay and resource… more
- Houston Methodist (The Woodlands, TX)
- …Houston Methodist, the Case Manager PRN (CM) position is a licensed registered nurse (RN) who comprehensively plans for case management of a target patient ... for the department and the hospital. **SERVICE ESSENTIAL FUNCTIONS** + Performs review for medical necessity of admission, continued stay and resource use,… more
- Molina Healthcare (TX)
- **Job Summary** **_For this position we are seeking a (RN) Registered Nurse who must be licensed for the state of KENTUCKY or have a compact license._** Provides ... achieve operational goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for… more