- Texas Health Resources (Arlington, TX)
- Clinical Reviews , Denial and Appeals RN Bring your passion to THR so we are Better + Together Work location: Remote (Local candidates only) Work hours: ... and effective appeal strategies for medical necessity denials. + Reviews clinical documentation in order to determine...Develops and maintains relationships with other departments related to appeals and denial management. + Serves as… more
- Molina Healthcare (Austin, TX)
- **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals ... Friday 8:00am - 5:00pm Central time Remote position **Essential Job Duties** * Performs clinical /medical reviews of previously denied cases in which a formal … more
- Cognizant (Austin, TX)
- …operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and concurrent reviews . Intermediate ... an impact by performing advanced level work related to clinical denial management and managing clinical...thinking skills to interpret guidelines of internal policies for clinical determination. . Medical Necessity Reviews can… more
- Houston Methodist (Houston, TX)
- …required to perform collections activities on complex denials and prepare complex appeals on outstanding insurance balances in the professional fee environment. This ... in account follow-up. Also is responsible for providing information regarding complex denial trends for future prevention. The individual who holds this position… more
- Molina Healthcare (San Antonio, TX)
- …national, state, and local laws and regulatory requirements affecting the medical and clinical staff. + Marketplace UM reviews + MD licenses required for ... reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves...reviews cases requiring concurrent review, and manages the denial process. + Monitors appropriate care and services through… more
- Molina Healthcare (Fort Worth, TX)
- …issues, focused reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical ... * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for...reviews cases requiring concurrent review and manages the denial process. * Monitors appropriate care and services through… more
- Houston Methodist (Houston, TX)
- …analytics and real-time dashboards to proactively manage authorization workflows, appeals , and peer reviews . **GROWTH/INNOVATION ESSENTIAL FUNCTIONS** + ... and advancement of a unified case management model grounded in clinical excellence, throughput efficiency, care transitions, and denials prevention. A champion… more