- Travelers Insurance Company (Austin, TX)
- …Utilize evaluation documentation tools in accordance with department guidelines. + Proactively review Claim File Analysis (CFA) for adherence to quality ... evaluating, reserving, negotiating and resolving assigned serious and complex Specialty claims . Provides quality claim handling throughout the claim… more
- USAA (San Antonio, TX)
- …Medicare-related claims . + Expert Advice: Ability to review complicated medical records and medical claims , and provide expert advice. Conducts ... us special and impactful. **The Opportunity** USAA Life Company's Claim Team is seeking a talented ** Medical ...review of complex healthcare fraud investigations and providing claims support + Medical Coding Proficiency: At… 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 medical record review for medical ...claim issues or concerns that may require clinical review during the pre-bill, audit, or appeal process. **GROWTH/INNOVATION… more
- CVS Health (Austin, TX)
- …with heart, each and every day. **Position Summary** This Case Manager - Registered Nurse (RN) position is with Aetna's National Medical Excellence (NME) team ... apply, however, preference is for candidates in compact Registered Nurse (RN) states. This role is a blended role...all case management activities with members to evaluate the medical needs of the member to facilitate the member's… more
- Public Consulting Group (Austin, TX)
- …and on a team. + Proven working experience in case management, including as a nurse , medical , mental health care manager or a related job + Excellent knowledge ... www.publicconsultinggroup.com . PCG is currently seeking a qualified Registered Nurse to perform as a Case Manager. The Case...be responsible for assisting enrollees of a publicly administered Medical Fund on behalf of a state agency. The… more
- Evolent (Austin, TX)
- …other clinicians who review the appeal, the claims department to review provider post-service claims for medical necessity, and managers for ... the mission. Stay for the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a meaningful impact as part of… more
- HCA Healthcare (Kingwood, TX)
- …step in your career path, we encourage you to apply for our Registered Nurse RN Emergency Department opening. We review all applications. Qualified candidates ... Do you have the career opportunities as a(an) Registered Nurse Employee Health you want in your current role?...colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no… more
- Molina Healthcare (TX)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... the likelihood of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge,… more
- CVS Health (Austin, TX)
- …frontline advocates for members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management ... and support safe transitions. **Required Qualifications** + 2+ years Licensed Practical Nurse / Licensed Vocational Nurse nursing experience + Candidate must… more
- Zurich NA (Austin, TX)
- …for the review of clinical services for the determination of medical necessity and appropriateness of care of our insureds' injured employees. You will ... AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is seeking...for business results and works with Managed Care and Claims leadership to create and align utilization and pharmacy… more