- 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 ...in case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… more
- HCA Healthcare (Kingwood, TX)
- …path, we encourage you to apply for our Registered Nurse RN Emergency Department opening. We review all applications. Qualified candidates will be ... **Introduction** Do you have the career opportunities as a(an) Registered Nurse Employee Health you want in...colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no… more
- Molina Healthcare (Houston, TX)
- …to health care fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews. ... nursing experience with broad clinical knowledge. + Five years experience conducting medical review and coding/billing audits involving professional and facility… more
- Molina Healthcare (Houston, TX)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/ medical reviews of… more
- Houston Methodist (Sugar Land, TX)
- …to department specifications. + Manages utilization management (UM) programs including Medical Claims Review , Precertification and Reconsiderations and ... efficiency of admission, concurrent and retrospective utilization management and medical claims functions to meet and exceed...progressive leadership abilities **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… more
- HCA Healthcare (Tomball, TX)
- …growth and continued learning is important to you, we encourage you to apply for our Registered Nurse RN Cardiac Rehab opening. Our team will promptly ... their positions. Join our Team as a(an) Employee Health RN PRN and access programs to assist with every... nurse . + Current Texas licenses as a Registered Nurse + Current Cardiopulmonary Resuscitation Course… more
- HCA Healthcare (Tomball, TX)
- …required. + * Master's degree in nursing or healthcare field preferred + * Current Registered Nurse License in the State of Texas or Multi-State Compact License ... colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no...You will work with defense legal counsel to coordinate claim investigations; Process claims against the facility,… more
- Elevance Health (Houston, TX)
- …enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims . + Responsible for independently ... Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Investigator Senior** is responsible for the independent… more