- 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 -...work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare,… more
- Molina Healthcare (Houston, TX)
- …assurance, or recovery auditing, ideally in a DRG/ Clinical Validation * 3+ years of Utilization Review and/or Medical Claims Review experience. * 3+ years ... and DRG validation experience are highly preferred. Work hours: Monday - Friday: 7:am - 5:00PM EST Remote position...audit letters, train team members. * Manage medical claim review team nurses, ensure operational goals are meet and… more
- Veterans Affairs, Veterans Health Administration (Houston, TX)
- …coordinated care delivery model. Coordinates with the patient care team to review clinic appointment availability ( utilization ) to ensure that clinic schedules ... centers, and other agencies Communicates with non-VA medical facilities Work Schedule: Typically Monday - Friday, 8:00 am - 4:30 pm CST; the work schedule will… more