- Molina Healthcare (Houston, TX)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... clinical/ medical reviews of retrospective medical claim reviews, medical claims and...Claims Auditing, Medical Necessity Review and Coding experience +… 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
- Elevance Health (Houston, TX)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management...management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisors on the development of… more
- Elevance Health (Houston, TX)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... different states; therefore Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for performing care management within… more
- Travelers Insurance Company (Houston, TX)
- …Utilizes evaluation documentation tools in accordance with department guidelines. + Proactively review Claim File Analysis (CFA) for adherence to quality ... negotiating and resolving assigned General Liability related Bodily Injury and Property Damage claims . Provides quality claim handling throughout the claim … more
- Houston Methodist (Webster, TX)
- …blood pressure, weight, and height), chief complaint(s), preforms medication(s) review , discusses/reviews medical and social history (as appropriate). ... Traveling/ Commuting will be expected.** At Houston Methodist, the Multi-Site Senior Medical Assistant, (Multi-Site Sr. MA) position is responsible for working at… more
- Molina Healthcare (Houston, TX)
- … claims with corresponding medical records to determine accuracy of claims payments. + Review of applicable policies, CPT guidelines, and provider ... policies, CPT guidelines, internal policies, and contract requirements. This position completes a medical review to facilitate a referral to law enforcement or… more
- Molina Healthcare (Houston, TX)
- …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial… more
- Houston Methodist (Sugar Land, TX)
- …to department specifications. + Manages utilization management (UM) programs including Medical Claims Review , Precertification and Reconsiderations and ... and efficiency of admission, concurrent and retrospective utilization management and medical claims functions to meet and exceed service-level goals… more
- MD Anderson Cancer Center (Houston, TX)
- …assists other providers with their patients with glycemic disorders. *PROVIDE DIRECT MEDICAL SKILLS WITHIN SCOPE OF PRACTICE (40%)* Provide medical skills ... Use judgment to work autonomously as defined by the nurse practice act or to collaborate with the healthcare...pump, Type 1 Diabetes, and those on concentrated insulin Review endocrine discharge instructions on patients pending discharge. Assist… more
- Veterans Affairs, Veterans Health Administration (Houston, TX)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... in the Department of Medicine at the Michael E. DeBakey VA Medical Center (MEDVAMC), Houston, Texas seeks and energetic and skilled hematologist/oncologist at… more