- Molina Healthcare (Houston, TX)
- JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities. Responsible for ensuring ... clinical/ medical reviews of retrospective medical claim reviews, medical claims and...hospital setting, including at least 1 year of utilization review , medical claims review… more
- 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 ... schedule) Looking for a RN with experience with appeals, claims review , and medical coding....clinical/ medical reviews of retrospective medical claim reviews, medical claims and… 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
- 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
- Sedgwick (Houston, TX)
- …the ADA process for claimants requesting accommodations under the ADAAA; to review complex medical information for temporary and permanent accommodation ... and/or client requirements. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Reviews medical information for ADAAA temporary and permanent accommodation requests. +… more
- Houston Methodist (Sugar Land, TX)
- …blood pressure, weight, and height), chief complaint(s), preforms medication(s) review , discusses/reviews medical and social history (as appropriate). ... At Houston Methodist, the Multi-Site Senior Medical Assistant, (Multi-Site Sr. MA) position is responsible...the direct supervision of a Physician, APP and/or Registered Nurse . This position oversees appropriate scope of practice, (ie… 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
- Sedgwick (Houston, TX)
- … review of referred claims ; documents decision rationale; and completes medical review of all claims to ensure information substantiates disability. ... + Provides clear and appropriate follow-up recommendations for ongoing medical management of claims ; ensures appropriate recommendations...change the duties of the position at any time. \# nurse Sedgwick is an Equal Opportunity Employer and a… 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
- 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
- GE Vernova (Houston, TX)
- …the purchase orders within budget * Supports Commodity Manager in contract claim management and ensures vendor recovery * Supports GCL/CSL/Buyer in invoices release, ... participation of project quality manager, PEM, lead engineers, scheduler and PM/PD to review procurement progress and generates the weekly PO progress review … more
- Houston Methodist (Sugar Land, TX)
- …Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management and appeals ... decisions and is accountable for reviewing denials for level of care, medical necessity, and as appropriate, DRG recoupments/downgrades, and denials for no… more
- Sedgwick (Houston, TX)
- …the ADA process for claimants requesting accommodations under the ADAAA; to review complex medical information for temporary and permanent accommodation ... are driven to deliver great work. + Apply your medical /clinical or rehabilitation knowledge and experience to assist in...the next round, a recruiter will be in touch. \# nurse Sedgwick is an Equal Opportunity Employer and a… more