- Corvel (Fort Worth, TX)
- The CERIS Professional Review Nurse provides analysis of medical services to determine appropriateness of charges on multiple types of medical bills and ... areas of OR, ICU, CCU, ER, and orthopedics preferred Prospective, concurrent and retrospective utilization review experience preferred PAY RANGE: CorVel… more
- Curative HR LLC (Austin, TX)
- …utilization management processes and improve member outcomes. Contribute to the development, review , and revision of medical policies, clinical guidelines, and ... necessity determinations. The Medical Director will serve as a key clinical expert, ensuring appropriate resource utilization, promoting evidence-based care, and… more
- Centene Corporation (Austin, TX)
- …needed to discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member ... approve medical determinations or provide recommendations based on requested services and concurrent review findings + Assists with providing education to… more
- Houston Methodist (The Woodlands, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) PRN position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... concurrent medical record review for medical necessity...regarding any claim issues or concerns that may require clinical review during the pre-bill, audit, or… more
- HCA Healthcare (Tomball, TX)
- …Tomball we support our colleagues in their positions. Join our Team as a Nurse Manager RN Women's Services and access programs to assist with every stage of ... and more affordable to gain certifications and job skills. Apply today for our Nurse Manager RN Women's Services opening and continue to learn! **Job Summary and… more
- HCA Healthcare (Houston, TX)
- …to you, we encourage you to apply for our Registered Nurse Clinical Reviewer opening. Our team will promptly review your application. Highly qualified ... in their positions. Join our Team as a(an) Registered Nurse Clinical Reviewer and access programs to...resource to Hospital and Medical Staff + Responsible for concurrent audits of patient charts. Inputs data for tracking,… more
- HCA Healthcare (Conroe, TX)
- …database to ensure adequate documentation as required by regulatory agencies. + Complete concurrent review of cases to identify quality, timelines and systems of ... you passionate about delivering patient-centered care?** Submit your application for Registered Nurse Trauma Coordinator position and spend more time at the bedside… more
- AdventHealth (Burleson, TX)
- …winning facility and departments including Great Place to Work by Beckers Hospital Review and Gallup. + Work with the latest technology and top experts including ... Patient Safety (PIPS) Program which include patient care coordination, improvement of clinical process through active participation in the evaluation of patient care… more
- Actalent (San Antonio, TX)
- Urgent Hiring for "Remote Clinical Review Nurses"in Texas! *Must be located in Texas* Job Description: + Review approximately 20 cases a day for medical ... other and complete cases. Qualifications: + 2+ years of utilization management, concurrent review , prior authorization, utilization review , case management,… more
- Houston Methodist (Sugar Land, TX)
- …competent and engaged employee group by conducting regular department meetings to review policies and procedures and operational matters, rounding on all employees, ... leadership to ensure operational effectiveness and efficiency of admission, concurrent and retrospective utilization management and medical claims functions to… more
- Centene Corporation (Houston, TX)
- …complete for allergies, height, weight, current and past medical history, clinical laboratory results and concurrent medications (including over-the-counter or ... + Assess responses to therapy, patient compliance, and ongoing review of drug regimens; report and manage adverse events...report and manage adverse events + Assist the physician, nurse and patient with clinical and technical… more
- Molina Healthcare (Fort Worth, TX)
- …requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care ... national, state, and local laws and regulatory requirements affecting the medical and clinical staff. MD licenses required for the following states: WA FL, MI, MS,… more
- HCA Healthcare (Austin, TX)
- …of medical services and discharge planning for specified patient populations. Performs concurrent and retrospective review of patient medical records for ... nurses play a vital part. We know that every nurse 's path and purpose is unique. Do you want...purposes of utilization review , care coordination compliance with requirements of external … more
- HCA Healthcare (Round Rock, TX)
- …and internal committees. What you will do in this position: . Perform daily concurrent chart review to ensure compliance with evidence-based program measures for ... data reporting timelines are met (IRR, normalization, etc). . Collaborate with clinical staff, physicians, and leaders to ensure evidence-based measures are met in… more
