- Centene Corporation (San Antonio, 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 (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 necessity...regarding any claim issues or concerns that may require clinical review during the pre-bill, audit, or… more
- ChenMed (Houston, TX)
- …+ Participates in surveys, studies and special projects as assigned. + Conducts concurrent medical record review using specific indicators and criteria as ... resources and mobilizes resources to assist in achieving desired clinical outcomes within specific timeframe. + Conducts review...clinical field preferred. + A valid, active Registered Nurse (RN) license in State of employment required. +… more
- HCA Healthcare (Kingwood, TX)
- …plans, education techniques, and evaluate program effectiveness.. + You will perform concurrent review of stroke patients for core measure compliance. What ... do in this role: + You will coordinate the clinical management of the stroke patient population across the...path, we encourage you to apply for our Registered Nurse Stroke Coordinator opening. We review all… more
- HCA Healthcare (Kingwood, 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
- HCA Healthcare (Brownsville, TX)
- …database to ensure adequate documentation as required by regulatory agencies + Complete concurrent review of cases to identify quality, timelines and systems of ... **Are you passionate about delivering patient-centered care?** Submit your application for Registered Nurse RN Coord Trauma PI position and spend more time at the… more
- HCA Healthcare (Brownsville, TX)
- …in developing and implementing processes to comply with regulatory standards + Conducts concurrent and retrospective chart review for the purpose of identifying ... in their positions. Join our Team as a(an) Registered Nurse RN Chest Pain Coordinator and access programs to...Joint Commission requirements, CMS Core Measure standards and ACC clinical practice guidelines for chest pain. In collaboration with… 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
- Catholic Health Initiatives (Houston, TX)
- …and/or surgical Registry Abstraction **Required Licensure and Certifications** Licensed Registered Nurse , Licensed Clinical Pharmacist, or other Licensed ... initiatives, including but not limited to, activities focused on clinical quality improvement, patient safety and risk reduction, patient...root cause analyses and medical staff improvement (eg case review for peer review , OPPE, FPPE). +… more
- Catholic Health Initiatives (Bryan, TX)
- …survey tracers. **Qualifications** Required Education and Experience: + Licensed Registered Nurse , Licensed Clinical Pharmacist, or other Licensed Clinical ... key initiatives, including but not limited to, activities focused on clinical quality improvement, patient safety and risk reduction, patient experience, efficiency,… more
- HCA Healthcare (Plano, TX)
- …you want to join an organization that invests in you as a Revenue Integrity Clinical Charge Analyst RN? At Parallon, you come first. HCA Healthcare has committed up ... the opportunity to make a difference. We are looking for a dedicated Revenue Integrity Clinical Charge Analyst RN like you to be a part of our team. **Job Summary… more
- Ascension Health (Austin, TX)
- **Details** + **Department:** Utilization Review + **Schedule:** PRN Day shift + **Location:** Remote - Must live within 60 miles of Texas Administrative Offices ... health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests within assigned… more
- Catholic Health Initiatives (Houston, TX)
- **Responsibilities** 1. At the request of third party payers, Provides concurrent and retrospective reviews in an effort to extend authorized days and ensure ... reimbursement due for services provided 2. Subject matter expert regarding clinical appropriateness and level of care for CIC staff as well as Patient Access… 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
- UTMB Health (Friendswood, TX)
- …a mechanism for the review of quality of care issues arising during concurrent review , and identifies areas of potential medical liability. + Educates the ... quality, cost, and service/outcomes. Supports and actualizes the UTMB Utilization Review /Case Management program by utilizing clinical knowledge, expertise,… more
- Molina Healthcare (Austin, TX)
- …requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care ... Director for Specialty Medical Services & Market Performance will provide clinical expertise and support to the enterprise. Primary responsibilities will include… more
- Texas Health Resources (Arlington, TX)
- …and all identified potentially compensable events (consumers and product). Concurrent review of medical records against pre-established criteria/quality ... RN - Registered Nurse RN - Registered Nurse Upon Hire required Or + Other Clinical...to address identified risk. + Ability to acquire and review multiple data sources and provide detailed analysis to… more
- Molina Healthcare (Austin, TX)
- …requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care ... state, and local laws and regulatory requirements affecting the medical and clinical staff. **Job Duties** + Provides medical oversight and expertise in… more