- Molina Healthcare (Fort Worth, TX)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... **Job Duties** + Performs clinical/ medical reviews of retrospective medical claim reviews, medical claims and previously denied cases, in which… 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 ...in case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… more
- HCA Healthcare (Kingwood, TX)
- …path, we encourage you to apply for our Registered Nurse RN Emergency Department opening. We review all applications. Qualified candidates will be ... **Introduction** Do you have the career opportunities as a(an) Registered Nurse Employee Health you want in...colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no… more
- USAA (Plano, TX)
- …to include 6 years of experience working as a Registered Nurse ( RN ), Nurse Practitioner (NP), or Medical Doctor (MD) with accountability for highly ... us special and impactful. **The Opportunity** USAA Life Company's Claim Team is seeking a talented ** Medical ...+ Expert Advice: Ability to review complicated medical records and medical claims ,… more
- CVS Health (Austin, TX)
- …- Perform medical necessity reviews. **Required Qualifications** - 5+ years' experience as a Registered Nurse ( RN ) with at least 1 year of experience in ... of residence.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS...a hospital setting. - A Registered Nurse that holds an active, unrestricted… more
- CVS Health (Austin, TX)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse ( RN ) with at least 1 year of experience in ... of residence.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS...a hospital setting. + A Registered Nurse that holds an active, unrestricted… more
- Public Consulting Group (Austin, TX)
- …sector. To learn more, visit www.publicconsultinggroup.com . PCG is currently seeking a qualified Registered Nurse to perform as a Case Manager. The Case Manager ... Proven working experience in case management, including as a nurse , medical , mental health care manager or...plans. + Current license, certification or registration as a Registered Nurse or Social Worker **Working Conditions**… more
- Molina Healthcare (TX)
- …to health care fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews. ... nursing experience with broad clinical knowledge. + Five years experience conducting medical review and coding/billing audits involving professional and facility… more
- Molina Healthcare (TX)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/ medical reviews of… more
- Guardian Life (Austin, TX)
- …providing comprehensive medical reviews and analysis of long-term disability claims . The RN Clinical Consultant identifies restrictions, limitations and ... duration impacting functional capacity based on medical data, to assist the Claim Managers...The RN Clinical Consultant reviews long-term disability claims to determine the impact of claimants' medical… more
- Houston Methodist (Sugar Land, TX)
- …to department specifications. + Manages utilization management (UM) programs including Medical Claims Review , Precertification and Reconsiderations and ... efficiency of admission, concurrent and retrospective utilization management and medical claims functions to meet and exceed...progressive leadership abilities **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… more
- HCA Healthcare (Tomball, TX)
- …growth and continued learning is important to you, we encourage you to apply for our Registered Nurse RN Cardiac Rehab opening. Our team will promptly ... their positions. Join our Team as a(an) Employee Health RN PRN and access programs to assist with every... nurse . + Current Texas licenses as a Registered Nurse + Current Cardiopulmonary Resuscitation Course… more
- Baylor Scott & White Health (Dallas, TX)
- …impact by taking initiative and delivering exceptional experience. **Job Summary** You, as a Registered Nurse in the Denial Resource Center at Baylor Scott & ... manage denials and appeals. Your job is to handle claim denials from all insurance companies, addressing various reasons....side of appeals and denials. + Experience in Utilization Review and Case Management. **Essential Functions of the Role**… more
- Sedgwick (Austin, TX)
- …accredited college or university preferred. Current Certified Rehabilitation Counselor (CRC) or Registered Nurse ( RN ) license required. Current license, ... clinical evaluations on claims that require additional review based on medical condition, client requirement,... management of claims , including comprehension of medical terminology and substantiating claim decisions. **ADDITIONAL… more
- Lincoln Financial (Austin, TX)
- …as indicated **What we're looking for** * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license in the state where the ... organization. This position will be responsible for reviewing, analyzing, and interpreting medical information available for disability claims . In this role you… more
- HCA Healthcare (Tomball, TX)
- …required. + * Master's degree in nursing or healthcare field preferred + * Current Registered Nurse License in the State of Texas or Multi-State Compact License ... colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no...You will work with defense legal counsel to coordinate claim investigations; Process claims against the facility,… more
- Otsuka America Pharmaceutical Inc. (Austin, TX)
- …to travel up to 25%.** **Educational Qualifications** Required: + Bachelor's Degree or Registered Nurse ( RN ). Minimum of 10 years industry experience ... and guidance, ICH/GCP, and Otsuka SOPs.** **Contribute to the development and review of all critical clinical study documents, including clinical protocols, informed… more
- Lincoln Financial (Austin, TX)
- …duties as required. **What we're looking for** * Minimum of 5 years of disability claims experience * Current Registered Nurse license or Licensure in ... you will be responsible for leading and managing a team of nurse disability consultants and behavioral health consultants. This includes partnering closely with… more
- Elevance Health (Grand Prairie, TX)
- …enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims . + Responsible for independently ... Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Investigator Senior** is responsible for the independent… more
- Elevance Health (Houston, TX)
- …enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims . + Responsible for independently ... Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Investigator Senior** is responsible for the independent… more