- 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 ... determinations + Recent work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare, Medicaid, and Managed… more
- HCA Healthcare (Houston, TX)
- …satisfaction and personal growth, we encourage you to apply for our Registered Nurse Case Manager opening. We promptly review all applications. Highly qualified ... integrity. We care like family! Jump-start your career as a(an) Registered Nurse Case Manager today with HCA Houston Healthcare Northwest. **Benefits** HCA Houston… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Transplant Recovery Nurse position leads organ procurement services required for transplantation and manages the peri-operative phase ... serves as a mentor and resources for team members. The Transplant Recovery Nurse position reviews cadaveric donor organ offers, assesses clinical diagnostics,… more
- ChenMed (Houston, TX)
- …explain nurse practitioner role. + Facilitates patient/family conferences to review treatment goals, optimize resource utilization , provide family education ... we need great people to join our team. The Nurse Practitioner (NP) acts as part of the clinical...and medical director to ensure compliance with guidelines. This position may require participation in risk and quality management… more
- Molina Healthcare (Houston, TX)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases… more
- HCA Healthcare (Houston, TX)
- …care patients deserve? At Texas Orthopedic Hospital we support our colleagues in their positions . Join our Team as a(an) Registered Nurse Quality Coordinator and ... Registered Nurse Quality Coordinator opening. Our team will promptly review your application. Highly qualified candidates will be contacted for interviews.… more
- US Tech Solutions (Houston, TX)
- …years of LPN/LVN clinical experience. + **Prior Authorization experience is required.** + ** Utilization Review Experience is also required.** + 1+ years of ... zone or Pacific Time zone are preferred. **Job Description:** This is a remote position and requires the ability to effectively support a work from home environment.… more
- MD Anderson Cancer Center (Houston, TX)
- …or treatment team concerning home care, potential problems, emotional concerns or utilization review status. Participates in regularly scheduled team conferences ... operations. Remains abreast of developments in the field of nursing or utilization review by attending seminars and workshops, communicating with peers,… more
- Fresenius Medical Center (Houston, TX)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Molina Healthcare (Houston, TX)
- **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States who has a compact, multi-state license. This team reviews the prior ... requests for transplants; the ideal candidate will have experience either in utilization review or case management for transplants. Preference will be… more
- Molina Healthcare (Houston, TX)
- …the effectiveness of UM practices. Actively monitors for over and under- utilization . Assumes a leadership position relative to knowledge, implementation, ... the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the… more
- Houston Methodist (Houston, TX)
- …while providing excellent customer/patient service. + Plays a leadership role in utilization review committee which includes identification of opportunities for ... At Houston Methodist, the Director Case Mgmt Social Svcs position is responsible for strategy, function and operations of the Case Management & Social Work… more
- Houston Methodist (Cypress, TX)
- … covering weekends** At Houston Methodist, the Case Manager (CM) Certified position is a registered nurse (RN) responsible for comprehensively planning ... targeted patient population on a designated unit(s) and/or service line. This position works with the physicians and interprofessional healthcare team to facilitate… more
- Houston Methodist (Cypress, TX)
- At Houston Methodist, the Case Manager (CM) Certified position is a registered nurse (RN) responsible for comprehensively planning for case management of a ... targeted patient population on a designated unit(s) and/or service line. This position works with the physicians and interprofessional healthcare team to facilitate… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Case Manager PRN (CM) position is a licensed registered nurse (RN) who comprehensively plans for case management of a target patient ... population on a designated unit(s). This position works with the physicians and interprofessional health care...department and the hospital. **SERVICE ESSENTIAL FUNCTIONS** + Performs review for medical necessity of admission, continued stay and… more
- Elevance Health (Houston, TX)
- …members and providers. **How you will make an impact:** + Perform physician-level case review , following initial nurse review , of Medical Oncology regimens ... and supportive care. + Perform physician-level case review , following initial nurse review ,...maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Case Manager (CM) Advanced position is a registered nurse (RN) responsible for promoting the achievement of optimal clinical and ... that is considered more complex and resource intensive. This position has achieved an expert level at all the...activities related but not limited to, throughput, readmissions, and utilization management to align with the visions and goals… more
- Houston Methodist (Cypress, TX)
- At Houston Methodist, the Case Manager (CM) position is a registered nurse (RN) responsible for comprehensively planning for case management, which includes care ... targeted patient population on a designated unit(s) and/or service lines. This position works with the physicians and interprofessional health care team to… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Manager Clinical Education position is responsible for collaboratively working with the Center for Nursing Research to support the ... advancement of nursing knowledge and practice. This position leads innovative solutions to complex patient problems through research, translation of evidence to the… more
- Houston Methodist (Webster, TX)
- At Houston Methodist, the Medical Assistant Certified (MA) position is responsible for assisting in the examination and treatment of patients under the direct ... supervision of the clinical or administrative leadership. This position is responsible for assisting providers in the administration of patient care in assigned… more