- Molina Healthcare (Houston, TX)
- JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities. Responsible for ensuring ... hospital setting, including at least 1 year of utilization review , medical claims review...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Houston, TX)
- …work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and ... Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in … more
- Molina Healthcare (Houston, TX)
- …Microsoft Excel (edit/save spreadsheets, sort/filter) **Required License, Certification, Association** Licensed registered nurse ( RN ), Licensed practical ... internal policies, and contract requirements. This position completes a medical review to facilitate a referral to...corresponding medical records to determine accuracy of claims payments. + Review of applicable policies,… 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 are made on claims .… more
- Houston Methodist (Houston, TX)
- …assigned patient population, under the direct supervision of a Physician, APP and/or Registered Nurse . This position oversees appropriate scope of practice, (ie ... patients visiting the clinic under the direct supervision of a Physician, Registered Nurse , or clinic leadership procedures. Complete pre-visit planning workflow… 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
- 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...one of the following licenses or certifications is required: RN or CRC. **TAKING CARE OF YOU BY** +… 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
- Elevance Health (Houston, TX)
- **Telephonic Nurse Case Manager II** **$3000 Sign-On Bonus** **Location: Virtual: This role enables associates to work virtually full-time, with the exception of ... in different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the… more