- Molina Healthcare (Houston, TX)
- …At least 2 years clinical nursing experience, including at least 1 year of utilization review , medical claims review , long-term services and supports (LTSS), ... that has a current active unrestricted license This a remote role and can sit anywhere within the United...Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Provides support for… more
- Molina Healthcare (Houston, TX)
- JOB DESCRIPTION **Job Summary** The Care Review Clinician (RN) provides support for clinical member services review assessment processes. Responsible for ... Hospital experience. Candidates with MCO experience are highly preferred. The Care Review Clinician must be able to work independently in a high-volume environment.… more
- Molina Healthcare (Houston, TX)
- …nursing experience in claims auditing, quality assurance, recovery auditing, DRG/clinical validation, utilization review and/or medical claims review , or ... quality audits experience. Work hours are: Monday- Friday 8:00am - 5:00pm Remote position Essential Job Duties * Develops diagnosis-related group (DRG) validation… more
- Molina Healthcare (Houston, TX)
- …DESCRIPTION Fully remote opportunity for a TX licensed RN with Utilization Management experience to join our Prior Authorization reviewing team. Previous UM ... and One Note. Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary… more
- Molina Healthcare (Houston, TX)
- For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity of ... on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member… more
- MD Anderson Cancer Center (Houston, TX)
- …*Cross-Departmental Coordination & Data Integrity* Assesses the need for protocol utilization of other services/departments and submits utilization requests and ... of data in designated protocols. Works with PI and with team to review data at designated intervals including as needed for safety reporting, futility analysis,… more
- Apex Health Solutions (Houston, TX)
- …served. Reports to: Director, Health Services Location: Houston, TX area; will consider remote deployment on a case by case basis Education Education: Registered ... Nurse (RN) LICENSES/CERTIFICATIONS: Registered Nurse (RN) with...travel in the Houston metro area may be required Remote deployment will be considered SKILLS Knowledge of healthcare… more