- Molina Healthcare (San Antonio, TX)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... schedule) Looking for a RN with experience with appeals, claims review , and medical coding....clinical/ medical reviews of retrospective medical claim reviews, medical claims and… more
- Sedgwick (San Antonio, 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...change the duties of the position at any time. \# nurse Sedgwick is an Equal Opportunity Employer and a… more
- Molina Healthcare (San Antonio, TX)
- …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial… more
- San Antonio Behavioral Health (San Antonio, TX)
- …hospital admissions and extended hospitals stays. Completing data collection of demographics, claim and medical information; non- medical analysis; and ... The Utilization Review Coordinator conducts utilization reviews to determine if...Essential Duties: + Collaborate and set standards with registered nurse (RN) case managers (CMs) and outcome managers to… more
- Veterans Affairs, Veterans Health Administration (San Antonio, TX)
- …Responsibilities The Home Based Primary Care Physician in collaboration with the Medical Directors and Program Managers of assigned services is responsible for the ... Duties: The Practitioner will participate in staff meetings; communicate administrative medical issues or concerns to the service medical director.… more