- HCA Healthcare (San Antonio, TX)
- **Description** **Introduction** Do you have the career opportunities as a Clinical Appeals Nurse you want with your current employer? We have an exciting ... caring group of colleagues. Do you want to work as a Clinical Appeals Nurse where your passion for creating positive patient interactions is valued? If you… more
- Molina Healthcare (TX)
- …appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct...denied cases in which a formal appeals request has been made or upon request by… more
- Evolent (Austin, TX)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a meaningful impact ... as part of a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to… more
- Evolent (Austin, TX)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and… more
- Adecco US, Inc. (Houston, TX)
- Adecco Healthcare & Life Sciences is assisting a client hire a Utilization Review Nurse in Houston, TX! This role is in person / on site. Please read below and apply ... **Pay:** $85,00 to $110,000 yearly **Responsibilities of the Utilization Review Nurse :** . **Review Medical Records:** Thoroughly evaluate patient medical records to… more
- Molina Healthcare (Austin, TX)
- …responsibilities will include specialized medical necessity reviews and/or appeals and supporting market performance. Performance activities include physician ... medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse… more
- Baylor Scott & White Health (Dallas, TX)
- …taking initiative and delivering exceptional experience. **Job Summary** You, as a Registered Nurse in the Denial Resource Center at Baylor Scott & White Health, ... manage denials and appeals . Your job is to handle claim denials from...Hospital. + Worked on the payer (Insurance) side of appeals and denials. + Experience in Utilization Review and… more
- Molina Healthcare (Austin, TX)
- …medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse ... and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends… more
- Sharecare (Austin, TX)
- …enrollment / new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited to medical, ... 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status +...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Houston Methodist (Sugar Land, TX)
- …(UM) programs including Medical Claims Review, Precertification and Reconsiderations and Appeals . Collaborates with the Director of Case Management/Social Svcs on ... **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure and/or Compact State Licensure...Licensure within 60 days **OR** + RN-Temp - Registered Nurse - Temporary State Licensure within 60 days **AND**… more
- Prime Therapeutics (Austin, TX)
- …leads cross functional committees that review FWA member lock in appeals . **Responsibilities** + Leverage clinical judgement to evaluate members for potential ... years of work experience in case management or professional practice + Current Registered Nurse (RN) license in good standing with the Board of Nursing as required… more