- Actalent (Houston, TX)
- Job Title: Review Nurse Job Description The Review Nurse will be responsible for reviewing approximately 20 cases a day to assess medical necessity for ... successful completion of cases. Essential Skills + Experience in utilization management, concurrent review , prior authorization, utilization review , case… more
- 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 ... concurrent medical record review for medical necessity...**LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure -… more
- HCA Healthcare (Houston, TX)
- …Registered Nurse Clinical Reviewer opening. Our team will promptly review your application. Highly qualified candidates will be contacted for interviews. ... in their positions. Join our Team as a(an) Registered Nurse Clinical Reviewer and access programs to assist with...resource to Hospital and Medical Staff + Responsible for concurrent audits of patient charts. Inputs data for tracking,… more
- Houston Methodist (Sugar Land, TX)
- …competent and engaged employee group by conducting regular department meetings to review policies and procedures and operational matters, rounding on all employees, ... leadership to ensure operational effectiveness and efficiency of admission, concurrent and retrospective utilization management and medical claims functions to… more
- Centene Corporation (Houston, TX)
- …weight, current and past medical history, clinical laboratory results and concurrent medications (including over-the-counter or home remedy medications) + Ensure ... and the results are obtained and discussed with the nurse and the physician + Provide patient counseling, education,...+ Assess responses to therapy, patient compliance, and ongoing review of drug regimens; report and manage adverse events… more
- Molina Healthcare (Houston, TX)
- …requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care ... Public Health, Healthcare Administration, etc. **PREFERRED EXPERIENCE:** + Peer Review , medical policy/procedure development, provider contracting experience. + Experience… more