- Molina Healthcare (Fort Worth, TX)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... clinical/ medical reviews of retrospective medical claim reviews, medical claims and...Claims Auditing, Medical Necessity Review and Coding experience +… more
- Elevance Health (Grand Prairie, TX)
- ** Nurse /CPC - Clinical Fraud Investigator Senior - SIU Fraud...control. + Review and conducts analysis of claims and medical records prior to payment. + ... + Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to… more
- Elevance Health (Grand Prairie, TX)
- **Telephonic Nurse Case Manager II** **Location: This is a virtual position. Candidates must reside within 50 miles of an Elevance Health Pulse Point location.** ... hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for performing care...management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisors on the development of… more
- Travelers Insurance Company (Richardson, TX)
- …Utilizes evaluation documentation tools in accordance with department guidelines. + Proactively review Claim File Analysis (CFA) for adherence to quality ... negotiating and resolving assigned General Liability related Bodily Injury and Property Damage claims . Provides quality claim handling throughout the claim … more
- Veterans Affairs, Veterans Health Administration (Dallas, TX)
- …by the VHA Education Loan Repayment Services program office after review of the EDRP application. Responsibilities Core responsibilities include leading and ... for Veterans. In conjunction with the Clinical Directors and Nurse Manager of this Mental Health Team, the incumbent...(1) Those approved by the Accreditation Council for Graduate Medical Education (ACGME), b) OR [(2) Those approved by… more
- Dallas Behavioral Healthcare Hospital (Desoto, TX)
- …and communicates patterns and trends or professional and comprehensive general liability claims experience to the administrative and medical staff. + Makes ... injury. Also, responsible for developing, implementing and monitoring of a quality review program. + Directs the collection, measurement and presentation of data… more
- Sedgwick (Fort Worth, 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...the next round, a recruiter will be in touch. \# nurse Sedgwick is an Equal Opportunity Employer and a… more