• Medical Claim Review

    Molina Healthcare (Houston, TX)
    …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... more
    Molina Healthcare (01/25/25)
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  • Clinical Appeals Nurse (RN): Texas and New…

    Molina Healthcare (Houston, TX)
    …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... more
    Molina Healthcare (02/09/25)
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  • Telephonic Nurse Case Manager II

    Elevance Health (Houston, 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.** ... more
    Elevance Health (02/13/25)
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  • UM Reviewer

    Apex Health Solutions (Houston, TX)
    …as well as carrying out day today pre-authorization functions. The Utilization Review Nurse will also be responsible for issuing pre-authorization ... more
    Apex Health Solutions (12/08/24)
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  • Medical Director (Medicare)

    Molina Healthcare (Houston, TX)
    …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... more
    Molina Healthcare (02/09/25)
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  • Medical Director (Marketplace)

    Molina Healthcare (Houston, TX)
    …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... more
    Molina Healthcare (02/06/25)
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  • Manager - Case Management and Social Work

    Houston Methodist (Houston, TX)
    …to department specifications. + Manages utilization management (UM) programs including Medical Claims Review , Precertification and Reconsiderations and ... more
    Houston Methodist (01/28/25)
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  • Risk Management Liaison

    Houston Methodist (Houston, TX)
    …implements an organized record keeping system for essential/critical documents (ie potential claims , claims , reports and patient/ medical staff matters) that ... more
    Houston Methodist (01/09/25)
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  • Lead Project Management Specialist - Project…

    GE Vernova (Houston, TX)
    …Presents all financial data in a transparent way, attends project and management review to present cost status + Provides change order calculations to ensure ... more
    GE Vernova (02/08/25)
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  • Commissioning Specialist

    GE Vernova (Houston, TX)
    …the test reports as soon as they are finished to the team for review . It's also a responsibility of the Commissioning Specialist to provide feedback about the ... more
    GE Vernova (01/31/25)
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