- 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 ... clinical/ medical reviews of retrospective medical claim reviews, medical claims and...Claims Auditing, Medical Necessity Review and Coding experience +… more
- Houston Methodist (Houston, TX)
- …blood pressure, weight, and height), chief complaint(s), preforms medication(s) review , discusses/reviews medical and social history (as appropriate). ... At Houston Methodist, the Multi-Site Senior Medical Assistant, (Multi-Site Sr. MA) position is responsible...the direct supervision of a Physician, APP and/or Registered Nurse . This position oversees appropriate scope of practice, (ie… more
- 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 ... writing. They will also coordinate pending cases for a review determination with Health Solutions Medical Director,...Duties and Responsibilities: Serves as a resource to the Claims Department in determining the medical necessity… more
- Molina Healthcare (Houston, TX)
- … claims with corresponding medical records to determine accuracy of claims payments. + Review of applicable policies, CPT guidelines, and provider ... policies, CPT guidelines, internal policies, and contract requirements. This position completes a medical review to facilitate a referral to law enforcement or… more
- 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 ... Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial… more
- Houston Methodist (Houston, TX)
- …to department specifications. + Manages utilization management (UM) programs including Medical Claims Review , Precertification and Reconsiderations and ... and efficiency of admission, concurrent and retrospective utilization management and medical claims functions to meet and exceed service-level goals… more
- 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 ... risk monitoring and reduction programs. Provides leadership in the review of system and entity policy and procedures. +...Develops and provides training and education programs for leadership, medical staff, and staff to improve patient care and… more
- HCA Healthcare (Webster, TX)
- …we support our colleagues in their positions. Join our Team as a(an) Registered Nurse Risk Management Coordinator and access programs to assist with every stage of ... and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low… more
- TEKsystems (Houston, TX)
- …medical coders who have obtained CPC for a company providing third party medical service review . + Clients consist of state/federal agencies, TPAs, healthcare ... insurance companies, and self-funded employers. + Provide advisory medical reviews on claims such as workers... such as workers comp, group health, and disability claims + QA Review Fully Remote -… more
- HCA Healthcare (Pasadena, TX)
- …satisfaction and personal growth, we encourage you to apply for our Registered Nurse Case Manager opening. We promptly review all applications. Highly qualified ... and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low… more
- 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 ... between approved project financial data and books + Support project close out and claims /Provide support to tenders + Oversee the planning function on the project +… more
- 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 ... feedback to business and support it with information in case of claims . + Collaborate in resolving complex problems. Mandatory Qualifications / Requirements: +… more
- 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 ... between approved project financial data and books + Support project close out and claims /Provide support to tenders + Oversee the planning function on the project +… more