• Medical Claim Review

    Molina Healthcare (Austin, 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 (Austin, 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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  • Initial Review Pharmacy Technician

    Prime Therapeutics (Austin, TX)
    …staff, cardholders, and pharmacies. + Escalates medical exception requests to nurse , pharmacist or physician on the utilization review clinical team when ... more
    Prime Therapeutics (02/12/25)
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  • Medical Director (Medicare)

    Molina Healthcare (Austin, 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 Specialty Medical

    Molina Healthcare (Austin, 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 (02/07/25)
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  • Case Manager RN

    CVS Health (Austin, TX)
    …5pm within time zone of residence.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993, ... more
    CVS Health (02/11/25)
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  • Case Manager RN

    CVS Health (Austin, TX)
    …wellness through integration. + Through the use of clinical tools and information/data review (eg, assessments, claims , etc..) conducts an evaluation of member's ... more
    CVS Health (02/08/25)
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  • Special Investigation Unit Manager Clinical…

    CVS Health (Austin, TX)
    …Direct and oversee complex reviews. Ensure timely and accurate reporting of review findings and coordinate with investigative to take appropriate action. Conducts ... more
    CVS Health (12/25/24)
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