- 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
- 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.** ... 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
- 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
- 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
- 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