- 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
- Lincoln Financial Group (Austin, TX)
- …for conducting initial and ongoing interviews with claimants, obtaining, and reviewing medical records and making timely and ethical claim determinations. You'll ... through phone and e-mail to gather information regarding the Short Term Disability claim . + Collaborating with fellow case managers, nurse case managers and… more
- Defense Health Agency (Fort Sam Houston, TX)
- …for arranging, scheduling, and coordinating interview of MEDCEN personnel by the Medical Claims Judge Advocate, Department of Justice or representatives of ... review , referral to an appropriate committee, a Serious Medical Incident Report to the US Army Medical.... Upon receipt of a copy of a malpractice claim , reviews the medical records to identify… more
- Lincoln Financial Group (Austin, TX)
- …organization. This position will be responsible for reviewing, analyzing, and interpreting medical information available for disability claims . In this role you ... a clinical resource for Group Protection benefit specialists and claim professionals. You will evaluate medical information...this role you will provide coaching and guidance to claims regarding medical management **What you'll be… more
- Elevance Health (Grand Prairie, TX)
- ** Nurse and CPC - Clinical Fraud Investigator II -...control. + Review and conducts analysis of claims and medical records prior to payment. Researches ... + Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to… more
- Indorama Ventures (Port Neches, TX)
- …+ Develop, implement, and maintain health policies and procedures. + Develop and review nursing protocols for medical surveillance programs. + Plays the lead ... : Indorama Ventures is seeking a dedicated Occupational Health Nurse to join our HS&S team. This role is...the OSHA 300 log. + Collaborate with the insurance claims department to manage the worker's compensation program. **Employee… 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
- 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
- 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
- HCA Healthcare (Corpus Christi, TX)
- …coverage; + * You will work with defense legal counsel to coordinate claim investigations; Process claims against the facility, including the preparation of ... an exciting opportunity for you to join Corpus Christi Medical Center Bay Area which is part of the...all regulatory/insurance survey report recommendations/deficiencies; + * You will review and follow up with RM Notification reports for… more
- Molina Healthcare (San Antonio, 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
- 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, ... Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support cost-effective quality care for members.… more
- United Therapeutics (Austin, TX)
- …reimbursement support, patient support programs, field reimbursement managers, patient navigators and nurse educators + Review Needs Assessment Forms related to ... and biotech industry, including FDA advertising and promotion, False Claims Act, Anti-Kickback Statute, OIG Guidance, the PhRMA Code,...+ Serve as the Legal representative on the Company's medical communications review , including review … more
- Veterans Affairs, Veterans Health Administration (Temple, TX)
- …Registered Nurse Anesthetists to veteran patients undergoing surgical or medical procedures. The Deputy Chief of Anesthesia has the following duties and ... determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply.… more
- Veterans Affairs, Veterans Health Administration (San Antonio, TX)
- …are determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Responsibilities The Geriatric and Extended Care ... Medical Practitioner will provide high quality patient centered care...other GEC providers. - Participates in chart reviews, peer review and other process improvement initiatives. The staff will… more