• Utilization Review - Case

    Methodist Health System (Celina, TX)
    …multidisciplinary team members to provide the very best care for our patients. The Case Coordinator In conjunction with and in support of the physician-led ... * Associates degree in nursing with insurance or hospital case management experience will be considered; BSN preferred *...experience will be considered; BSN preferred * CCM in case management preferred * Current license to practice professional… more
    Methodist Health System (01/11/25)
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  • Case Coordinator - Denials

    Methodist Health System (Dallas, TX)
    …of patient care through coaching and mentoring care givers, case managing selected cases, and facilitating discharge/transition planning. Participates in ... * Associates Degree in Nursing with insurance or hospital case management experience will be considered. * Current license...* Assures that appropriate application of internal and external utilization criteria for MMC patients * Acts as resource… more
    Methodist Health System (01/11/25)
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  • Social Worker (Program Coordinator

    Veterans Affairs, Veterans Health Administration (Balcones Heights, TX)
    Summary The Suicide Prevention Coordinator (SPC) facilitates implementation of suicide prevention strategies at the local level through education, monitoring, & ... and Overdose Report and Comprehensive Suicide Risk Evaluation report. Providing comprehensive case management to ensure veterans assigned a patient record flag for… more
    Veterans Affairs, Veterans Health Administration (11/09/24)
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  • Transplant Coordinator RN

    Catholic Health Initiatives (Houston, TX)
    …candidates. Review medical information, schedule testing including physician and coordinator consultations, collect data, review results and compile data for ... health of the communities we serve. **Responsibilities** The Transplant Coordinator RN provides coordination of all aspects of the...presentation of patient's case at Medical Review Board. + Primary… more
    Catholic Health Initiatives (11/24/24)
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  • Senior Research Data Coordinator

    MD Anderson Cancer Center (Houston, TX)
    **SUMMARY** The primary purpose of the Senior Research Data Coordinator for the Department of Gynecologic Oncology & Reproductive Medicine is to serve as a lead in ... relevant source documents. Enters research study data into electronic case report forms (CRFs) or local data systems as...notified in a timely fashion. Performs ongoing and concurrent review of data to ensure completeness and accuracy. Addresses… more
    MD Anderson Cancer Center (01/03/25)
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  • Blood Cancer Unit Clinical Nurse…

    HCA Healthcare (Austin, TX)
    …as Registered Nurse in transplant services + Minimum 3 years' experience in Case Management/ Utilization **Education** + Graduate of an accredited school of ... FC, Austin's first major league team. **The Bone Marrow Transplant Coordinator :** + Monitors patient/family before, during and after transplantation for physical,… more
    HCA Healthcare (12/20/24)
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  • Senior Intake Coordinator

    Highmark Health (Austin, TX)
    …coverage, creation of a prior authorization case in Highmark's Utilization Management system for Prior Authorization clinical review , status research, ... :** **JOB SUMMARY** This job captures all inbound phone inquires for utilization management review from providers and pharmacies. The incumbent assesses… more
    Highmark Health (11/09/24)
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  • RN Case Manager PRN

    HCA Healthcare (San Antonio, TX)
    …performed. + Prefer at least one year experience in utilization review , resource management, discharge planning or case management. Methodist Hospital opened ... rights and responsibilities. + You will act as the coordinator of patient/family/caregiver education. You will promote the participation...growth, we encourage you to apply for our RN Case Manager PRN opening. We review all… more
    HCA Healthcare (01/11/25)
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  • Case Manager RN

    CVS Health (Austin, TX)
    …with transferring patients to lower levels of care - 1+ years' experience in Utilization Review - CCM and/or other URAC recognized accreditation preferred - 1+ ... within Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible… more
    CVS Health (01/10/25)
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  • R&R Case Manager

    Sunrun (Austin, TX)
    …commitment to diversity, inclusion and belonging. **Overview** The Field Service Coordinator is responsible for coordinating effective execution of field service ... and develop partner or branch relationships including weekly/monthly reviews, utilization and workload management, process updates and identification and resolution… more
    Sunrun (12/10/24)
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  • UM Reviewer

    Apex Health Solutions (Houston, TX)
    …serves as a contact and resource person to Health Solutions' members for the utilization review (UR) of healthcare services. The UM Reviewer will be responsible ... for complying with utilization review procedures in accordance with Texas...as part of the preauthorization process; flags cases for review by the Appeals & Outcomes Coordinator more
    Apex Health Solutions (12/08/24)
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  • Behavioral Health Provider (O-6 Billet)…

    Immigration and Customs Enforcement (El Paso, TX)
    …health assessment, evaluation, and diagnosis of detained non-citizens (including the utilization of the DSM-V to formulate findings). Provides supportive counseling, ... electronic medical record (EMR) to complete clinical documentation, and to review and process telephone encounters, etc. Promotes and facilitates multidisciplinary… more
    Immigration and Customs Enforcement (01/01/25)
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  • Rehab Specialist

    HCA Healthcare (San Antonio, TX)
    …and off-site review of patients in designated facilities to assist Case Management in identifying patients that could clinically benefit from rehab services. + ... and expertise! **Job Summary and Qualifications** This position acts as a coordinator between internal and external referral sources, and acute inpatient rehab… more
    HCA Healthcare (11/13/24)
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  • Registered Nurse, Outpatient Behavioral Health…

    Veterans Affairs, Veterans Health Administration (El Paso, TX)
    …include group programming, evidence-based treatments, tele-mental health, medication management, case management/ Mental Health Treatment Coordinator (MHTC), ... 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 (12/12/24)
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  • Prior Authorization - LPN - LVN - Remote

    CVS Health (Austin, TX)
    …reviews as per the health plan/employer agreed criteria, including inbound from the coordinator as needed as well as outreach calls to physician offices. -Conducts ... prospective, concurrent, and/or retrospective review of cases using health plan/employer agreed upon -Documentation...upon -Documentation of required clinical/ medical data that support case decision as required - electronically and/or in written… more
    CVS Health (01/10/25)
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  • Registered Nurse- In Home Primary…

    The Cigna Group (Houston, TX)
    The RN Coordinator serves as the key contact point for the patient to coordinate and streamline all services offered within Evernorth Health Services. The patient ... and make specific recommendations based on their goals 4. Review paperwork for patients to ensure it meets all...of the team to manage heath care cost and utilization **Provider Support** 1. Completes telephonic nursing assessments including… more
    The Cigna Group (12/18/24)
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  • Licensed Professional Mental Heath Counselor (SUD…

    Veterans Affairs, Veterans Health Administration (El Paso, TX)
    …by the VHA Education Loan Repayment Services program office after complete review of the EDRP application. Responsibilities The position is located within the ... as per BHS and/or facility policy. identifies, develops, and facilitates accessibility and utilization of VA and community resources to meet the needs of the… more
    Veterans Affairs, Veterans Health Administration (11/25/24)
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  • Transplant Financial Counselor

    Catholic Health Initiatives (Houston, TX)
    …when required, obtaining pre-certification reference number, approved length of stay, and utilization review company contact person and telephone number + ... referred for Transplant and/or VAD services. The Transplant Financial Coordinator will be a designated member of the transplant...Notifies hospital Case Managers on all in-house patients regarding insurance plan… more
    Catholic Health Initiatives (12/02/24)
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