- Molina Healthcare (Fort Worth, TX)
- …* Reviews medically appropriate clinical guidelines and other appropriate criteria with chief medical officer on denial decisions. * Resolves escalated ... JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for internal appeals clinical processes...* Prepares and presents cases in conjunction with the chief medical officer for administrative law judge… more
- HCA Healthcare (Fort Worth, TX)
- …innovation of ideas. **Job Summary and Qualifications** Under the supervision of the Assistant Chief Nursing Officer , the Director of Progressive Care shares ... for the effective and efficient operation of the assigned nursing department(s). Functions will be performed in accordance with...department(s). Functions will be performed in accordance with the nurse practice act in a manner consistent with the… more
- Molina Healthcare (Fort Worth, TX)
- …Pharmacy and Therapeutics (P&T) and other committees as directed by the chief medical officer . * Evaluates authorization requests in timely support ... of nurse reviewers, reviews cases requiring concurrent review and manages...appropriate care and services through continuum among hospitals, skilled nursing facilities and home care to ensure quality, cost-efficiency,… more
- Texas Health Resources (Arlington, TX)
- …Orients medical staff on care transition management principles. Escalates issues to Chief Quality Medical Officer (CQMO), Physician Advisor, and/or Senior ... patient, staff, physician, and other department complaints Education Bachelor's Degree Nursing Required Or Master's Degree Social Work Required Master's Degree… more