Utilization Review Nurse Health Plans - HP Utilization Management CHRISTUS HealthUtilization Review Nurse Health Plans - HP Utilization ManagementIrving, TXPerform provider outreach to address post-hospital discharge services, redirection to in-network providers for appropriate steerage, durable equipment usage, and utilization of other medical services and/or procedures and other necessary telephonic follow-up. This nurse effectively communicates with internal and external clinical professionals, efficiently organizes the financial insurance care of the patients, and relays clinical data to insurance providers and vendors to obtain approved certification for services.
NewUtilization Review Nurse Oscar HealthUtilization Review NurseDallas, TXRemote$35–$45.94 / hourWork Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois; Iowa; Kansas; Michigan; Missouri; Nebraska; New Jersey; North Carolina; Ohio; Oklahoma; Pennsylvania; South Carolina; Tennessee; Texas; or Virginia. Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC).
Utilization Review Nurse Bracane CoUtilization Review NursePlano, TexasRemoteThis position is responsible for performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness, and quality of medical/surgical services, and serving as liaison between providers and medical and network management divisions. RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan.
Nurse Case Manager - Utilization Review - Nights (Fri-Sun, 7p-7a) JPS Health NetworkNurse Case Manager - Utilization Review - Nights (Fri-Sun, 7p-7a)Fort Worth, TXDescription: The Nurse Case Manager - Inpatient is responsible for coordinating the care and service of assigned patients with physicians, nurses, social workers and other members of the healthcare team to facilitate the progression of care from hospital admission through discharge. The Nurse Case Manager- Inpatient is also responsible for ensuring that the patient is placed in the appropriate level of care while monitoring the utilization of healthcare resources and discharge planning to achieve the desired clinical, financial, and resource utilization outcomes.
Nurse Case Manager - Utilization Review - Mon, Tue, Sat, Sun JPS Health NetworkNurse Case Manager - Utilization Review - Mon, Tue, Sat, SunFort Worth, TXDescription: The Nurse Case Manager - Inpatient is responsible for coordinating the care and service of assigned patients with physicians, nurses, social workers and other members of the healthcare team to facilitate the progression of care from hospital admission through discharge. The Nurse Case Manager- Inpatient is also responsible for ensuring that the patient is placed in the appropriate level of care while monitoring the utilization of healthcare resources and discharge planning to achieve the desired clinical, financial, and resource utilization outcomes.
RN Case Manager/Utilization Review, Full-Time (Hybrid) Surgery Partners IncRN Case Manager/Utilization Review, Full-Time (Hybrid)TXJob Summary: The RN Case Manager/Utilization Review is responsible for performing prospective, concurrent, and post-discharge utilization reviews to ensure appropriate patient status, medical necessity, and compliance with hospital policy, payer requirements, and applicable local, state and federal regulations, including Centers for Medicare & Medicaid Services (CMS) guidelines. Monitor, track, and analyze avoidable days and extended lengths of stay; identify contributing factors related to utilization, payer processes, discharge barriers, and system delays, and collaborate with Case Management, physicians, and interdisciplinary teams to support timely resolution.
RN Utilization Review Coordinator, Full-time Methodist Hospital for SurgeryRN Utilization Review Coordinator, Full-timeAddison, TXFull timeMonitor, track, and analyze avoidable days and extended lengths of stay; identify contributing factors related to utilization, payer processes, discharge barriers, and system delays, and collaborate with Case Management, physicians, and interdisciplinary teams to support timely resolution. The RN Case Manager/Utilization Review is responsible for performing prospective, concurrent, and post‑discharge utilization reviews to ensure appropriate patient status, medical necessity, and compliance with hospital policy, payer requirements, and applicable local, state and federal regulations, including Centers for Medicare & Medicaid Services (CMS) guidelines.
Utilization Review Nurse Health Plans - Case Management Christus HealthUtilization Review Nurse Health Plans - Case ManagementIrving, TXToggle Mobile Navigation Menu. Non-Clinical Careers.
Afterhours Utilization Management Representative I Elevance HealthAfterhours Utilization Management Representative IGrand Prairie, TexasWe are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.
Clinical Review Specialist (31389) GI AllianceClinical Review Specialist (31389)Southlake, TXWorks collaboratively with multiple stakeholders in Infusion Operations to ensure required clinical information is received and reviewed in the infusion intake workflow based on payer and regulatory requirements and lead and manage the appeal process as required. Work Environment: Work requires hand dexterity for office machine operation, stooping and bending to files and supplies, mobility to complete errands, or sitting for extended periods of time.
Hand Surgeon Medical Review Stream Physician Concentra Inc.Hand Surgeon Medical Review Stream PhysicianDallas, TXMust be in active medical practice to perform appeals JOB-RELATED EXPERIENCE:Post-graduate experience in direct patient careJOB-RELATED SKILLS/COMPETENCIES: -Demonstrated computer skills, telephonic skills-Demonstrated ability to perform review services.-Ability to work with various professionals including members of regulatory agencies, carriers, employers, nurses and health care professionals. -Current, unrestricted clinical license(s) (or if the license is restricted, the organization has a process to ensure job functions do not violate the restrictions imposed by the State Board); -Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties is required for MD or DO reviewer.
Spine Telecommute Medical Review Stream Physician Concentra Inc.Spine Telecommute Medical Review Stream PhysicianDallas, TXMust be in active medical practice to perform appeals JOB-RELATED EXPERIENCE:Post-graduate experience in direct patient careJOB-RELATED SKILLS/COMPETENCIES: -Demonstrated computer skills, telephonic skills-Demonstrated ability to perform review services.-Ability to work with various professionals including members of regulatory agencies, carriers, employers, nurses and health care professionals. -Current, unrestricted clinical license(s) (or if the license is restricted, the organization has a process to ensure job functions do not violate the restrictions imposed by the State Board); -Board certification by American Board of Medical specialties or American Board of Osteopathic Specialties is required for MD or DO reviewer.
NewPersonal Health Nurse - Remote Tenet Healthcare CorpPersonal Health Nurse - RemoteFrisco, TXRemote$64,168–$96,262 / yearExcellent verbal communication skills with the ability to communicate with members and communicate professionally with individuals who serve in a variety of functions, i.e. physicians, client managers, customer service staff, CCCS executive management, other CCCS Medical Management nurses, hospital utilization review nurses, etc. The PHN performs the Personal Health Management process: assess the member; work with the member, family and physician to identify problems; establish goals and develop plans of care; coordinate services; educate members; and empower members to independently self-manage and to make knowledgeable health care decisions.
Nurse Reviewer 1 Elevance Health IncNurse Reviewer 1Grand Prairie, TXMinimum Requirements: Requires AS in nursing and minimum of 3 years of clinical nursing experience in an ambulatory or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management, and/or call center experience; or any combination of education and experience, which would provide an equivalent background. Through work experience and mentoring learns to conduct medical necessity clinical screenings of preauthorization requests to assess the medical necessity of diagnostic imaging procedures, out of network services, and appropriateness of treatment.
RN Manager - Case Management, Full-Time (Onsite) Surgery Partners IncRN Manager - Case Management, Full-Time (Onsite)TXCare Coordination and Case Management Facilitate seamless transitions of care across the continuum (e.g., inpatient, outpatient, home health) Collaborate with physicians, nurses, and other healthcare professionals to develop and implement patient-centered care Facilitate the discharge planning process for our patient population. ESSENTIAL FUNCTIONS: Leadership and Team Management Lead, mentor, and manage the small case management team Develop, maintain, and implement policies and procedures to improve departmental efficiency and compliance with regulatory agencies Conduct regular performance evaluations and provide professional development opportunities.
Team Manager Nursing Home VITAS Healthcare CorpTeam Manager Nursing HomeDallas, TXAssures that problems/grievances/service failures experienced by individual patients/families or physicians/MCOs are addressed with team members, vendors, other VITAS departments, and are resolved promptly and satisfactorily. Monitors the type and level of team services provided (staffing, medications, HME, supplies, level of care changes to inpatient and continuous care, etc.) to assure that they are appropriate and responsive to patient/family needs and expectations.
Nurse Case Manager II Elevance Health IncNurse Case Manager IIGrand Prairie, TXThe Telephonic Nurse Case Manager II is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
Telephonic Nurse Case Manager II Elevance Health IncTelephonic Nurse Case Manager IIGrand Prairie, TX$79,464–$119,196 / yearThe Telephonic Nurse Case Manager II is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
Nurse Case Manager - Inpatient JPS Health NetworkNurse Case Manager - InpatientFort Worth, TXDescription: The Nurse Case Manager - Inpatient is responsible for coordinating the care and service of assigned patients with physicians, nurses, social workers and other members of the healthcare team to facilitate the progression of care from hospital admission through discharge. The Nurse Case Manager- Inpatient is also responsible for ensuring that the patient is placed in the appropriate level of care while monitoring the utilization of healthcare resources and discharge planning to achieve the desired clinical, financial, and resource utilization outcomes.
Intake Registered Nurse (7a-7p) Perimeter Healthcare LLCIntake Registered Nurse (7a-7p)Garland, TXAs an Intake Registered Nurse (RN), you will play a critical role in coordinating patient admissions, conducting behavioral health assessments, and ensuring a smooth intake process for patients and referral sources. Our hospital provides inpatient psychiatric care for adolescents, adults, and senior adults in a peaceful 22-acre campus in Garland, Texas.
Intake Registered Nurse (7p-7a) Perimeter Healthcare LLCIntake Registered Nurse (7p-7a)Garland, TXPerimeter Behavioral Hospital of Dallas is a premier behavioral health facility providing inpatient psychiatric treatment for adolescents, adults, and senior adults. The Intake Registered Nurse (RN) plays a vital role in the admissions process, managing inbound calls, coordinating referrals, and ensuring timely patient placement.
Senior Analyst, Healthcare (RN) Molina Healthcare IncSenior Analyst, Healthcare (RN)Dallas, TXRegisted Nurse to perform research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Supervises completion of special projects as requested, by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations.
NewCritical Care Nurse Educator Tenet Healthcare CorpCritical Care Nurse EducatorSunnyvale, TXBaylor Scott & White Medical Center - Sunnyvale is seeking a dedicated Critical Care Nurse Educator to collaborate with department managers and unit leaders in assessing, planning, implementing, and evaluating orientation, competency validation, and continuing education programs for nursing staff. This role develops and delivers educational programs, evaluates staff competencies, facilitates professional development, and collaborates with nursing leadership to ensure excellence in clinical practice and patient outcomes.
Registered Nurse Case Manager PRN HCA HealthcareRegistered Nurse Case Manager PRNPlano, TXThe RN Case Manager is responsible for promoting patient-centered care by coordinating the plan of care for the patient stay, managing the length of stay, ensuring appropriate resource management, and developing a safe appropriate discharge plan in collaboration with the multidisciplinary team. Considers patient’s readmission status or risk of readmission and develops strategies to mitigate including education on appropriately accessing healthcare resources, preventative education, and community based resources.
RN Case Manager PRN HCA Healthcare IncRN Case Manager PRNMcKinney, TXThe RN Case Manager is responsible for promoting patient-centered care by coordinating the plan of care for the patient stay, managing the length of stay, ensuring appropriate resource management, and developing a safe appropriate discharge plan in collaboration with the multidisciplinary team. Considers patient's readmission status or risk of readmission and develops strategies to mitigate including education on appropriately accessing healthcare resources, preventative education, and community based resources.
RN Case Manager HCA Healthcare IncRN Case ManagerDallas, TXThe RN Case Manager is responsible for promoting patient-centered care by coordinating the plan of care for the patient stay, managing the length of stay, ensuring appropriate resource management, and developing a safe appropriate discharge plan in collaboration with the multidisciplinary team. Considers patient's readmission status or risk of readmission and develops strategies to mitigate including education on appropriately accessing healthcare resources, preventative education, and community based resources.
Mental Health House Supervisor - RN HCA Healthcare IncMental Health House Supervisor - RNFort Worth, TXWith the resources and experience of HCA Healthcare, including 186 hospitals in the United States and England, Medical City Healthcare is one of the North Texas region's largest and most comprehensive healthcare providers and includes 16 hospitals, about 5000 working physicians, and more than 17,000 employees in Dallas-Fort Worth. What qualifications you will need:Basic Cardiac Life Support must be obtained within 30 days of employment start dateNonviolent Crisis Intervention must be obtained within 30 days of employment start dateAssociate Degree No Travel Required 5 years experience Required Years of Experience Benefits Medical City Alliance Mental Health, offers a total rewards package that supports the health, life, career and retirement of our colleagues.
Mental Health House Supervisor - RN - PRN HCA Healthcare IncMental Health House Supervisor - RN - PRNFort Worth, TXWith the resources and experience of HCA Healthcare, including 186 hospitals in the United States and England, Medical City Healthcare is one of the North Texas region's largest and most comprehensive healthcare providers and includes 16 hospitals, about 5000 working physicians, and more than 17,000 employees in Dallas-Fort Worth. Practices and adheres to the "Code of Conduct" and "Mission and Value Statement."What qualifications you will need:Basic Cardiac Life Support must be obtained within 30 days of employment start dateNonviolent Crisis Intervention must be obtained within 30 days of employment start dateAssociate Degree, or Registered Nurse DiplomaNo Travel Required5 years experience Required Years of Experience BenefitsMedical City Alliance Mental Health, offers a total rewards package that supports the health, life, career and retirement of our colleagues.
Registered Nurse Case Manager HCA Healthcare IncRegistered Nurse Case ManagerDallas, TXRegistered Nurse with current TX state license required • Associate Degree in Nursing or Nursing diploma required • Bachelors Degree in Nursing preferred • 3 years of clinical hospital nursing experience required • OR 2 years experience in case management required • Certification in case management preferred • InterQual experience preferred. • Reassesses the patients clinical condition as indicated, considering their readmission status or risk of readmission and develops strategies to mitigate, including education on appropriately accessing healthcare resources and preventative education and community-based resources.
Case Manager Registered Nurse CVS Health CorpCase Manager Registered NurseTXRemote$60,522–$129,615 / yearThe RN Case Manager is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness. Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.
Intake Registered Nurse (7a-7p) Perimeter HealthcareIntake Registered Nurse (7a-7p)garland, TXFull timeAs an Intake Registered Nurse (RN) , you will play a critical role in coordinating patient admissions, conducting behavioral health assessments, and ensuring a smooth intake process for patients and referral sources. Our hospital provides inpatient psychiatric care for adolescents, adults, and senior adults in a peaceful 22-acre campus in Garland, Texas.
Intake Registered Nurse (7p-7a) Perimeter HealthcareIntake Registered Nurse (7p-7a)garland, TXFull timeAs an Intake Registered Nurse (RN) , you will play a critical role in coordinating patient admissions, conducting behavioral health assessments, and ensuring a smooth intake process for patients and referral sources. Our hospital provides inpatient psychiatric care for adolescents, adults, and senior adults in a peaceful 22-acre campus in Garland, Texas.
RN Case Manager PRN Days United Surgical Partners InternationalRN Case Manager PRN DaysIrving, TXServing North Texas:Covering the expansive North Texas region, we provide a wide range of medical and surgical services across 7 Operating Rooms, 12 private inpatient rooms, and a 3-bed Emergency Department. Welcome toBaylor Scott & White Surgical Hospital Las Colinas, Irving, TX, where innovation, collaboration, and patient-centered care converge to create an exceptional workplace!
RN, Case Manager, Inpatient (NEX) Cook Children's Health Care SystemRN, Case Manager, Inpatient (NEX)Fort Worth, TXAt least three years of any combination of experiences working in/with case management, care coordination, utilization review, patient intake, discharge planning and troubleshooting fund resources, quality assurance, clinical pathways, continuous quality improvement, or state and federal health plans or commercial insurance plans in a clinical or managed care environment. The Case Manager will assist with the identification of appropriate providers and facilities throughout the continuum of care, to ensure that resources of both CCMC and the patient are used in a timely and cost-effective manner to meet the healthcare needs of the patient.
Care Management Specialist - LVN (84368) Regency Integrated Health Services LLCCare Management Specialist - LVN (84368)Richardson, TXAction Rarely Occasionally Frequently Lifting - 1-25 lbs X Lifting - 25-50 lbs X Lifting - 50+ lbs X Carrying - 1-25 lbs X Carrying - 25-50 lbs X Carrying - 50+ lbs X Pushing/Pulling - 1-25 lbs X Pushing/Pulling - 25-50 lbs X Pushing/Pulling - 50+ lbs X Sliding/Transferring - 1-25 lbs X Sliding/Transferring - 25-50 lbs X Sliding/Transferring - 50+ lbs X Standing X Sitting X Walking X Speaking X Driving X Balancing/Climbing X Stooping/Kneeling X Crouching/Crawling X Reaching X Hearing/Listening X Seeing X Turning/Twisting/Leaning X. Tracks Skilled (MRA/MCO/MCG/MMP) customers utilizing Case Management Tools to determine continued and appropriate Medicare/Managed Care eligibility and benefit period through regular communications with Regional Care Management Specialist, Business Office and external Case Managers.
Operating Room Registered Nurse HCA Healthcare IncOperating Room Registered NurseDallas, TXWhat you will do in this role: Oversee the instrument and equipment set-up for your OR, including utilization of preference cards and ability to anticipate your surgeons needs Coordinate and oversee your room during a case as the circulator You will facilitate effective and efficient transition between surgical procedures Utilize appropriate body mechanics in moving your patients to stretchers and OR tables to prevent injury Manage your patients care and medication, including assistance with anesthesia Consistently review your charts for completeness, in accordance with documentation protocols prior to and after the surgical procedure Qualifications you will need: Graduate from an accredited school of professional nursing Minimum 1 year of experience in an operating room setting, preferably in an ambulatory surgery center Active RN license as required by state of employment or appropriate compact licensure Valid BCLS Certification upon employment *online certification not acceptable ACLS as required by facility PALS is preferred, but may be required at some facilities CNOR certification preferred Benefits Medical City Ambulatory Surgery Center, offers a total rewards package that supports the health, life, career and retirement of our colleagues. At HCA Healthcare, we are committed to equipping nurses with the tools and resources they need to deliver exceptional patient care, championing the profession, and supporting the advancement of nursing's future."
Operating Room RN Float Pool HCA HealthcareOperating Room RN Float PoolDallas, TXAdditional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts. HCA Healthcare Co-Founder If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Operating Room RN Float Pool opening.
OR Nurse - Float Pool HCA HealthcareOR Nurse - Float PoolDallas, TXAdditional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. Whether you choose to focus on bedside care, a leadership or C-suite role, shape business and operational outcomes, or work to deliver clinical excellence behind the scenes in data science, case management or transfer centers.
Operating Room RN PRN HCA HealthcareOperating Room RN PRNAllen, TXWith over 30 years of pioneering experience in the industry, our physician partners offer exceptional outpatient care to over 800,000 patients in communities across our network. We have an exciting opportunity for you to join Medical City Surgery Center - Allen which is part of the nation's leading provider of healthcare services, HCA Healthcare.
NewOperating Room RN HCA HealthcareOperating Room RNDallas, TXOur parent company, HCA Healthcare, is a world leader in ethical healthcare practices and has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts.
NewOperating Room RN PRN Float Pool HCA HealthcareOperating Room RN PRN Float PoolDallas, TXWe have an exciting opportunity for you to join North Texas Float Pool which is part of the nation's leading provider of healthcare services, HCA Healthcare. Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts.
OR Registered Nurse PRN HCA HealthcareOR Registered Nurse PRNNorth Richland Hills, TXAdditional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.
RN Case Manager Lead HCA Healthcare IncRN Case Manager LeadPlano, TXWhat qualifications you will needBachelor's Degree in NursingTX State RN license or compact license is acceptableMinimum 3 year Case Management experience in an acute care setting, Supervisory experience a plusStrong communication skills and the ability to listen, interact, and communicate verbally in writing, excellent interpersonal skills Benefits Medical City Plano, offers a total rewards package that supports the health, life, career and retirement of our colleagues. Assists the Manager and Director in the development and check-off of on-going staff competencies and ensures that all staff members are compliant with annual safety, HIPAA and Code of Conduct requirements; provides input on staff performance evaluationsFunctions effectively as a multi-disciplinary team member; exercises independent judgment within the context of the interdisciplinary patient care team.
RN Manager - Case Management, Full-Time (Onsite) Methodist Hospital for SurgeryRN Manager - Case Management, Full-Time (Onsite)Addison, TXFull timeThe Manager of Case Management will oversee the daily operations of the case management department, ensuring efficient utilization management, compliance with regulatory requirements, and optimal patient care outcomes. While performing the duties of this job the employee is frequently required to sit, converse, and listen; use hands to touch, handle, or feel objects, tools or controls; and to reach with hands and arms.
Nurse II Texas Health and Human Services CommissionNurse IITerrell, TX$6,579.41–$7,761.50Provides direction and coordination of staffing and patient care activities on assigned units in a consultative manner with nurse administrators and staff nurses by addressing performance problems promptly and keeping accurate documentation of interventions. Additional Information: Applicants must pass a fingerprint criminal background check, pre-employment drug screen, and registry checks including the Client Abuse/Neglect Reporting System (CANRS), Nurse Aid, Medication Aide and Employee Misconduct, List of Excluded Individuals/Entities (LEIE).
Charge Nurse OR- Days SP MANAGEMENT SERVICES INCCharge Nurse OR- DaysMcKinney, TXFull timeWhile performing the duties of this job the employee is frequently required to sit, converse, and listen; use hands to touch, handle, or feel objects, tools or controls; and to reach with hands and arms. Collaborates with surgeons, anesthesia providers, PAT, SPD, PACU, Pre-Op, and inpatient units.
NewNurse Administrator Discovery Behavioral HealthNurse AdministratorPlano, TXConducts face-to-face evaluations for all potential admissions, ensuring medical appropriateness and collaborating with medical/psychiatric providers to obtain admission orders. Preferred: Experience as a staff nurse, preferably in the field of chemical dependency, eating disorders and/or behavioral health.
Appeals and Grievances - RN, Consultant (MediCare) Blue Cross and Blue Shield AssociationAppeals and Grievances - RN, Consultant (MediCare)Dallas, TXIn this role, you will: Perform retrospective utilization reviews and first level determination approvals for members using BSC evidenced based guidelines, policies and nationally recognized clinal criteria across lines of business or for a specific line of business such as Medicare and Med-Cal, including dual-eligibility products. In this role you will be leading a team of nurses who will be responsible for performing first level appeal reviews for members utilizing the National Coverage Determination (NCD) guidelines, Local Coverage Determination (LCD) Guidelines, and nationally recognized sources such as MCG, NCCN, and ACOG.
RN House Supervisor - Full Time / Nights SP MANAGEMENT SERVICES INCRN House Supervisor - Full Time / NightsMcKinney, TXFull timeWhile performing the duties of this job the employee is frequently required to sit, converse, and listen; use hands to touch, handle, or feel objects, tools or controls; and to reach with hands and arms. Supervises: All nursing and ancillary support personnel involved in the planning, implementation of, and evaluation of patient care services throughout the hospital during designated shifts.
Registered Nurse - Care Coordinator - Care Management Parkland HospitalRegistered Nurse - Care Coordinator - Care ManagementTXEstablishes and maintains an efficient, cost effective care management process by determining patient financial and medical eligibility, medical necessity, and by developing, implementing and monitoring individual patient plans of care and communicating these plans to patients, families, and Parkland staff to ensure quality patient care throughout the healthcare continuum and compliance with program/Parkland policies and procedures. Directs liaison activities to appropriately integrate the patient into the health care continuum including procuring of services, health promotion and counseling, disease prevention, health education and screening, and community resource linkage.