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Parallon Workforce Management Solutions - HOUSTON, TX US
Staffing Coordinator Houston, Texas US This PRN (as needed) position assists in the coordination of daily staffing with all designated facilities by effectively ...
The Social Services Coordinator role offers a rewarding opportunity to make a positive impact in the lives of seniors every day. You will be involved with residents ...
Medical Office Coordinator East Houston General Surgery Houston, TX2062220301 Primary Location: United StatesTexasHouston Job: Supervisors Team Leaders ...
POSITION SUMMARY: The Laboratory Shift Supervisor performs all laboratory procedures in a prompt, accurate, and reliable manner according to established hospital ...
Performs or assists on electroneurodiagnostic studies in the Neuro Lab, ICU, OR, and patients rooms as necessary to assist neurologist in diagnosis and treatment ...
This position receives and processes incoming supplies, instrumentation and equipment, performs cleaning and sterilizing duties, prepares packs of supplies, ...
Front Desk Coordinator Exp. able to multitask required for Busy Family Practice in Conroe. EClinical experience a plus Fax resume This job has originated ...
We are currently looking for a Registered Nurse RN whose compassion, clinical expertise, and excellence are top priority. As an RN, you will conduct patient ...
Referred Testing amp; Call Center Coordinator, Pathology (Main Campus) Texas Children's Hospital Houston, TX Texas Children s Hospital is an internationally ...
* Represents Park Plaza Hospital through offering worksite wellness programs centered on biometric screening and health risk assessments in a professional ...
Responsible for collaborating with healthcare providers and members to optimize member benefits and to promote effective use of resources. Assesses the medical necessity of inpatient admissions, outpatient services, surgical and diagnostic procedures, and out of network services. May also manage appeals for services denied. May conduct pre-certification, concurrent and retrospective reviews to ensure compliance with medical policy, member eligibility, benefits, and contracts. May be responsible for day-to-day operations of a single or multiple IPA/IPOD and staff, and may serve as liaison with the local health plan to ensure continuity for IPA/IPOD members. Required Skills
Responsible for the effective and sufficient support of all utilization management activities to include prospective/ pre-certification review of inpatient and outpatient medical services for medical necessity and appropriateness of setting according to established policies. Using an established set of criteria, evaluates and authorizes the medical necessity of inpatient and outpatient services. Notifies provider of recommended changes in level of care. Evaluates cases for quality of care and documents quality issues. Issues letter to provider if the service meets certification criteria, and escalates to manager or Medical Director for review if the service does not meet certification criteria, and may issues denial letters. May participate or assist in the planning of team, UM/QM, PCP, IPA, and/or Health Plan meetings. Required Experience
Minimum Requirements: Current licensure as a Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN). At least one year clinical experience. Preferred Requirements: Current licensure as a Registered Nurse (RN). Managed care experience. At least two years experience in utilization review. Knowledge of ICD-9 and CPT Coding guidelines. HealthSpring, Inc. is an EEO/AA employer. Job Location Houston, TX, US. Position Type Full-Time/Regular Salary n/a-n/a
