Jobs near Houston: 12,019
RS
Relevance Score ranked on: APPEALS
STAR+PLUS Appeals Nurse RN
Houston
STAR PLUS Appeals Nurse assists in the review of medical records submitted for appeals by providers due to adverse determination. Utilize evidence-based criteria, regulatory guidelines and Medical Affairs departmental policies for medical necessity and level of care determination. Provides written re...
Search Terms: Appeals, Nurse, RN, Healthcare, Medical
92.6
0mi
Updated: September 19
STAR+PLUS Appeals Coordinator
Houston
The STAR PLUS Appeals Coordinator is responsible for intake of all forms of correspondence for the medical appeals team to process for medical appeals, post service claim and medical appeal that are assigned to a nurse to facilitate medical necessity review. This position is responsible for the accur...
Search Terms: Appeals, Coordinator, Data Entry, Administrative, Healthcare
88.7
4.9mi
Updated: September 19
STAR+PLUS Appeals Coordinator
Houston
The STAR PLUS Appeals Coordinator is responsible for intake of all forms of correspondence for the medical appeals team to process for medical appeals, post service claim and medical appeal that are assigned to a nurse to facilitate medical necessity review. This position is responsible for the accur...
Search Terms: Appeals, Coordinator, Data Entry, Administrative, Healthcare
88.7
4.9mi
Updated: September 19
STAR+PLUS Appeals Nurse RN
Houston
STAR PLUS Appeals Nurse assists in the review of medical records submitted for appeals by providers due to adverse determination. Utilize evidence-based criteria, regulatory guidelines and Medical Affairs departmental policies for medical necessity and level of care determination. Provides written re...
Search Terms: Appeals, Nurse, RN, Healthcare, Medical
84.7
4.9mi
Updated: August 29
StarPlus State Fair Hrng/EMR C
Houston
Under the supervision of STAR PLUS Supervisor of State Fair Hearing Appeals and Grievance will review SFH/ EMR request and collaborate with STAR PLUS Service Coordinator to ensure all The STAR PLUS STATE FAIR HEARING/ EMR COORDINATOR will attend any mandated HHSC trainings. JOB SPECIFICATIONS Essenti...
Search Terms: Medical Director, Appeals, Care Coordinator, Management, Healthcare
71.4
4.9mi
Updated: September 19
Care Mgmt Nurse LVN
Houston
"Under the direction of a Registered Nurse the License Vocational Nurse (LVN) provides telephonic services to Community Health Choice (CHC) Members and their families for purposes of, identifying members with special health needs and available resource assistance. Work with the member or the members ...
Search Terms: LVN, Nurse, Vocational Nurse, Healthcare, Skills
0
0mi
Updated: September 19
Performance Adherence Specl
Houston
The overall objective of the Performance Adherence Specialist is to monitor and report the program outcomes for the STAR, STAR PLUS, Marketplace and DSN - Ps contracts. The Performance Adherence Specialist will be responsible to monitor and report the activities of Service Coordination, Case Manageme...
Search Terms: Performance, Technology, Healthcare, Regulatory, Audit
0
0mi
Updated: September 19
Customer Service Advocate I
Houston
Responsible for accomplishing their primary goal of providing support and rendering Excellent Customer Service by addressing all Health Plan Member's calls related to inquiries, questions and concerns in all areas including enrollment, benefit interpretation and eligibility for medical care. Serving ...
Search Terms: Customer Service, Advocate, Service, Retail, Healthcare
0
0mi
Updated: September 18
Claims Supervisor
Houston
Supervise and mentor the claims staff to achieve production, quality and turn around goals as set by Community Health Choice (CHC). Responsibilities include reviewing the Texas Medicaid Banner and Bulletin messages. Work closely with the claims departments to ensure that any additions or revisions id...
Search Terms: Claims Supervisor, Claims, Supervisor, Team Lead, Insurance
0
0mi
Updated: September 18
Enrollment Data Specialist
Houston
The Enrollment Data Specialist performs operational solutions to optimize membership enrollment and premium billing accuracy and collaborates and supports internal and external customers. This position researches and reconciles systemic eligibility/enrollment or premium billing /payment discrepancies...
Search Terms: Data Specialist, Enrollment, Specialist, Technology, Healthcare
0
0mi
Updated: September 18
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