Clinical Review Nurse - Concurrent Review - J00933 - Katy - Axelon Services Corporation

    Axelon Services Corporation
    Description
    Location: Remote, Compact Nursing License Required, Central Time Zone

    Do not wait to apply after reading this description a high application volume is expected for this opportunity.

    SHIFT: Mon-Friday, 10AM to 7pm CST; Weekends and Holidays on a rotation basis based on business needs -(Weekends are more of an if needed basis but holidays are rotated

    Duration: 11 months, Possibility of extending it to 12 months

    Requirement: Must have a Compact RN Licensure/LVN Licensure

    Description: Job Profile Summary: Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists evaluating inpatient services to validate the necessity and setting of care being delivered to the member.

    Job Purpose: Needing 1 nurse to join the team to process denial letters for Medicaid Behavioral Health codes that will need prior authorization. Dependent on business needs this will extend to completing Physical Health Medicaid denial letters.

    Typical Day in the Role:
    Denial Letters for TX Medicaid Behavioral Health Codes
    Daily Points are the measurement of production
    Must meet 100% production after training period
    Remote Work, Various Schedules Available
    Will work within TruCare Cloud
    Candidate Requirements Education/Certification Required: Required: Highschool Diploma, Nursing Degree- Associates or Above Preferred: Licensure Required: Compact Nursing License-RN, LPN, LVN. Preferred: xhuatnn Years of experience required: 1+ years,

    Disqualifiers: Inability to work possible weekend hours and holidays on a rotation basis as applicable or needed by business needs

    Additional qualities to look for: MCO experience, specifically with Medicaid, True Care Cloud experience is a bonus, experience working remote
    • Top 3 must-have hard skills stack-ranked by importance
    1 Ability to complete work independently and with minimal supervision after training. 2 Team player 3 Great organizational skills

  • Work in company

    RN Inpatient Concurrent Review

    Only for registered members

    HealthCare Support is seeking an RN Inpatient Concurrent Review to fill an opening in Houston. · ...

    Houston

    3 weeks ago

  • Work in company

    RN Inpatient Concurrent Review

    Only for registered members

    RN Inpatient Concurrent Review to fill an opening in Houston Texas. · Maintains knowledge of the designated referral and provider software systems. · ...

    Houston, TX

    3 weeks ago

  • Work in company

    RN Inpatient Concurrent Review

    Only for registered members

    Maintains knowledge of the designated referral and provider software systems. Verifies member eligibility, benefit coverage and facility contract status prior to processing authorization requests. · ...

    Houston

    3 weeks ago

  • Work in company

    Director Centralized Utilization Review

    Only for registered members

    The Director Centralized Utilization Review position at Houston Methodist Continuing Care Hospital oversees all aspects of utilization review to ensure medical necessity, level of care appropriateness, and compliance with CMS Conditions of Participation. · Bachelor's and Master's ...

    Katy

    1 month ago

  • Work in company

    Director Centralized Utilization Review

    Only for registered members

    The Director Centralized Utilization Review (UR) position at Houston Methodist oversees all aspects of utilization review to ensure medical necessity, level of care appropriateness, and compliance with CMS Conditions of Participation. · ...

    Katy

    2 weeks ago

  • Work in company

    Land Planning Internship - Summer 2026

    Only for registered members

    As part of the Quiddity Internship Program, · the Planning Intern will provide support on multiple platting projects contributing to · the design and planning of master planned residential communities, · commercial and site development projects. · ...

    Katy InternshipSHIP

    2 weeks ago

  • Work in company

    Centralized Utilization Review Manager

    Only for registered members

    At Houston Methodist Continuing Care Hospital come lead with us as Manager Centralized Utilization Review (UR). This role ensures efficient high-quality compliant utilization management practices across the organization timely initial concurrent retrospective reviews for medical ...

    Katy

    1 month ago

  • Work in company

    Utilization Review Coordinator

    Only for registered members

    The Utilization Review Coordinator is responsible for management of all utilization review and case management activities for the facility's inpatient, partial hospitalization, and outpatient programs. · ...

    Katy

    1 week ago

  • Work in company

    Centralized Utilization Review Manager

    Only for registered members

    The Centralized Utilization Review (UR) Manager position at Houston Methodist ensures efficient high-quality utilization management practices across the organization. · ...

    Katy

    2 weeks ago

  • Work in company

    On-Site General Manager

    Only for registered members

    Job summary · Join Inframark's Community Management Services Team. At Inframark Community Management Services, you're not just starting a job — you're building a career. · ...

    Katy Full time

    1 day ago

  • Work in company

    Centralized Utilization Review Manager

    Only for registered members

    The Centralized Utilization Review Manager position at Houston Methodist leads daily operations of the Utilization Review department to ensure efficient utilization management practices across the organization. · ...

    Katy, TX

    5 days ago

  • Work in company

    Clinical Research Coordinator II, Katy, TX

    Only for registered members

    The Study Manager (Clinical Research Coordinator II) plays a key role in assisting in the conduct of clinical trial activities, in accordance with all applicable regulations governing the conduct of clinical trials. · Ability to recognize and synthesize information about the orga ...

    Katy, TX,

    6 days ago

  • Work in company

    Houston 65

    Only for registered members

    H-E-B needs energetic and motivated Partners willing to work hard and have fun while treating our Customers to excellent service. · ...

    Katy, TX Part time

    2 days ago

  • Work in company

    Infection Preventionist

    Only for registered members

    At Houston Methodist, the Infection Preventionist position is responsible for implementing and maintaining the multiple facets of the Infection Control Program. · ...

    Katy

    1 week ago

  • Work in company

    Education Center Manager

    Only for registered members

    The Center Manager will be responsible for managing day-to-day operations of the center, including assessing & enrolling students and ensuring that students are provided with an enjoyable and fun learning experience. · ...

    Katy, TX

    6 days ago

  • Work in company

    Jordan Ranch Connect Demo

    Only for registered members

    +H-E-B needs energetic and motivated Partners willing to work hard and have fun while treating our Customers to excellent service. · As a Selling Demo Representative you'll sell products through various selling and hospitality events to educate and inform Customers of product fea ...

    Katy, TX Part time

    1 month ago

  • Work in company

    Temporary Bilingual Recruiting Coordinator

    Only for registered members

    We are seeking a Temporary Bilingual Recruiting Coordinator to join our team and support our continued growth. · ...

    Katy, TX

    1 month ago

  • Work in company

    Branch Manager

    Only for registered members

    The Branch Manager is responsible for the service and efficient daily operation of the credit union office. · ...

    Katy, TX

    3 weeks ago

  • Work in company

    Education Center Manager

    Only for registered members

    This is a great job opportunity for you. It's a great opportunity for Mom's who love Math or retired or current Math teachers who are willing to learn and lead a team to change lives of students through Math. · ...

    Katy, TX

    3 days ago

  • Work in company

    Utilization Review Coordinator

    Only for registered members

    +The Utilization Review Coordinator is responsible for management of all utilization review and case management activities for the facility's inpatient, partial hospitalization, and outpatient programs. · +Conducts concurrent reviews of all medical records to ensure criteria for ...

    Katy, TX

    1 month ago

Jobs
>
Katy