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Remote Rn Case Review Jobs in Texas (NOW HIRING)

Corvel

Itemization Review Nurse II

Fort Worth, TX · Remote

$61K - $98K/yr

This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Collects supporting data and ... R. as an R.N. * Associate Degree in Nursing or higher * Experience in medical bill auditing ...

Corvel

Itemization Review Nurse II

Fort Worth, TX · Remote

$61K - $98K/yr

This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Collects supporting data and ... R. as an R.N. * Associate Degree in Nursing or higher * Experience in medical bill auditing ...

CERiS

Itemization Review Nurse II

Fort Worth, TX · Remote

$61K - $98K/yr

This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Collects supporting data and ... R. as an R.N. * Associate Degree in Nursing or higher * Experience in medical bill auditing ...

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All JobsRemote Rn Case Review JobsRemote Rn Case Review Jobs in Texas

Remote Rn Case Review information

What is the difference between Remote Rn Case Review vs Remote Rn Utilization Review?

AspectRemote Rn Case ReviewRemote Rn Utilization Review
CredentialsRegistered Nurse (RN), licensure, case review certificationsRegistered Nurse (RN), licensure, utilization review certifications
Work EnvironmentRemote, healthcare settings, insurance companiesRemote, healthcare settings, insurance companies
Employer & IndustryHospitals, insurance firms, healthcare providersInsurance companies, healthcare management organizations

Remote Rn Case Review and Remote Rn Utilization Review roles both involve remote nursing work within the healthcare and insurance industries. While they share similar credentials and work environments, case review focuses on evaluating individual patient cases, whereas utilization review assesses the necessity and appropriateness of healthcare services. Understanding these distinctions helps job seekers identify the right role based on their skills and career goals.

What are the most commonly searched types of Rn Case Review jobs in Texas? The most popular types of Rn Case Review jobs in Texas are:
What are popular job titles related to Remote Rn Case Review jobs in Texas? For Remote Rn Case Review jobs in Texas, the most frequently searched job titles are:
What job categories do people searching Remote Rn Case Review jobs in Texas look for? The top searched job categories for Remote Rn Case Review jobs in Texas are:
What cities in Texas are hiring for Remote Rn Case Review jobs? Cities in Texas with the most Remote Rn Case Review job openings:
Remote Rn Case Review jobs near you
Primary Nurse Case Admin 1 - Work From Home

Primary Nurse Case Admin 1 - Work From Home

Health Care Service Corporation

Corpus Christi, TX • Remote

$61K - $136K/yr

Full-time

Medical, Life, Retirement, PTO

Posted 18 days ago

Job description

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job SummaryThis position is responsible for performing all functions of Utilization Management (UM), Case Management (CM) and Disease Management (DM) and is a single source of contact for members, health care personnel and all other entities involved in managing care. The Primary Nurse Coordinator performs concurrent review, discharge planning and care coordination; identifies alternate treatment programs; consults with physicians, providers, members, and other resources to evaluate options and services required to meet an individual's health needs; promotes quality and cost effective outcomes; and serves as liaison to physicians and members. Other functions also include episodic case management, determining member assignment of treatment, and pre-admission/post-discharge counseling for an acute condition. Establish relationship with the member through the immediate post discharge follow-up period or until all short term care needs are met. Provide education/local resource information and encourage member (self) education. Functioning in a clinical care advisory role, the Primary Nurse Coordinator assesses members for wellness education and disease management, introduces members to our website tools, educates members regarding wellness and specific conditions, and facilitates the coordination of care for identified members.

JOB REQUIREMENTS:
* Registered Nurse (RN) with current, valid, unrestricted license in state of operations
* 2 years clinical practice experience of direct clinical care to the customer
* 1 year experience in Condition Management or Case Management in a health insurance, managed care, physician office or hospital setting.
* PC proficiency to include Word, Excel, Lotus Notes and database experience
* Clear and concise verbal and written communication skills
* Knowledge of UM/CM/DM activities and standardized criteria set
* Familiarity of ancillary services including HHC, SNF, Hospice, etc
* Verbal and written communication skills; analytical skills; sound clinical judgment
* Incumbents with nursing licenses in positions/departments requiring multi-state licenses are required to obtain and maintain additional current, valid, and unrestricted applicable nursing licenses in other states as determined by management. Multi-state license fees will be provided by HCSC. Incumbents with other clinical licenses are not required to obtain multi-state licenses.
PREFERRED JOB REQUIREMENTS:
* Experience in managing complex or catastrophic health cases
* Specialty clinical experience in intensive care medicine, orthopedic, NICU/pediatric, oncology, diabetic member management, obstetric (low to high risk maternity management)
* Working toward or completion of CCM/CCP/CDE certification or Advanced degree
* Knowledge of Milliman Guidelines or similar clinical guidelines
* Knowledge of medical management policies and procedures

#LI-FW1

#LI-Remote
This is a Remote/Work-From-Home role. Must have an active and unrestricted Nursing license (in Texas) or an active and unrestricted Compact Nursing license.

Sponsorship is not available

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plansubject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range$61,500.00 - $136,100.00

Exact compensation may vary based on skills, experience, and location.

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