• LTSS Service Coordinator - RN

    Elevance Health (Rockwall, TX)
    …individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management , or similar role; or any combination of ... law._ The **LTSS Service Coordinator-RN** is responsible for overall management of member's case within the scope...+ May also assist in problem solving with providers, claims or service issues. + Directs and/or supervises the… more
    Elevance Health (11/22/25)
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  • Medical Director (NV)

    Molina Healthcare (Fort Worth, TX)
    …(CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) ... health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies to ensure… more
    Molina Healthcare (11/21/25)
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  • RN UM Clinical Appeals Nurse Remote

    Molina Healthcare (Austin, TX)
    …(CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional ... likelihood of a formal appeal being submitted. * Reevaluates medical claims and associated records independently by applying advanced clinical knowledge, knowledge… more
    Molina Healthcare (11/14/25)
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  • Leave of Absence Specialist

    OneMain Financial (Fort Worth, TX)
    …**Job Description Summary** Reporting directly to the Health and Welfare Benefits Manager , this position is responsible for coordinating employee lave program in ... This role ensures compliance with federal, state and company policies, monitors case activity for accuracy and timelines, and provides guidance to team members,… more
    OneMain Financial (09/25/25)
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  • Paralegal

    Robert Half Legal (Houston, TX)
    …work under pressure. + Legal research skills preferred. + Experience with ProLaw case management system preferred (not required). Education & Experience + 3-5 ... Training: 5 days/week in-office + Post-Training: Potential flex to 4 days in-office ( manager discretion) + Hours: Monday-Friday, 8:30 AM - 5:30 PM (1-hour unpaid… more
    Robert Half Legal (11/12/25)
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  • Surveillance Investigator

    The Robison Group (Lubbock, TX)
    …FOR GROWTH WITHIN THE COMPANY INCLUDE: SIU work, Field Supervisor, Field Operations Manager , Case Management , etc. Department Surveillance Employment Type ... the position will be expected to perform investigations of workers compensation claims , liability investigations, multi-line insurance claims , criminal and civil… more
    The Robison Group (10/24/25)
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  • Lead Investigator, Special Investigative…

    Molina Healthcare (Houston, TX)
    …to leading a team of investigators and analysts, the Team Lead will ensure the Manager is aware of any major case developments, and ensure cases are being ... **JOB DESCRIPTION** **Job Summary** Under direct supervision of the Manager , SIU, the Team Lead is responsible to lead...utilization by providers and recipients. The position will review claims data, medical records, and billing data from all… more
    Molina Healthcare (11/21/25)
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  • Leader, Global Distribution Programs

    Cisco (Austin, TX)
    …communication, tackling multiple global initiatives. **Your Impact** As the Program Manager , you will be instrumental in building and articulating a Distribution ... regarding program adherence + Review exceptions and holds on claims submitted by Distributors + Monitor the payment process...**Minimum Qualifications** + 5+ years of project or program management experience + 3+ years of people management… more
    Cisco (11/23/25)
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  • Managed Care Pharmacy Resident

    Elevance Health (Grand Prairie, TX)
    …care management process through reviewing member profiles, recommending members for lock-in, case management or disease management . + Respond to and ... of the CarelonRx pharmacy program, including Prior Authorizations, Medication Therapy Management (MTM), Lock-in, and Drug Utilization Review (DUR) programs. **How… more
    Elevance Health (10/20/25)
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  • Business Analyst/Product Owner

    Cayuse Holdings (Austin, TX)
    …test scenarios and participates in systems and user acceptance testing. + Creates use case scenarios, test plans, and exit criteria that accurately map back to the ... that guide solution development. + Reports project status to management on established timelines. + Documents action items and...Medicaid systems and processes. + 8 years' experience in claims processing. + Must be able to pass a… more
    Cayuse Holdings (11/22/25)
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