• Mgr Comprehensive Care RN

    Baylor Scott & White Health (Mckinney, TX)
    …Baylor Medical Center, Garland/McKinney,** **5252 W University Dr, McKinney, 75071** **DEPARTMENT: Case Management , Manager Comprehensive Care, RN** **SHIFT: ... upon position type and/or level **Job Summary** As the Manager of Comprehensive Care, you will manage a team...ongoing issues tied to patient care coordination, discharge planning, case management , and utilization review.… more
    Baylor Scott & White Health (09/03/25)
    - Related Jobs

  • Regional Team Leader, Specifications

    CDM Smith (El Paso, TX)
    …our Specifications Group. We're looking for candidates with experience as a Senior Manager and Senior Specification Writer. At CDM Smith, we are invested in your ... of your team. - Coordinating workload within your Technical Services group and utilization goals for the individuals on your team. - Coordinating with your TDM… more
    CDM Smith (08/01/25)
    - Related Jobs

  • Medical Director-OBGYN or Pediatric Specialty…

    Elevance Health (TX)
    …Obstetrics and Gynecology (OBGYN) or Pediatrics strongly preferred. + 1-2 years Utilization Management experience strongly preferred. + Managed care experience ... with providers and external physicians. + May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss… more
    Elevance Health (10/01/25)
    - Related Jobs

  • Medical Director

    Elevance Health (TX)
    …a State agency.*_ **Preferred Skills, Capabilities and Experiences:** + 1-2 years Utilization Management experience strongly preferred. + Strong oral, written, ... with providers and external physicians. + May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss… more
    Elevance Health (09/29/25)
    - Related Jobs

  • Behavioral Health Medical Director-Psychiatrist…

    Elevance Health (Grand Prairie, TX)
    …and Experiences:** + Child and Adolescent experience strongly preferred. + Utilization Management experience. + Applied Behavior Analysis (ABA) experience. ... clinical operational aspects of a program. + Conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss… more
    Elevance Health (09/10/25)
    - Related Jobs

  • Infusion Referral Nurse Sr- REMOTE

    Prime Therapeutics (Austin, TX)
    …of post-degree clinical experience. + Experience in managed care, specialty drugs, care management and utilization review. + Meets Credentialing criteria. + At ... for drug services. + Will actively maintain a required case load and the activities to reach overall goals...appeals program. + Participates in meetings and consults with management on regular basis to discuss member interaction and… more
    Prime Therapeutics (09/04/25)
    - Related Jobs

  • Construction Project Engineer

    Baker Construction (Houston, TX)
    …in establishing clinics, managing first report of injuries, and assisting with co-worker case management + Follows Company Recruitment and Hiring Guidelines + ... and other reports + Alerts the Superintendent and Project Manager of project impact relating to resource management...utilization , MBE/SBE participation, etc., and advises the Project Manager of issues + Interfaces with Safety and Risk… more
    Baker Construction (09/17/25)
    - Related Jobs

  • LVN Delegation Oversight Nurse Remote

    Molina Healthcare (Fort Worth, TX)
    …Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM) or Certified ... reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. + Participates as needed in joint… more
    Molina Healthcare (09/20/25)
    - Related Jobs

  • Nurse Practitioner, Cardiology

    ChenMed (Houston, TX)
    …development of the nursing plan of care, health education, physician referrals, case management referrals, follow-up and clear documentation according to ChenMed ... guidelines. This position may require participation in risk and quality management programs, clinical meetings and other meetings. The Nurse Practitioner, Specialty… more
    ChenMed (09/26/25)
    - Related Jobs

  • Medical Claim Review Nurse (RN)

    Molina Healthcare (San Antonio, TX)
    …Clinical Coder, Certified Medical Audit Specialists, Certified Case Manager , Certified Professional Healthcare Management , Certified Professional in ... of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals.… more
    Molina Healthcare (09/06/25)
    - Related Jobs