- CenterWell (Austin, TX)
- … clinical RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity ... and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that… more
- Centene Corporation (Austin, TX)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... Zone. Experience with ABA, Psychological Testing, Neuropsychological Testing required. Utilization Management experience strongly preferred. **Position Purpose:** Authorize, direct… more
- CVS Health (Austin, TX)
- …use of health care resources. Under the direction of the Lead Clinical Psychologist, this position will focus on utilization , quality, and review ... disorders. + Make recommendation for enhancements to current managed care , review guidelines, and clinical ...clinical criteria based on extensive knowledge of health care delivery systems, utilization methods, reimbursement methods,… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent ... the revenue cycle regarding any claim issues or concerns that may require clinical review during the pre-bill, audit, or appeal process. **GROWTH/INNOVATION… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... this position is able to cover a multitude of utilization review functions through point of entry,...regarding any claim issues or concern that may require clinical review during the pre-bill, audit, or… more
- HCA Healthcare (Pasadena, TX)
- …Eligibility for benefits may vary by location._** Come join our team as a Behavioral Health Utilization Review RN MSW. We care for our community! Just last ... like family! Jump-start your career as a Behavioral Health Utilization Review RN MSW today with Parallon....application and use of InterQual + Analyze documentation of clinical care from the electronic medical record… more
- Genesis Healthcare (Dallas, TX)
- …rehabilitation department, including oversight related to case management, quality improvement, care planning, clinical utilization , and patient ... Director in the timely completion of the annual merit review for therapy staff. 6. Assists Clinical ...utilization with input from treating therapists, consideration of clinical requirements, and recommendations from the Clinical … more
- Molina Healthcare (Fort Worth, TX)
- …preferred. **Preferred Experience** 3-5 years clinical practice with managed care , hospital nursing, utilization and/or care management experience. ... role must complete courses required to obtain licensure in all states. + Utilization Review Lead responsibilities also include but not limited to, collaborate… more
- Humana (Austin, TX)
- …Qualifications:** + Experience in managed care pharmacy, particularly in utilization management review **Additional Information:** **Interview Format** : ... part of our caring community and help us put health first** The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting medical… more
- CenterWell (Austin, TX)
- …member service or customer service telephone experience desired + Experience with Utilization Review and/or Prior Authorization, preferably within a managed ... of our caring community and help us put health first** The Utilization Management (UM) Administrative Coordinator 2 is responsible for providing high-quality support… more