• Utilization Review Nurse

    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 ... resource to the physicians and provides education and information on resource utilization and national and local coverage determinations (LCDs & NCDs). This position… more
    Houston Methodist (07/25/25)
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  • Utilization Management Nurse

    CenterWell (Austin, TX)
    …or ability to obtain Compact Nursing License + A minimum of three years clinical RN experience; + Prior clinical experience, managed care experience, DME, ... Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability...of home health services, and fourth largest pharmacy benefit manager , CenterWell is focused on whole-person health by addressing… more
    CenterWell (08/02/25)
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  • Clinical Research Nurse

    Texas A&M University System (College Station, TX)
    Job Title Clinical Research Nurse Manager Agency Texas A&M Agrilife Research Department Institute for Advancing Health through Agriculture-Project Management ... producers and the environment. The Research Nurse Coordinator/ Manager , operating under the direction of the Clinical...Serves as the primary point of contact for the utilization of the IHA Research Clinic, engaging with internal… more
    Texas A&M University System (07/15/25)
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  • Utilization Review Specialist RN - FT Days

    Houston Methodist (Sugar Land, TX)
    At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry ... this position is able to cover a multitude of utilization review functions through point of entry, observation progression...prompt notification of any denials to the appropriate case manager , denials, and pre-bill team members, as well as… more
    Houston Methodist (07/29/25)
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  • Dialysis Clinical Manager Registered…

    Fresenius Medical Center (Laredo, TX)
    **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... functions, leading your business, and advanced leadership. As a Clinical Manager , you may advance your career...Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and… more
    Fresenius Medical Center (08/02/25)
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  • Dialysis Clinical Manager Registered…

    Fresenius Medical Center (Round Rock, TX)
    …the delivery of maximum quality care to all patients. + Must complete Clinical Manager training modules and ongoing developmental programs within the specified ... requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory… more
    Fresenius Medical Center (08/02/25)
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  • Clinical Appeals Nurse (RN)

    Molina Healthcare (Fort Worth, TX)
    …decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical ... For this position we are seeking a (RN) Registered Nurse who must be licensed for the state they...Hearings as may be required. + Serves as a clinical resource for Utilization Management, Chief Medical… more
    Molina Healthcare (08/02/25)
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  • Clinical UM Nurse 2

    CenterWell (Austin, TX)
    **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and ... your skills to make an impact** **Required Qualifications** + Licensed Registered Compact Nurse license (RN) with no disciplinary action and ability to obtain non… more
    CenterWell (08/01/25)
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  • Nurse Manager - Emergency Department…

    AdventHealth (Mansfield, TX)
    …care and services of selected patient populations across the continuum of illness. The Nurse Manager promotes effective utilization of health care resources, ... clinical , human resource, and financial data, the Nurse Manager supports decision-making. Demonstrating leadership through...provide care in a professional and caring manner. The Nurse Manager maintains clinical competency… more
    AdventHealth (08/07/25)
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  • Case Manager - Registered Nurse

    CVS Health (Austin, TX)
    …we do it all with heart, each and every day. **Position Summary** This Case Manager - Registered Nurse (RN) position is with Aetna's National Medical Excellence ... is a blended role doing both Case Management and Utilization Management. The RN Case Manager is...licensure in the state of residence + 5 years clinical practice experience as an Registered Nurse more
    CVS Health (08/08/25)
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