• Medical Director (Medicare)

    Molina Healthcare (Dallas, TX)
    …in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership ... of 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 (01/07/26)
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  • Field Medical Director, Interventional Cardiology…

    Evolent (Austin, TX)
    … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... for the culture. **What You'll Be Doing:** Job Description **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a… more
    Evolent (12/18/25)
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  • Chief Medical Officer

    HCA Healthcare (Conroe, TX)
    …a data-driven environment of quality and cost improvement and develops systems to review utilization of resources and objectively measure outcomes of care in ... for appeals and denials process, discharge planning, case management, and utilization review /management. + Consults with facility-level staff regarding delegated… more
    HCA Healthcare (11/02/25)
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  • Acute, Nurse Case Manager

    ChenMed (Houston, TX)
    …engagement with patient and family. + Facilitates patient/family conferences to review treatment goals and optimize resource utilization ; provides family ... achieving desired clinical outcomes within specific timeframe. + Conducts review for appropriate utilization of services from...of care/LOS. + Validates Discharge plan for safe transition home , utilization of preferred providers or timely… more
    ChenMed (12/09/25)
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  • Field Medical Director - Vascular Surgery

    Evolent (Austin, TX)
    … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Director you will be a key member of the utilization management team. We can offer you a meaningful...rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
    Evolent (01/08/26)
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  • Field Medical Director, Cardiology

    Evolent (Austin, TX)
    … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Director you will be a key member of the utilization management team. We can offer you a meaningful...the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
    Evolent (12/31/25)
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  • Pre-Authorization Nurse 2

    Humana (Austin, TX)
    …for review depending on case findings. Educates providers on utilization and medical management processes. Enters and maintains pertinent clinical information in ... three years varied nursing experience + Previous experience in utilization management, case management, discharge planning and/or home...posting. The pay range may be higher or lower based on geographic location and individual pay will vary… more
    Humana (01/18/26)
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  • Clinical Informatics Coordinator

    HCA Healthcare (San Antonio, TX)
    …implementation of clinical informatics workflows and tools. 12. Assists with Evidence- Based Order set review , approval, build, and maintenance updates. ... protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care...a 100% match on 3% to 9% of pay ( based on years of service) + Employee Stock Purchase… more
    HCA Healthcare (01/17/26)
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  • Field Medical Director, Radiation Oncologist

    Evolent (Austin, TX)
    … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... FMD, you will be a key member of the utilization management team. We can offer you a meaningful...rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
    Evolent (01/18/26)
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  • Field Medical Director, Pain Management

    Evolent (Austin, TX)
    … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Management, you will be a key member of the utilization management team. We can offer you a meaningful...the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
    Evolent (12/25/25)
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