• Field Medical Director, Oncology

    Evolent (Austin, TX)
    … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Oncology, 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 (11/18/25)
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  • Physician Advisor

    Ascension Health (Georgetown, TX)
    …your community _Benefit options and eligibility vary by position. Compensation varies based on factors including, but not limited to, experience, skills, education, ... (Adult Medicine Hospitialist experience preferred), preferably with some Physician Advisory/ Utilization Management work experience. If you are ready to join a… more
    Ascension Health (01/08/26)
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  • Clinical Reviewer, Occupational Therapy

    Evolent (Austin, TX)
    …call center staff. Initial clinical reviewers are supported by Physician clinical review staff (MDs) in the utilization management determination process. Job ... Reviewer you will be a key member of the utilization management team. We can offer you a meaningful...needed or required. Job Summary Functions in a clinical review capacity to evaluate all cases, which do not… more
    Evolent (01/16/26)
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  • Medical Director Medicaid

    Humana (Austin, TX)
    …this knowledge in their daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review ... with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health… more
    Humana (01/18/26)
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  • Medical Director - IP Claims Management

    Humana (Austin, TX)
    …this knowledge in their daily work. The Medical Director's work includes computer- based review of moderately complex to complex clinical scenarios, ... with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health… more
    Humana (12/11/25)
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  • Appeals Nurse

    Evolent (Austin, TX)
    …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
    Evolent (12/24/25)
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  • Medical Director - Medicaid (Oklahoma)

    CVS Health (TX)
    …a Plus **Preferred Qualifications:** -Preferred Oklahoma residency -Health plan/payor Utilization Management / Review experience. -Managed Care experience. ... the Aetna Better Health Plan of Oklahoma. This UM ( Utilization Management) Medical Director will be a "Work from... Management) Medical Director will be a "Work from Home " position primarily supporting the Aetna Oklahoma Medicaid plan… more
    CVS Health (01/16/26)
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  • RN Coordinator Patient Throughput

    HCA Healthcare (San Antonio, TX)
    …and improve the patient flow program effectiveness as it relates to utilization review , resource management, and discharge planning and care coordination. ... 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 (01/18/26)
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  • Client Care Coordinator

    Elara Caring (Arlington, TX)
    …Collaborate with payroll and timekeeping teams to resolve timesheet discrepancies + Review utilization reports, identify trends, and address inconsistencies on a ... a huge role in the growth of an entire home care industry. Here, each employee has the chance...to ensure appropriate coverage and continuity of care + Review and maintain contract-specific documentation and ensure authorizations align… more
    Elara Caring (01/13/26)
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  • Registered Nurse Case Manager PRN

    HCA Healthcare (El Paso, TX)
    …and retrospective review of patient medical records for purposes of utilization review , compliance with requirements of external review agencies ... Working knowledge of case management philosophy/process/role, needs assessment, principles of utilization review /quality assurance, use of InterQual(R) or other… more
    HCA Healthcare (12/18/25)
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