• 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 (05/08/25)
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  • Division Vice President Case Management

    HCA Healthcare (Dallas, TX)
    …+ Lead centralized case management function, including Clinical Case Management, Utilization Review Services, and Clinical Documentation Improvement. Works ... + Lead centralized case management function, including Clinical Case Management, Utilization Review Services, and Clinical Documentation Improvement. + Develop,… more
    HCA Healthcare (05/09/25)
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  • Texas State Dental Director DHMO

    Guardian Life (Austin, TX)
    …to the entire dental product and to assume responsibility for the functions of utilization management and utilization review , as requested by the Dental ... expected to uphold Guardian's commitment to ethical business practices. You will + Review & ensure that determination and processing of claims, referrals and appeals… more
    Guardian Life (05/10/25)
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  • Market CMO-North Texas

    CenterWell (Dallas, TX)
    …medical guidance and expertise. + Develop, implement and monitor the outcomes of utilization review and disease management programs to meet the quality and ... care being provided meets appropriate standards and to ensure cost-effective utilization practices. + Oversee the development, revision, and implementation of… more
    CenterWell (04/29/25)
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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 (05/10/25)
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  • Medical Director - Pacific SW Region

    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 (05/10/25)
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  • Medical Director - Care Plus - Florida

    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 (04/24/25)
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  • RN Case Manager PRN

    HCA Healthcare (San Antonio, TX)
    …Bachelor of Science in Nursing Prefer at least one year experience in utilization review , resource management, discharge planning or case management. Methodist ... 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 (05/01/25)
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  • Registered Nurse Case Manager PRN

    HCA Healthcare (Tomball, TX)
    …protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, ... a 100% match on 3% to 9% of pay ( based on years of service) + Employee Stock Purchase...+ Referral services for child, elder and pet care, home and auto repair, event planning and more +… more
    HCA Healthcare (03/20/25)
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  • Physician - Physician Advisor

    Ascension Health (Austin, TX)
    …your community _Benefit options and eligibility vary by position. Compensation varies based on factors including, but not limited to, experience, skills, education, ... recent work experience in a hospital setting, preferably with some Physician Advisory/ Utilization Management work experience. If you are ready to join a talented… more
    Ascension Health (05/07/25)
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