- Evolent (Austin, TX)
- …contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager , Utilization ... Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for processing… more
- Catholic Health Initiatives (Houston, TX)
- **Responsibilities** The Utilization Management (UM) Manager is responsible for managing day-to-day UM operations within the markets, focusing on effective ... medical necessity determinations; processes appeals and reconsiderations. Act as a working manager within Utilization Management , performing essential duties… more
- Molina Healthcare (San Antonio, TX)
- …Nurse who be licensed in the state they reside. We are looking for a RN Manager to manage a utilization management team supporting 14 Marketplace plans. Home ... - Flexibility to cover any weekend time if needed Preferred candidate with Utilization Management and leadership experience (Direct Reports) Compact RN license… more
- CVS Health (Austin, TX)
- …Must have active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include ... surg or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing in CST zones **Education**… more
- Dallas Behavioral Healthcare Hospital (Desoto, TX)
- The Utilization Review Case Manager is responsible for working with insurance companies and managed care systems for the authorization, concurrent and ... to help patients access the full range of their benefits through the utilization review process. + Conducts admission reviews. + Conducts concurrent and extended… more
- Elevance Health (Houston, TX)
- ** Utilization Management Representative I** **Location:** This role enables associates to work virtually full-time, with the exception of required in person ... **Hours:** Monday - Friday, 8am - 5pm PST The ** Utilization Management Representative I** is responsible for...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Adecco US, Inc. (Houston, TX)
- …records (EHR) systems is essential. . Preferred certifications include Certified Case Manager (CCM) or Certified Utilization Review Nurse (CURN). **Pay ... & Life Sciences is assisting a client hire a Utilization Review Nurse in Houston, TX! This role is...Texas . 2 to 3 years of clinical nurse/case management experience . 2 to 3 years of coding… more
- Guardian Life (Austin, TX)
- …as needed (eg Specialty Referral Guidelines) with guidance from the Quality and Utilization Management Manager + Demonstrate expertise in QMP processes ... entire dental product and to assume responsibility for the functions of utilization management and utilization review, as requested by the Dental Director,… more
- Houston Methodist (Houston, TX)
- …to ensure operational effectiveness and efficiency of admission, concurrent and retrospective utilization management and medical claims functions to meet and ... At Houston Methodist, the Manager Case Mgmt Social Svcs position is responsible...and other areas according to department specifications. + Manages utilization management (UM) programs including Medical Claims… more
- HCA Healthcare (Dallas, TX)
- …sites of care in 21 states and the United Kingdom. We are looking for a Manager of Case Management for our Medical City Dallas team where excellence creates ... to be an influencer in healthcare? **Apply for our Manager of Case Management role today!** **Job...supporting a balance of optimal care and appropriate resource utilization . **What qualifications you will need:** **Education & Experience:**… more