- Humana (Austin, TX)
- **Become a part of our caring community and help us put health first** The Manager , Utilization Management Nursing (LTSS Utilization Management ... communication of medical services and/or benefit administration determinations. The Manager , Utilization Management Nursing works...of Michigan. + Previous experience in utilization management and/or utilization review . +… more
- Texas Health Resources (Arlington, TX)
- Director Utilization Management -Clinical Review _Are you looking for a rewarding career with family-friendly hours and top-notch benefits? We're looking for ... system services for wholly owned and Partner hospitals for utilization management . Job Duties OPERATIONS: Plans, organizes...of Texas required upon hire ACM - Accredited Case Manager or CCM, CPHM or Milliman certification preferred upon… more
- Baylor Scott & White Health (Dallas, TX)
- …to fit their needs. + Proficiency in discharge planning, setting case management referral standards, reviewing utilization , and categorizing levels of care. ... position type and/or level **Job Summary** + You will review patient cases for medical necessity and establish service...in Microsoft Office and medical documentation systems. + Case management certifications, such as Certified Case Manager ,… more
- Molina Healthcare (Dallas, TX)
- … (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management ), clinical pharmacy ... **JOB DESCRIPTION** **Job Summary** Molina Pharmacy Services/ Management staff work to ensure that Molina members have access to all medically necessary prescription… more
- Elevance Health (Grand Prairie, TX)
- ** Utilization Management Representative II** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... an accommodation is granted as required by law._ The ** Utilization Management Representative II** is responsible for...provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for… more
- Texas Health Resources (Arlington, TX)
- …Req And Bachelor's Degree Nursing Pref Experience 3 Years in an acute care setting, case management or utilization review Req 1 Year of acute case ... organizations and seminars as deemed appropriate by director and/or manager including but not limited to management ...Experience 3 Years in an acute care setting, case management or utilization review Req… more
- Houston Methodist (Houston, TX)
- …state, local and federal programs + Progressive knowledge of discharge planning, utilization management , case management , performance improvement and managed ... At Houston Methodist, the Case Manager (CM) position is a registered nurse (RN)...registered nurse (RN) responsible for comprehensively planning for case management , which includes care transitions and discharge planning of… more
- HCA Healthcare (El Paso, TX)
- …Come build your career with us! **Job Summary and Qualifications** The Case Management Manager works in conjunction with other members of the interdisciplinary ... **Description** **Introduction** We are seeking a(an) RN Manager Case Management with Del Sol...as needed + You will complete accurate and timely utilization review of patient charts to insure… more
- AdventHealth (Mansfield, TX)
- …**Location:** 2300 Lonestar RD, Mansfield, TX 76063 **The role you'll contribute:** "The Care Management Manager is under the general leadership of the Care ... daily operations and supervision of team members. The Care Management Manager is responsible for, but not...degree + 3 years of experience in direct Care Management / Utilization Management experience in an… more
- Molina Healthcare (San Antonio, TX)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years… more
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