- Humana (Austin, TX)
- …Registered Nurse (RN) license in the state of Michigan. + Previous experience in utilization management and/or utilization review . + Minimum of two (2) ... of our caring community and help us put health first** The Manager , Utilization Management Nursing (LTSS Utilization Management Leader) utilizes clinical… 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 ... leader for system services for wholly owned and Partner hospitals for utilization management. Job Duties OPERATIONS: Plans, organizes and delegates activities as… more
- Baylor Scott & White Health (Dallas, TX)
- …vary based upon position type and/or level **Job Summary** + You will review patient cases for medical necessity and establish service suitability. You'll educate ... plan and the provider's care coordination departments. Your expertise is needed to review medical necessity. + Working with the team, you'll verify medical records… more
- Molina Healthcare (Dallas, TX)
- …(such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services ... (such as, therapeutic drug monitoring, drug regimen review , patient education, and medical staff interaction), and oversight (establishing and measuring performance… 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 training ... unless an accommodation is granted as required by law._ The ** Utilization Management Representative II** is responsible for managing incoming calls, including… more
- Texas Health Resources (Arlington, TX)
- …barriers to clinical stabilization and continuity of care to prevent readmission. 35% C. Utilization Review : 1. Performs utilization review according to ... Registered Nurse (RN) - Case Manager - PRN Work location: Texas Health Arlington...Years in an acute care setting, case management or utilization review Req 1 Year of acute… more
- Molina Healthcare (San Antonio, TX)
- …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and experience,… more
- HCA Healthcare (Houston, TX)
- …your career path, we encourage you to apply for our Registered Nurse Case Manager opening. We review all applications. Qualified candidates will be contacted by ... have the career opportunities as a Registered Nurse Case Manager you want in your current role? We invest...in accordance with procedures set forth in the Hospital Utilization Management Plan and the criteria and standards approved… more
- HCA Healthcare (Houston, TX)
- …planning, implementation and overall evaluation of individual patient needs. Care coordination, utilization review and management, as well as discharge planning ... physicians and other members of the team on issues related to utilization review including inappropriate admissions and placements. Payer-based requests… more
- Covenant Health (Lubbock, TX)
- …Surgical or Inpatient setting. + IRR or annual competency testing in Utilization Review . **Preferred Qualifications:** + Bachelor's Degree in Nursing within ... **Description** **Care Manager RN** **The Care Manager RN...+ 1 year of experience in care management or utilization review in any setting or successful… more