• Utilization Review Specialist Nurse (RN) | Case…

    Houston Methodist (Houston, TX)
    …of care and ensures prompt notification of any denials to the appropriate case manager , denials, and pre-bill team members, as well as management. The URSN position ... continued stay, and resource use, appropriate level of care and program compliance. Identifies when services no longer meet evidence-based criteria, initiates… more
    Houston Methodist (11/02/25)
    - Related Jobs
  • Specialist, Quality Interventions/QI Compliance…

    Molina Healthcare (Dallas, TX)
    …Experience** 1 year of experience in Medicare and in Medicaid . **Preferred License, Certification, Association** + Certified Professional in Health Quality ... with and between other departments within the organization. + Evaluates project/ program activities and results to identify opportunities for improvement. + Surfaces… more
    Molina Healthcare (11/21/25)
    - Related Jobs
  • Insurance Collections Specialist - CBO

    HCA Healthcare (Austin, TX)
    …assistance (tuition, student loan, certification support, dependent scholarships) + Colleague recognition program + Time Away From Work Program (paid time off, ... collections for patient services. Under the supervision of the Business Office Manager /Business Office Supervisor, you will obtain payment from third party payers… more
    HCA Healthcare (10/30/25)
    - Related Jobs
  • Managed Care Pharmacy Resident

    Elevance Health (Grand Prairie, TX)
    …Care Pharmacy Resident** **Location:** This role requires associates to be in-office ** 1 - 2** days per week, fostering collaboration and connectivity, while ... for various operational or clinical aspects of the CarelonRx pharmacy program , including Prior Authorizations, Medication Therapy Management (MTM), Lock-in, and Drug… more
    Elevance Health (11/17/25)
    - Related Jobs
  • Senior Application Architect Contact Center…

    Humana (Austin, TX)
    …name a few: * Work-Life Balance * Generous PTO package * Health benefits effective day 1 * Annual Incentive Plan * 401K - * Well-being program * Paid Volunteer ... information to the application at Humana's secure website. + Position reports to Manager , Technology Solutions, IT HPE - Digital Channels & Contact Centers +… more
    Humana (11/12/25)
    - Related Jobs
  • Cardiometabolic Care Specialist I - P Spring…

    Novo Nordisk (Houston, TX)
    …co-promotion partners. Internally, the CMCS I reports to the Portfolio District Business Manager of the specific sales territory. The CMCS I also interacts and ... of the local payer market including Medicare, Commercial and Medicaid benefit designs, Payer Coverage, Prescription Coverage Requirements, Step Therapy,… more
    Novo Nordisk (11/08/25)
    - Related Jobs
  • PCO Medical Director - UM - Part Time (Hourly)

    CenterWell (Austin, TX)
    …of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other medical management organizations, hospitals/ ... Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 1 **Pay Range** The compensation range below reflects a good faith estimate of… more
    CenterWell (11/06/25)
    - Related Jobs