- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... concurrent medical record review for medical ...work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare,… more
- CVS Health (Austin, TX)
- …solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team. ... (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible,...experience in Nursing. + At least 1 year of Utilization Management experience in concurrent review or… more
- Baylor Scott & White Health (Dallas, TX)
- …health plan and the provider's care coordination departments. Your expertise is needed to review medical necessity. + Working with the team, you'll verify ... any technical/connection issues **Essential Functions of the Role** + You will review medical services. Use guidelines to assess appropriateness. + Evaluate… more
- Houston Methodist (Houston, TX)
- …intensive. This position has achieved an expert level at all objectives delineated in the Utilization Review Nurse and Utilization Review Specialist ... At Houston Methodist, the Sr Utilization Review Specialist Nurse ...Functions as a resource to department staff in communicating medical information required by external review entities,… more
- Molina Healthcare (Houston, TX)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in… more
- Texas Health Resources (Arlington, TX)
- Registered Nurse (RN) - Case Manager - PRN Work...and continuity of care to prevent readmission. 35% C. Utilization Review : 1. Performs utilization ... Texas Health Arlington Memorial Hospital, a 369-bed acute-care, full-service medical center has been serving Arlington and the surrounding...Years in an acute care setting, case management or utilization review Req 1 Year of acute… more
- Veterans Affairs, Veterans Health Administration (El Paso, TX)
- Summary The Registered Nurse - Women's Veteran Program Manager provides care and counseling of persons or the promotion and maintenance of health and prevention of ... assessment, appropriate nursing judgment, and evaluation of human responses. The nurse 's primary commitment is to the patient, whether an individual, family,… more
- Veterans Affairs, Veterans Health Administration (Big Spring, TX)
- …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... period. The duties and responsibilities for the Community Living Center, Registered Nurse include, but are not limited to the following: Provide competent,… more
- Evolent (Austin, TX)
- …team approach with call center staff. Clinical Reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + ... it. **What You'll Be Doing:** As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way… more
- Evolent (Austin, TX)
- …team approach with call center staff. Clinical Reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + ... culture. **What You'll Be Doing:** As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way… more