- 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
- AdventHealth (Mansfield, TX)
- …and services of selected patient populations across the continuum of illness. The Nurse Manager promotes effective utilization of health care resources, monitors ... develop a brand new $150 million community hospital and medical office building that will provide services such as...programs such as Shared Governance Program, which may include Nurse Advisory Council, Peer Review , Evidence-Based Practice… more
- HCA Healthcare (Houston, TX)
- …(5) years recent acute care experience required. Minimum of two (2) years of utilization review /case management experience and minimum of one (1) year experience ... front line, empathetic for patients. At HCA Houston Healthcare Medical Center our nurses set us apart from any...any other healthcare provider. We are seeking a(an) Registered Nurse Case Manager to join our healthcare family. **Benefits**… more
- HCA Healthcare (Kingwood, TX)
- …in this role: + Actively participates in the collaborative program which requires review of patient activities related to medical necessity of hospitalization, ... us apart from any other healthcare provider. We are seeking a(an) Registered Nurse Case Manager to join our healthcare family. **Benefits** HCA Houston Healthcare… more
- HCA Healthcare (Corpus Christi, TX)
- …Do you want to join an organization that invests in you as a(an) Registered Nurse Case Manager PRN? At Corpus Christi Medical Center, you come first. HCA ... a difference. We are looking for a dedicated Registered Nurse Case Manager PRN like you to be a...+ Actively participates in the collaborative program which requires review of patient activities related to medical … more
- CVS Health (Austin, TX)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management...**Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in… more
- HCA Healthcare (Houston, TX)
- …integrates national standards for case management scope of services including + Utilization Management supporting medical necessity and denial prevention + ... our Registered Nurse Case Manager opening. Our team will promptly review your application. Highly qualified candidates will be contacted for interviews. **Unlock… more
- HCA Healthcare (Houston, TX)
- …integrates national standards for case management scope of services including + Utilization Management supporting medical necessity and denial prevention + ... colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no...growth, we encourage you to apply for our Registered Nurse Case Manager opening. We promptly review … more
- Molina Healthcare (San Antonio, TX)
- …1-3 years Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and ... outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/ medical reviews of previously denied… more