- 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
- 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 ... Arlington, TX + Core work hours: Monday-Friday 8:00a-5:00p. This position is hybrid remote /onsite. Vast majority of time will be remote , but there will… 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 ... provider's care coordination departments. Your expertise is needed to review medical necessity. + Working with the team, you'll...efficient resource use. **Schedule** + You will work primarily remote . + Will be required to work onsite at… more
- Centene Corporation (Austin, TX)
- …perspective on workplace flexibility. **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical Review ... team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure adherence… more
- 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 nursing… more
- Humana (Austin, TX)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to...Weekly Hours: 40 + Travel: While this is a remote position, occasional travel to Humana's offices for training… more
- CVS Health (Austin, TX)
- …dedicated Utilization Management (UM) Nurse Consultant to join our remote team. **Key Responsibilities** + Apply critical thinking and evidence-based clinical ... some weekends and holidays, per URAC and client requirements. ** Remote Work Expectations** + This is a 100% ...experience in Nursing. + At least 1 year of Utilization Management experience in concurrent review or… more
- Actalent (Houston, TX)
- Clinical Review Nurse ( Utilization Management) 100% Remote Job Description The role of the Utilization Management Nurse involves performing concurrent ... Perform concurrent reviews to assess member's overall health. + Review the type of care being delivered and evaluate...setting of care. Essential Skills + 2+ years of utilization management experience + Active Texas RN license +… more
- CVS Health (Austin, TX)
- …program for Aetna Medicaid. The Clinical Pharmacist performs retrospective drug utilization reviews. They distribute clinical drug information and educate providers, ... regimens. This individual will be responsible for: Performing pharmacy review and making evidence-based recommendations regarding Medicaid members. Identify… more
- Prime Therapeutics (Austin, TX)
- …+ Escalates medical exception requests to nurse, pharmacist or physician on the utilization review clinical team when further review is necessary. ... fuels our passion and drives every decision we make. **Job Posting Title** Initial Review Pharmacy Technician - Remote **Job Description** The Initial Review … more