- Actalent (Houston, TX)
- "Urgent Hiring for " Utilization Review RN" Job Description: + Perform concurrent reviews to assess member's overall health. + Review the type of care being ... setting of care. Qualifications: + 4+ years experience in utilization management and utilization review /managed...or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to… more
- Cognizant (Austin, TX)
- **Schedule:** Monday to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work ... as well as timely filing deadlines and processes. + Review clinical denials including but not limited to referral,...Based on this role's business requirements, this is a remote position open to qualified applicants in United States.… more
- Highmark Health (Austin, TX)
- …determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by ... requests for prior authorization or appeals against medical policy through the Utilization Review system. Update the system records appropriately to ensure… more
- Dallas Behavioral Healthcare Hospital (Desoto, TX)
- The Utilization Review Case Manager is responsible for working with insurance companies and managed care systems for the authorization, concurrent and ... access the full range of their benefits through the utilization review process. + Conducts admission reviews....service standards. *This position is on-site and NOT a remote position.* Requirements + Education: Clinical degree such as… more
- CVS Health (Austin, TX)
- …care experience is in behavioral health) **Preferred Qualifications** + 1+ years' experience Utilization Review experience + 1+ years' experience Managed Care + ... Summary** This Utilization Management (UM) Nurse Consultant role is 100% remote and the candidate can live in any state. **Normal Working Hours: Monday… more
- CVS Health (Austin, TX)
- …care experience is in behavioral health) **Preferred Qualifications** + 1+ years' experience Utilization Review experience + 1+ years' experience Managed Care + ... with heart, each and every day. **Position Summary** This Utilization Management (UM) Nurse Consultant role is 100% ...Utilization Management (UM) Nurse Consultant role is 100% remote and the candidate can live in any state.… 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
- CenterWell (Austin, TX)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to… more
- Evolent (Austin, TX)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... for the culture. **What You'll Be Doing:** Job Description **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a… more
- Molina Healthcare (Dallas, TX)
- …candidate with a RN licensure, Diagnosis-Related Group (DRG) experience, 2 years of Utilization Review and/or Medical Claims Review experience. Knowledge in ... a plus. Work hours: Monday - Friday 8:00am- 5:00pm Remote position **Essential Job Duties** * Performs clinical/medical reviews...the specific programs supported by the plan such as utilization review , medical claims review ,… more