• Case Manager, Registered Nurse

    CVS Health (Austin, TX)
    …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
    CVS Health (08/15/25)
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  • Utilization Review RN

    Baylor Scott & White Health (Dallas, TX)
    …least (3) three years of professional experience is required. + You must hold a valid Registered Nurse License ( RN ). As a health care system committed to ... position type and/or level **Job Summary** + You will review patient cases for medical necessity and establish service...efficient resource use. **Schedule** + You will work primarily remote . + Will be required to work onsite at… more
    Baylor Scott & White Health (08/29/25)
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  • SNF Utilization Management RN

    Humana (Austin, TX)
    …an impact** **Use your skills to make an impact** **Required Qualifications** + **​Licensed Registered Nurse ( RN )** in the (appropriate state) with no ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...in an acute care setting + Previous experience in utilization management/ utilization review for a… more
    Humana (09/12/25)
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  • RN , Manager, Utilization Management…

    Humana (Austin, TX)
    …areas. **Use your skills to make an impact** **Required Qualifications** + An active, unrestricted Registered Nurse ( RN ) license in the state of Michigan. + ... Previous experience in utilization management and/or utilization review ....business administration. **Additional Information** + **Workstyle:** This is a remote position. + **Travel:** Up to 25% travel may… more
    Humana (09/28/25)
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  • Director Utilization Management-Clinical…

    Texas Health Resources (Arlington, TX)
    … Management required 3 years previous leadership experience required Licenses and Certifications RN - Registered Nurse Current license to practice ... Director Utilization Management-Clinical Review _Are you looking...Core work hours: Monday-Friday 8:00a-5:00p. This position is hybrid remote /onsite. Vast majority of time will be remote more
    Texas Health Resources (09/25/25)
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  • Utilization Management Nurse

    Actalent (Houston, TX)
    Clinical Review Nurse ( Utilization Management) 100% Remote Job Description The role of the Utilization Management Nurse involves performing ... setting of care. Essential Skills + 2+ years of utilization management experience + Active Texas RN ...+ Bachelor's or Associate's degree in Nursing. + Texas Registered Nurse License. + Strong multitasking and… more
    Actalent (09/19/25)
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  • Medical Claim Review Nurse

    Molina Healthcare (San Antonio, TX)
    …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... hours 6 AM to 6 PM (Team will work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing… more
    Molina Healthcare (09/06/25)
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  • Infusion Referral Nurse Sr- REMOTE

    Prime Therapeutics (Austin, TX)
    …Patient Programs. **Minimum Qualifications** + Associates - Nursing + Bachelors - Nursing + RN - Registered Nurse , State and/or Compact State Licensure - ... for work visa or residency sponsorship **Additional Qualifications** + Registered Nurse ( RN ). + 5...Experience in managed care, specialty drugs, care management and utilization review . + Meets Credentialing criteria. +… more
    Prime Therapeutics (09/04/25)
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  • Disease Management Nurse - Remote

    Sharecare (Austin, TX)
    …to enable individuals with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the state in which they ... utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification… more
    Sharecare (09/13/25)
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  • Case Manager

    Apex Health Solutions (Houston, TX)
    …will consider remote deployment on a case by case basis Education Education: Registered Nurse ( RN ) LICENSES/CERTIFICATIONS: Registered Nurse ( ... communication skill Some travel in the Houston metro area may be required Remote deployment will be considered SKILLS Knowledge of healthcare delivery Ability to… more
    Apex Health Solutions (08/24/25)
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