• Case Manager, Registered Nurse

    CVS Health (Austin, TX)
    …care. + Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse ( RN ) 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 (05/09/25)
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  • 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 (05/09/25)
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  • Transplant Care Nurse RN - Stem…

    Highmark Health (Austin, TX)
    …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and… more
    Highmark Health (04/25/25)
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  • Investigator, SIU RN - Remote

    Molina Healthcare (TX)
    …abuse through the identification of aberrant coding and/or billing patterns through utilization review . * Incorporate leadership and communication skills to work ... care experience. **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION** : Active, unrestricted State Registered Nursing ( RN ) license in good standing. **PREFERRED… more
    Molina Healthcare (04/12/25)
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  • Clinical Coding and OASIS Review Manager

    BAYADA Home Health Care (Austin, TX)
    …with an industry leader. Apply now for immediate consideration. OASIS Review , Utilization Review , Quality Assurance, Remote , Home Health Coding, Coder, ... immediate opening for a **Full Time,** OASIS and Coding Review Manager with OASIS and Coding certification to work...Manager with OASIS and Coding certification to work remotely. RN , PT, OT, and SLP's with certifications will be… more
    BAYADA Home Health Care (04/02/25)
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  • Delegation Oversight Nurse Remote

    Molina Healthcare (TX)
    …Practical Nurse in good standing. **Preferred Education** Completion of an accredited Registered Nurse ( RN ) Program or a bachelor's degree in Nursing. ... Practical Nurse (LPN) Program **Required Experience** + Minimum two years Utilization Review experience. + Knowledge of audit processes and applicable state… more
    Molina Healthcare (04/12/25)
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  • Registered Dietitian - Remote

    Sharecare (Austin, TX)
    …of the care enhancement program by providing telephonic care and resource utilization for members in an appropriate, efficient, and cost-effective manner while ... orientation and to take the pre and post-test to review competency during orientation. Yearly competency test is required...will follow company policy to transfer call to an RN or appropriate colleague when member needs are outside… more
    Sharecare (05/03/25)
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  • Practice Transformation Specialist

    Apex Health Solutions (Houston, TX)
    …(CPC) Certified Professional in Healthcare Quality (CPHQ) Licensed Vocational Nurse (LVN) Registered Nurse ( RN ) ABOUT APEX HEALTH SOLUTIONS Apex Health ... Manager, Practice Transformation. The PTS is responsible for providing on-site and remote assistance and /or education to clinicians, care teams and their associated… more
    Apex Health Solutions (04/12/25)
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  • Consultant, Nurse Disability

    Lincoln Financial (Austin, TX)
    …as indicated **What we're looking for** * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license in the state where the ... **Alternate Locations:** Work from Home **Work Arrangement:** Remote : Work at home employee **Relocation assistance:**...Trauma , Disability, Workman's comp or case management or Utilization review **Application Deadline** **What's it like… more
    Lincoln Financial (04/30/25)
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  • Divisional Director of Care Management, Strategy…

    CenterWell (Austin, TX)
    …consistent and standardized program workflows, dyad communication/partnership, and quarterly business review of acute care and post-acute care utilization . + ... and coordinating care to reduce acute and post-acute care utilization . The Divisional Director role is a hybrid with...experience preferred + Current and unrestricted US medical or RN license + Excellent verbal and written communication skills… more
    CenterWell (05/04/25)
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