- 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
- 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
- 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 (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
- 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
- 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
- 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
- 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
- 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
- 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
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