- Datavant (Austin, TX)
- …with clinical knowledge and expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in DRG downgrade ... by management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well...table:** + Two (2) years managed care experience in UM/ CM /CDI Department preferred + Knowledge of CMS, State Regulations,… more
- Health Care Service Corporation (Houston, TX)
- …and facilitates the coordination of care for identified members. **JOB REQUIREMENTS:** ** Registered Nurse ( RN ) with current, valid, unrestricted license ... This position will be responsible for performing all functions of case management ( CM ) and is a primary source of contact for members, health care personnel… more
- Houston Methodist (Houston, TX)
- …leading multi-site or enterprise-level programs preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... leadership performance, operational benchmarks, and accountability frameworks for hospital CM Directors and Central UR Director. **SERVICE ESSENTIAL FUNCTIONS** +… more
- HCA Healthcare (Dallas, TX)
- …based on plan outcomes. What You Will Do In This Role + In partnership with RN CM , the social worker is responsible for ensuring the post-acute medical needs and ... care are appropriate + The social worker will respond timely to referrals from RN CM or other staff when risk factors for social determinants of health are… more
- CVS Health (Austin, TX)
- …in medical management, including Utilization Management (UM) and Case Management ( CM ). + Strong understanding of healthcare quality, accreditation processes, and ... NCQA standards. + Licensed clinical professional ( RN preferred). + Excellent analytical, organizational, and communication skills. + Proficiency in audit… more
- Highmark Health (Austin, TX)
- …experience + 1 year in a clinical setting **Preferred** + 5 years in UM/ CM /QA/Managed Care + 1 year in advanced training and experience in cognitive behavioral ... in addressing targeted populations **LICENSES or CERTIFICATIONS** **Required** + RN license in PA or WV or DE or...or WV or DE or NY is required. Other RN license(s), if applicable, must be obtained within the… more