- Molina Healthcare (TX)
- For this position we are seeking a ( RN ) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity ... * Collaborates with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (San Antonio, TX)
- …managed care , or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted in ... * Collaborates with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM...unit (ICU) or emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization… more
- UTMB Health (Webster, TX)
- …testing is also required. **_REQUIRED EDUCATION/EXPERIENCE_** **:** + Current Texas licensure as a Registered Nurse ( RN ).with a minimum of three (3) years ... with complicated treatment plans through multidisciplinary conferences and medical record review . + Facilitates clinical care progression of patient throughout… more
- Actalent (San Antonio, TX)
- Remote Clinical Review Nurse - Prior Authorization Location: Must be located in Central or Eastern time zones Employment Type: Full‑Time About the Role We are ... seeking an experienced Registered Nurse to join our team within...improvement initiatives and contribute to process optimization within the UM department. Required Qualifications + Active Compact RN… more
- Centene Corporation (Austin, TX)
- …Counselor required or + LMFT - Licensed Marital and Family Therapist required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure ... + Experience working with providers and healthcare teams to review care services, precertification, concurrent review...experience + Direct work experience in Behavioral Health UR, UM , or CM in Managed Care Organizations,… more
- CVS Health (Austin, TX)
- …in clinical setting with diverse cultural dynamics of clinical staff and patients. Registered Nurse ( RN ) required. Licensed Clinical Social Worker (LCSW) ... and state regulated turn-around times. This includes reviewing written clinical records. The UM Nurse Consultant job duties include (not all encompassing): +… more
- Evolent (Austin, TX)
- …medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum ... for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification...of experience with medical management activities in a managed care environment + UM /UR experience + Clinical… more
- Elevance Health (Grand Prairie, TX)
- Behavioral Health Care Manager I- Behavioral Health Care Manager I **Locations:** The selected candidate must reside within a reasonable commuting distance of ... is granted as required by law. The **Behavioral Health Care Manager I** is responsible for managing psychiatric and...outpatient professional treatment health benefits through telephonic or written review . **How you will make an impact:** + Uses… more
- Elevance Health (Grand Prairie, TX)
- **Behavioral Health Care Manager I (3rd Shift - After Hours)** **Virtual:** This role enables associates to work virtually full-time, except for required in-person ... for autism and depression, and insightful analytics to improve the delivery of care . **Location:** North Carolina **Work Shift:** 3rd Shift - Holiday and weekend… more
- Highmark Health (Austin, TX)
- …and/or triaging members to appropriate resources for additional support. + Implement care management review processes that are consistent with established ... in a clinical setting **Preferred** + 5 years in UM /CM/QA/Managed Care + 1 year in advanced...**LICENSES or CERTIFICATIONS** **Required** + Current State of PA RN licensure OR Current multi-state licensure through the enhanced… more