• Utilization Management Nurse - Home…

    Humana (Austin, TX)
    …of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require ... courses of action. As a Utilization Management RN working on the OneHome/Home Solutions UM ...+ Minimum of Associate Degree in nursing + Licensed Registered Nurse ( RN ) in a… more
    Humana (01/13/26)
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  • Care Review Clinician ( RN )

    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 ... promote the Molina care model. * Adheres to utilization management ( UM ) policies and procedures. Required Qualifications...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
    Molina Healthcare (12/24/25)
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  • Care Review Clinician ( RN )

    Molina Healthcare (San Antonio, TX)
    …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM ) policies and procedures. Required Qualifications * At least 2… more
    Molina Healthcare (01/09/26)
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  • Supervisor, Behavioral Health Utilization…

    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 ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a...members, and providers + Works with the BH senior management to develop and implement UM policies,… more
    Centene Corporation (01/11/26)
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  • Utilization Management Nurse

    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) ... preferred. + Requisition Job Description **Position Summary** This Utilization Management ( UM ) Nurse Consultant role...2+ years of acute hospital clinical experience as an RN with preference for medical -surgical and ICU… more
    CVS Health (01/01/26)
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  • Clinical Reviewer, Nurse ( Medical

    Evolent (Austin, TX)
    …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... precertification and prior approvals. Tasks are performed within the ** RN /LVN/LPN** scope of practice, under the Medical ...InterQual) + Minimum of one year of experience with medical management activities in a managed care… more
    Evolent (12/10/25)
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  • Senior Strategy Advancement Professional

    Humana (Austin, TX)
    …the design, implementation, and advancement of strategic initiatives within the Utilization Management ( UM ) function. This role is responsible for leveraging ... or program management . + Advanced degree or professional certification (eg, RN , LPN, MBA, PMP, ASA/FSA). + Experience with designing and implementing clinical… more
    Humana (01/07/26)
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  • Utilization Management Nurse

    CVS Health (Austin, TX)
    …And we do it all with heart, each and every day. **Position Summary** This Utilization Management ( UM ) Nurse Consultant role is 100% remote and the candidate ... shift 9:30-6CST.** **No travel is required.** As a Utilization Management Nurse Consultant, you will utilize clinical...2+ years of acute hospital clinical experience as an RN with preference for medical -surgical and ICU… more
    CVS Health (01/01/26)
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  • Utilization Review Case Mgr - CMC - Clear Lake…

    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 ... 5:00 PM **Webster, Texas, United States** Nursing & Care Management UTMB Health Requisition # 2507031 The mission of...of enhancing quality clinical outcomes, promoting timely access to medical care, and managing care cost and efficient use… more
    UTMB Health (12/12/25)
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  • Clinical Review Nurse (Remote)

    Actalent (San Antonio, TX)
    …time zones Employment Type: Full‑Time About the Role We are seeking an experienced Registered Nurse to join our team within a leading Managed Care Organization. ... Support quality improvement initiatives and contribute to process optimization within the UM department. Required Qualifications + Active Compact RN License… more
    Actalent (01/11/26)
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