- Humana (Austin, TX)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
- Texas Health Resources (Arlington, TX)
- Director Utilization Management -Clinical Review _Are you looking for a rewarding career with family-friendly hours and top-notch benefits? We're looking for ... system services for wholly owned and Partner hospitals for utilization management . Job Duties OPERATIONS: Plans, organizes...3 years previous leadership experience required Licenses and Certifications RN - Registered Nurse Current… more
- Cognizant (Austin, TX)
- …have to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization management experience with ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and… more
- UTMB Health (Galveston, TX)
- Utilization Review Case Mgr - Galv....nursing and current Texas Nursing licensure as a professional registered nurse . Minimum of three years of ... the use of medical services, procedures, and facilities. Supports the UTMB Utilization Management Program utilizing clinical knowledge, expertise, and criteria… more
- Elevance Health (Grand Prairie, TX)
- ** Nurse Reviewer I** **Location:** Virtual: This...hospital setting or minimum of 1 year of prior utilization management , medical management and/or ... an accommodation is granted as required by law. The ** Nurse Reviewer I** will be responsible for...required. **Preferred Skills, Capabilities, and Experiences:** + Familiarity with Utilization Management Guidelines, ICD 10 coding, and… more
- Houston Methodist (Houston, TX)
- …with HM performance that demonstrates leadership responsibility **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... At Houston Methodist, the Director Case Management & Social Services RN position...excellent customer/patient service. + Plays a leadership role in utilization review committee which includes identification of… more
- HCA Healthcare (Houston, TX)
- …to physicians, patients, families and caregivers **What qualifications you will need:** + ( RN ) Registered Nurse + Bachelors Degree, or Associate Degree ... case management scope of services including + Utilization Management supporting medical necessity and denial...encourage you to apply for our Registered Nurse Case Manager opening. We promptly review … more
- HCA Healthcare (Houston, TX)
- …to physicians, patients, families and caregivers **What qualifications you will need:** + ( RN ) Registered Nurse + Bachelors Degree, or Associate Degree ... colleagues in their positions. Join our Team as a(an) Registered Nurse Case Manager and access programs...case management scope of services including + Utilization Management supporting medical necessity and denial… more
- HCA Healthcare (Houston, TX)
- …planning, implementation and overall evaluation of individual patient needs. Care coordination, utilization review and management , as well as discharge ... and healthcare facilities. **What qualifications you will need:** + ( RN ) Registered Nurse + Associate...care experience required. Minimum of two (2) years of utilization review /case management experience and… more
- Houston Methodist (Sugar Land, TX)
- …Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management ... clinical nursing/patient care experience which includes three years in utilization review , case management or...nongovernmental payers preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… more