• Care Review Clinician ( RN )

    Molina Healthcare (Austin, 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 ... (Team will work on set schedule) Looking for a RN with experience with appeals, claims review ,...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
    Molina Healthcare (11/01/25)
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  • Care Review Clinician ( RN ) Prior…

    Molina Healthcare (Dallas, TX)
    …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... Fully remote opportunity for a TX licensed RN with Utilization Management experience to join...Note. Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are… more
    Molina Healthcare (10/29/25)
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  • Utilization Management Nurse

    CenterWell (Austin, TX)
    …and the healthcare industry as a whole. Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed ... medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part...skills to make an impact** **Role Essentials** + Active RN license + Possession of or ability to obtain… more
    CenterWell (11/13/25)
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  • Utilization Management Nurse

    CenterWell (Austin, TX)
    …community and help us put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed ... medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that focuses on excellent… more
    CenterWell (11/13/25)
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  • RN Telephonic Advice Line Nurse

    Humana (Austin, TX)
    …concerns.** **Use your skills to make an impact** **Required Qualifications** + **Active Registered Nurse ( RN ) Multi-state/Compact State license with no ... to act as a clinical concierge. The NAL Telephonic Nurse role is a remote position, with...Bachelor's degree in nursing (BSN) + Previous case management, utilization review , or triage experience + Previous… more
    Humana (11/15/25)
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  • Disease Management Nurse - Remote

    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
    Sharecare (10/22/25)
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  • Transplant Care Nurse ( Remote )

    Highmark Health (Austin, TX)
    …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and… more
    Highmark Health (11/06/25)
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  • Nurse Defense Auditor

    MD Anderson Cancer Center (Houston, TX)
    …reviews and audits of patient accounts to complete Defense Audits. *Ideal Candidate:* A * Registered Nurse ( RN )* with experience in *appeals* and * nurse ... Contact third-party payers, insurance medical directors, case management, and utilization review to request reconsideration and/or appeal.... Prefer Houston/local area. *LICENSES AND CERTIFICATIONS* * Required: RN - Registered Nurse -… more
    MD Anderson Cancer Center (11/15/25)
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  • UM Behavioral Health Nurse

    Humana (Austin, TX)
    …timeframe **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) Compact license, with no disciplinary action ... caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes...Complete medical record reviews + Assess discharge plans + Review and extract information from claims + Complete documentation… more
    Humana (11/15/25)
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  • Clinical Rehab Specialist PRN

    HCA Healthcare (Dallas, TX)
    …(RRT / RCP), or State Registered Respiratory Therapist, or Occupational Therapy (OT), or ( RN ) Registered Nurse + 2 years of clinical experience in an ... rehabilitation services prior to returning home. The Clinical Rehabilitation Specialist will review these patients daily until they have strong clinical evidence to… more
    HCA Healthcare (09/27/25)
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