- 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 ... the Molina care model. * Adheres to utilization management ( UM ) policies and procedures. Required Qualifications * At least...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Humana (Austin, TX)
- …Standard Time **Required Qualifications** + Minimum of Associate Degree in nursing + Licensed Registered Nurse ( RN ) in a compact state with no disciplinary ... and independent determination of the appropriate courses of action. As a Utilization Management RN working on the OneHome/Home Solutions UM Team, you will have… more
- 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 ... teams to promote the Molina care model. * Adheres to utilization management ( UM ) policies and procedures. Required Qualifications * At least 2 years experience,… 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 ... clinicians and ensures compliance with applicable guidelines + Monitors and tracks UM BH resources to ensure adherence to performance, quality, and efficiency… more
- Humana (Austin, TX)
- …and advancement of strategic initiatives within the Utilization Management ( UM ) function. This role is responsible for leveraging data-driven insights, ... industry best practices, and cross-functional collaboration to optimize UM processes, improve clinical outcomes, and enhance member and provider experiences. The… 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)
- …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed… more
- 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. ... Remote Clinical Review Nurse - Prior Authorization Location: Must be located...improvement initiatives and contribute to process optimization within the UM department. Required Qualifications + Active Compact RN… 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 ... AS 400. + Demonstrates skill in accurately entering required UM data. + Monitors and facilitates appropriate utilization of...transfers and admissions from the prison facility. + Conducts nurse to nurse conference calls for all… more
- San Antonio Behavioral Health (San Antonio, TX)
- …May consult with staff as needed. Essential Duties: + Collaborate and set standards with registered nurse ( RN ) case managers (CMs) and outcome managers to ... indicated. + Identify and facilitate resolution of system process problems impeding UM functions. Identify and resolve delays and obstacles as appropriate. +… more