• Utilization Review Specialist RN - FT Days

    Houston Methodist (Sugar Land, TX)
    At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... of the URN, this position is able to cover a multitude of utilization review functions through point of entry, observation progression of care management, concurrent… more
    Houston Methodist (07/29/25)
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  • Utilization Review Nurse - Transition…

    Houston Methodist (Houston, TX)
    At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent ... resource to the physicians and provides education and information on resource utilization and national and local coverage determinations (LCDs & NCDs). This position… more
    Houston Methodist (07/25/25)
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  • Staff Utilization Management Pharmacist

    Humana (Austin, TX)
    …of our caring community and help us put health first** The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting medical necessity ... work **1 company holiday in 2025** **Job Description:** The Staff Utilization Management Pharmacist is a clinical professional responsible for conducting… more
    Humana (08/13/25)
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  • SNF Utilization Management RN - Compact Rqd

    Humana (Austin, TX)
    …part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to support the ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently… more
    Humana (08/09/25)
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  • Utilization Management Clinical Consultant

    CVS Health (Austin, TX)
    …skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in clinically ... appropriate treatment, evidence-based care, and medical necessity criteria for appropriate utilization of services for child and adolescent members. + Consults and… more
    CVS Health (07/31/25)
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  • Lead Utilization Management Coordinator-…

    Houston Behavioral Healthcare Hospital (Houston, TX)
    …Healthcare Hospital (HBHH) currently has an opening for Full-time Lead Utilization Management Coordinator, Monday-Friday, 8a-4p. The Lead Utilization Management ... Coordinator will report to the Director of Utilization Review and will be responsible to provide quality case management services to all patients and their families,… more
    Houston Behavioral Healthcare Hospital (08/09/25)
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  • Utilization Management Senior Business…

    Molina Healthcare (San Antonio, TX)
    **Knowledge/Skills/Abilities** + Perform research and analysis of complex healthcare utilization and performance date, claims data, pharmacy data, and lab data ... regarding utilization and cost containment information. + Evaluate, write, and...cost containment information. + Evaluate, write, and present healthcare utilization and cost containment reports and makes recommendations based… more
    Molina Healthcare (08/02/25)
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  • Utilization Management Administration…

    CenterWell (Austin, TX)
    …of our caring community and help us put health first** The Utilization Management (UM) Administrative Coordinator 2 is responsible for providing high-quality support ... service or customer service telephone experience desired + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care… more
    CenterWell (08/13/25)
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  • Utilization Management Representative III

    Elevance Health (San Antonio, TX)
    ** Utilization Management Representative III** **Location:** This role requires associates to be in-office 5 days per week, at our San Antonio, TX location. The ** ... Utilization Management Representative III** is responsible for coordinating cases for precertification and prior authorization review. **How you will make an… more
    Elevance Health (08/12/25)
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  • Utilization Management Nurse

    CenterWell (Austin, TX)
    …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare +… more
    CenterWell (08/08/25)
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