- Houston Methodist (Houston, 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
- Evolent (Austin, TX)
- …with others. **Collaboration Opportunities:** + The Manager, Client Services oversees daily utilization management and directs the medical care of our members on ... health plans and serves in a supporting role to the Director, Intake and Utilization Management Operations. + This individual will not only lead a production team… more
- 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
- CVS Health (Austin, TX)
- …pm EST or 9:30am to 6:00pm EST with occasional weekend/holiday/evening rotation.** ** Utilization Management is a 24/7 operation and work schedules will include ... opportunities to promote quality effectiveness of Healthcare Services and benefit utilization + Consults and lends expertise to other internal and external… more
- HCA Healthcare (Pasadena, TX)
- …integrity. We care like family! Jump-start your career as a Behavioral Health Utilization Review RN MSW today with Parallon. **Benefits** Parallon offers a total ... location._** Come join our team as a Behavioral Health Utilization Review RN MSW. We care for our community!...on Notice of Admission (NOA), initial and continued stay utilization review and discharge reviews as needed for authorization… more
- 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 (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
- 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
- Elevance Health (Grand Prairie, TX)
- ** Utilization Management Representative II** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... unless an accommodation is granted as required by law._ " The ** Utilization Management Representative II** is responsible for managing incoming calls, including… more
- Elevance Health (Grand Prairie, TX)
- ** Utilization Management Representative I** **Location:** This role enables associates to work virtually full-time, with the exception of required in person training ... by law_ **Hours:** Monday - Friday, 8am - 5pm PST The ** Utilization Management Representative I** is responsible for coordinating cases for precertification and… more