- Centene Corporation (Austin, TX)
- …Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure ... adherence to performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues +… more
- Molina Healthcare (Dallas, TX)
- **JOB DESCRIPTION** **JOB DESCRIPTION** **Job Summary** The **Senior Analyst, Utilization Management ** plays a critical role in supporting clinical and ... business needs into technical solutions. This role works closely with clinicians, utilization management teams, and business stakeholders to gather requirements… more
- Humana (Austin, TX)
- …community and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to support ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and… more
- CVS Health (Austin, TX)
- …work S/S/M/T 10 hour shifts (AFTER training M-F for about 4 - 5 months).** ** Utilization Management is a 24/7 operation and work schedules will include holidays ... hour shifts central or eastern time zone (AFTER 4-5 months of training). Utilization Management is a 24/7 operation and work schedules will include holidays and… more
- Humana (Austin, TX)
- …a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and… 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 ... leader for system services for wholly owned and Partner hospitals for utilization management . Job Duties OPERATIONS: Plans, organizes and delegates activities… more
- Houston Behavioral Healthcare Hospital (Houston, TX)
- …Houston Behavioral Healthcare Hospital (HBHH) currently has an opening for Part-time Utilization Management Coordinator. The Utilization Management ... Director of Utilization Review and will be responsible to provide quality case management services to all patients and their families, to serve as a member of… more
- Cognizant (Austin, TX)
- …. Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan . 3 years' ... in health care revenue cycle or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial… more
- Molina Healthcare (Houston, TX)
- …state board licensing mandate. + At least 2 years in case, disease or utilization management ; managed care; or medical/behavioral health settings. + One year of ... or Clinical Social Worker/Counseling License. + Certified Case Manager (CCM), Utilization Management Certification (CPHM), Certified Professional in Health Care… more
- Molina Healthcare (Dallas, TX)
- … (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management ), clinical pharmacy ... **JOB DESCRIPTION** **Job Summary** Molina Pharmacy Services/ Management staff work to ensure that Molina members...initiatives under the direction of leadership. + Monitors drug utilization and assists leadership team in understanding quality and… more
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