- CenterWell (Austin, TX)
- …+ Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Orthopedic procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare… more
- Houston Methodist (The Woodlands, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) PRN position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare,...state, local, and federal programs + Progressive knowledge of utilization management , case management , performance… more
- Evolent (Austin, TX)
- …As a Clinical Reviewer , Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in ... Clinical Reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical… more
- Evolent (Austin, TX)
- …As a Clinical Reviewer , Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in ... Clinical Reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical… more
- Evolent (Austin, TX)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks ... quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on… more
- UTMB Health (Webster, TX)
- Utilization Review Case Mgr - CMC - Clear Lake Center **Webster, Texas, United States** **New** Nursing & Care Management UTMB Health Requisition # 2504557 ... efficient use of medically appropriate services. Integrates and coordinates utilization management activities, care coordination, discharge planning functions,… more
- Elevance Health (Grand Prairie, TX)
- …Finder and follows up with provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer ; and handles referrals for specialty ... ** Utilization Management Representative II** **Virtual:** This...+ Processes incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and… more
- Elevance Health (Grand Prairie, TX)
- …precertification, prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer . + Responsible for the ... ** Utilization Management Representative I** **Location:** This...responsible for coordinating cases for precertification and prior authorization review . **How will you make an impact:** + Managing… more
- Baylor Scott & White Health (Austin, TX)
- …Note: Benefits may vary based on position type and/or level **Job Summary** As the Utilization Review RN you will review patient cases for medical necessity ... to fit their needs. + Proficiency in discharge planning, setting case management referral standards, reviewing utilization , and categorizing levels of care.… more
- Molina Healthcare (Houston, TX)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... Experience using PEGA **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). MULTI STATE / COMPACT… more