- UTMB Health (Friendswood, TX)
- …area and/or general nursing . + Provides assistance with clinical issues for non- nursing Utilization Review Case Management staff. + Contributes to the ... Medical Staff and Nursing Staff on the Utilization Review/Case Management program and provides specific...school of Professional Nursing + Current Texas Nursing Licensure as a Registered Nurse (RN).… more
- Houston Methodist (Houston, TX)
- …and trends in the areas of care coordination, evidence- based practice, utilization management , and service excellence. Disseminates information and focuses the ... utilization of resources to avoid denials and resource management as it pertains to delivery of care. **GROWTH/INNOVATION...**LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure -… more
- Houston Methodist (Sugar Land, TX)
- …years clinical nursing /patient care experience which includes three years in utilization review, case management or equivalent revenue cycle clinical role + ... partners. This position uses sound clinical judgement in the Utilization Management process and knowledge of regulatory...**LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure -… more
- HCA Healthcare (Houston, TX)
- …and other third-party payers in accordance with procedures set forth in the Hospital Utilization Management Plan and the criteria and standards approved by the ... any other healthcare provider. We are seeking a(an) Registered Nurse Case Manager to join our healthcare family. **Benefits**...extended stays in accordance with criteria approved by the Utilization Management Committee and Medical Staff with… more
- Evolent (Austin, TX)
- …sources to establish and maintain the definitive source of truth for specialty Utilization Management (UM) agreements. This important work is achieved through ... Minimum 3 years of professional experience in value-based healthcare analytics or utilization management within a payer, provider, clinical vendor, managed care,… more
- Molina Healthcare (Austin, TX)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more
- Actalent (Dallas, TX)
- …Utilization Management )100% Remote Job Description The role of the Utilization Management Nurse involves performing concurrent reviews, determining ... setting of care. Essential Skills + 2+ years of utilization management and utilization review...or Associate's degree in Nursing . + Compact/Multistate Nursing License. + Strong multitasking and time management… more
- Catholic Health Initiatives (College Station, TX)
- …2. Clinical Management a. Serves as a clinical resource for utilization management , compliance for the rules and regulations for government, non-government ... **The following will be REQUIRED in order to be considered for the Manager, Care Management postion.** + **Must be a Registered Nurse (RN)** + **Must have have… more
- Molina Healthcare (San Antonio, TX)
- …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... as may be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. +… more
- CVS Health (Austin, TX)
- …Registered Nurse (RN) states. This role is a blended role doing both Case Management and Utilization Management . The RN Case Manager is responsible for ... years' experience in critical care + 6+ months case management or utilization management experience...+ Must be able to obtain multi state Registered Nurse (RN) licensures **Preferred Qualifications** + Case Management… more