- Evolent (Austin, TX)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… more
- Molina Healthcare (Houston, TX)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... Experience using PEGA **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). MULTI STATE / COMPACT… more
- CVS Health (Austin, TX)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... or Maternity/ Obstetrics experience . **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- Humana (Austin, TX)
- … licensure + Previous Medicare/Medicaid experience a plus + Previous experience in utilization management , case management , discharge planning and/or home ... review depending on case findings. + Educates providers on utilization and medical management processes. + Enters...health or rehab + Certification in Case Management (CCM) or Managed Care Nursing (CMCN)… more
- HCA Healthcare (Houston, TX)
- …national standards for case management scope of services including + Utilization Management supporting medical necessity and denial prevention + Transition ... opportunity to make a real impact. As a(an) Registered Nurse Case Manager PRN you can be a part...and professional goals. Help to advance the practice of nursing and improve positive outcomes for your patients as… more
- HCA Healthcare (Houston, TX)
- …national standards for case management scope of services including + Utilization Management supporting medical necessity and denial prevention + Transition ... integrity. We care like family! Jump-start your career as a(an) Registered Nurse Case Manager today with HCA Houston Healthcare Northwest. **Benefits** HCA Houston… more
- CenterWell (Austin, TX)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and ... high-volume community or mail order pharmacy practice environment + Previous experience in utilization management + Education: BSN or Bachelor's degree in a… more
- Houston Methodist (Houston, TX)
- …state, local and federal programs + Comprehensive knowledge of discharge planning, utilization management , case management , performance improvement and ... nurse (RN) responsible for comprehensively planning for case management of a targeted patient population on a designated...nursing experience which includes two years in case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN -… more
- Houston Methodist (The Woodlands, TX)
- …state, local and federal programs + Comprehensive knowledge of discharge planning, utilization management , case management , performance improvement and ... At Houston Methodist, the Case Manager PRN (CM) position is a licensed registered nurse (RN) who comprehensively plans for case management of a target patient… more
- Houston Methodist (The Woodlands, TX)
- …state, local and federal programs + Progressive knowledge of discharge planning, utilization management , case management , performance improvement and managed ... registered nurse (RN) responsible for comprehensively planning for case management , which includes care transitions and discharge planning of a targeted patient… more