- Elevance Health (Houston, TX)
- …The **Telephonic Nurse Case Manager Senior** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager Senior** **Location:** This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures, chairs and… more
- HCA Healthcare (Houston, TX)
- …tenets customer service skills. **What qualifications you will need:** + (RN) Registered Nurse license + Nursing Diploma or Associates degree required or higher ... any other healthcare provider. We are seeking a(an) Registered Nurse Case Manager to join our healthcare family. **Benefits**...care experience required. Minimum of two (2) years of utilization review/case management experience and minimum of… more
- Humana (Austin, TX)
- …during Medicare and Medicaid LOB - Medicare Clinical Criteria Review (MCCR), Utilization Management Committee (UMC), Medical Coverage Policy Adoption (MCPA) + ... **Desired Qualifications** + Master's degree in health-or business-related field + Utilization management experience (Commercial and/or Medicare) + Proven… more
- Elevance Health (Grand Prairie, TX)
- …criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Location: This role enables...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more
- Elevance Health (Grand Prairie, TX)
- …criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care ... **Telephonic Nurse Case Manager II** **Location: Virtual: This role...claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:**… more
- Molina Healthcare (Fort Worth, TX)
- …Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or medical… more
- Molina Healthcare (Austin, TX)
- …including 3 or more years in one or more of the following areas: utilization management , case management , care transition and/or disease management ... work of external vendors. + Focuses on process improvement, organizational change management , program management and other processes relative to the business.… more
- MTC (Anson, TX)
- …are accurate and recorded as required. + Practice basic cost containment and utilization management for patient care and facility operations. + Perform quality ... The pharmacy technician utilizes appropriate skills in delegating, educating and evaluating nursing staff to ensure that the pharmacy program operates in compliance… more
- Elevance Health (TX)
- …patients with IDD and patients with special needs is preferred. + Home Health, Utilization Management or Case Management experience strongly preferred. + ... agencies and appropriate provider/network. + Refers member to catastrophic case management . **Minimum Requirements:** Requires AS in nursing and minimum… more
- Humana (Austin, TX)
- …20% 2. Review and monitor Contract Change Orders and evaluate impact on Utilization Management processes. Organize and facilitate Change Order workgroup and ... following areas: benchmarking, business process analysis and re-engineering, change management and measurement, and/or process-driven systems requirements. Advise executives… more