- Humana (Austin, TX)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...who will assist in preparation of cases prior to review by the Humana G&A Medicare Medical Directors. The… more
- CVS Health (TX)
- …with regulatory and organizational standards - Provide education and support regarding utilization management processes to colleagues and providers - Document ... and organizational skills - Proficiency with electronic medical records and utilization review systems **Required Qualifications** - Must have active,… more
- 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 (Katy, TX)
- …hiring **EXPERIENCE** + Five years in case management with three years including utilization review , with two years in people management in a healthcare ... At Houston Methodist, the Director Centralized Utilization Review (UR) position is responsible...responsible for strategic, administrative, and operational leadership for the Utilization Management (UM) department across the Houston… more
- Houston Methodist (Katy, TX)
- … Review department to ensure efficient, high-quality, and compliant utilization management practices across the organization. This position ensures timely ... other areas according to department specifications. + Manages utilization management (UM) programs including Medical Claims Review , Precertification and… more
- UTMB Health (Webster, TX)
- Utilization Review Case Mgr - CMC - Clear Lake Center - M-F, 8:00 AM - 5:00 PM **Webster, Texas, United States** Nursing & Care Management UTMB Health ... efficient use of medically appropriate services. Integrates and coordinates utilization management activities, care coordination, discharge planning functions,… more
- Humana (Austin, TX)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...in an acute care setting + Previous experience in utilization management / utilization review … more
- Molina Healthcare (TX)
- …ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) ... modification of payment decisions. + Serves as a clinical resource for utilization management , CMOs, physicians and member/provider inquiries/appeals. + Provides… more
- Actalent (San Antonio, TX)
- Remote Clinical Review Nurse - Prior Authorization Location: Must be located in Central or Eastern time zones Employment Type: Full‑Time About the Role We are ... seeking an experienced Registered Nurse to join our team within a leading Managed...organizational standards. + Maintain up‑to‑date knowledge of clinical guidelines, utilization management policies, and industry best practices.… more
- ChenMed (Houston, TX)
- …engagement with patient and family. + Facilitates patient/family conferences to review treatment goals and optimize resource utilization ; provides family ... we need great people to join our team. The Nurse Case Manager 1 (RN) is responsible for achieving...achieving desired clinical outcomes within specific timeframe. + Conducts review for appropriate utilization of services from… more