• Utilization Review Specialist…

    Houston Methodist (Houston, TX)
    At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of ... hospital clinical nursing experience, which includes three years in utilization review and/or case management ...**LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure -… more
    Houston Methodist (11/02/25)
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  • Utilization Management Nurse…

    CVS Health (Austin, TX)
    …role is 100% remote and the candidate can live in any state. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, ... with heart, each and every day. **Position Summary** This Utilization Management (UM) Nurse Consultant...goals and expectations. **Preferred Qualifications:** + 1+ years' experience Utilization Review experience + 1+ years' experience… more
    CVS Health (11/21/25)
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  • Utilization Review Case Mgr - CMC…

    UTMB Health (Webster, TX)
    Utilization Review Case Mgr - CMC - Clear Lake Center **Webster, Texas, United States** **New** Nursing & Care Management UTMB Health Requisition # 2506588 ... efficient use of medically appropriate services. Integrates and coordinates utilization management activities, care coordination, discharge planning functions,… more
    UTMB Health (11/21/25)
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  • Registered Nurse Case Manager…

    Prime Healthcare (Weslaco, TX)
    …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/233536/registered- nurse -case-manager utilization - ... KNAPP MEDICAL CENTER IS LOOKING FOR A PRN REGISTERED NURSE CASE MANAGER TO WORK WEEKENDS. WE OFFER: +...visit www.KnappMed.org Responsibilities Responsible for the quality and resource management of all patients that are admitted to the… more
    Prime Healthcare (11/12/25)
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  • Utilization Management Nurse

    CenterWell (Austin, TX)
    …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
    CenterWell (11/22/25)
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  • Utilization Management Nurse

    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
    CenterWell (11/13/25)
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  • SNF Utilization Management RN…

    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
    Humana (09/12/25)
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  • UM Behavioral Health Nurse

    Humana (Austin, TX)
    **Become a part of our caring community and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills ... communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Nurse ...Health Provider Disputes based on the business need + Review and extract information from claims + Work in… more
    Humana (11/27/25)
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  • Care Review Clinician (RN)

    Molina Healthcare (Houston, TX)
    …(ICU) or emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At… more
    Molina Healthcare (11/27/25)
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  • Nurse Reviewer I

    Elevance Health (Houston, TX)
    …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... ** Nurse Reviewer I** **Virtual:** This role enables associates...required. **Preferred Skills, Capabilities, and Experiences​:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding,… more
    Elevance Health (11/26/25)
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