• Utilization Review Nurse

    Houston Methodist (The Woodlands, TX)
    At Houston Methodist, the Utilization Review Nurse (URN) PRN position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare,...state, local, and federal programs + Progressive knowledge of utilization management , case management , performance… more
    Houston Methodist (07/12/25)
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  • Clinical Review Nurse

    Actalent (Dallas, TX)
    Clinical Review Nurse ( Utilization Management )100% Remote Job Description The role of the Utilization Management Nurse involves performing ... setting of care. Essential Skills + 2+ years of utilization management and utilization review expertise. + Experience in concurrent review and… more
    Actalent (08/08/25)
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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 (08/08/25)
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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 (08/02/25)
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  • Utilization Review Specialist RN…

    Houston Methodist (Sugar Land, TX)
    At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of ... this position is able to cover a multitude of utilization review functions through point of entry,...to physicians, nurses, and other health care providers on utilization management topics. + Initiates improvement of… more
    Houston Methodist (07/29/25)
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  • Clinical Review Nurse

    Actalent (San Antonio, TX)
    …to ensure the successful completion of cases. Essential Skills + Experience in utilization management , concurrent review , prior authorization, utilization ... Job Title: Clinical Review NurseJob Description: The Review Nurse will be responsible for reviewing...Proficiency with InterQual. + Active Compact RN License. + Utilization Management /Concurrent Review experience. +… more
    Actalent (08/01/25)
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  • Care Review Clinician, Prior Auth (RN) Pega…

    Molina Healthcare (Houston, TX)
    …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... Experience using PEGA **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). MULTI STATE / COMPACT… more
    Molina Healthcare (07/12/25)
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  • Medical Claim Review Nurse (RN)

    Molina Healthcare (San Antonio, TX)
    …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years… more
    Molina Healthcare (08/08/25)
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  • Disease Management Nurse - Remote

    Sharecare (Austin, TX)
    …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… more
    Sharecare (08/13/25)
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  • Registered Nurse Case Manager

    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
    HCA Healthcare (08/10/25)
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