- 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 (Houston, 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
- 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
- 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 (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
- Elevance Health (Grand Prairie, TX)
- ** Utilization Management Representative II** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... accommodation is granted as required by law._ " The ** Utilization Management Representative II** is responsible for...provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer; and handles… more
- Elevance Health (Grand Prairie, TX)
- ** Utilization Management Representative I** **Location:** This role enables associates to work virtually full-time, with the exception of required in person ... **Hours:** Monday - Friday, 8am - 5pm PST The ** Utilization Management Representative I** is responsible for...and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible… more
- 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
- Veterans Affairs, Veterans Health Administration (El Paso, TX)
- …application. Former EDRP participants ineligible to apply. Responsibilities The Registered Nurse - Mental Health Intensive Case Management (MHICM) position is ... education, orientation, competencies and providing quality improvement and outcomes utilization consultation. Provides patient-centered, recovery-oriented principles, tele-mental health, community-based… more
- 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