• Physician Advisor | Case Management

    Houston Methodist (Houston, TX)
    … of resources. This position is a key member and leader of the hospital's utilization review / management committee, which is charged with regulatory goals of ... care, length of stay, and quality issues. + Chair the utilization review / management committee, actively participates in defining operational strategic… more
    Houston Methodist (12/26/25)
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  • Senior Director Case Management

    Houston Methodist (Houston, TX)
    …oversight for all hospital-based Case Management Directors and the Central Utilization Review Director across the system. This position is responsible for ... initiatives. + Provides strategic vision and execution for case management and utilization review across all hospitals and central departments. Establishes… more
    Houston Methodist (10/16/25)
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  • Nurse Reviewer I

    Elevance Health (Grand Prairie, 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** **Location:** This role enables associates to...required. **Preferred Skills, Capabilities and Experiences:** + Familiarity with Utilization Management Guidelines is preferred + ICD-9… more
    Elevance Health (12/31/25)
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  • Field Medical Director, Pain Management

    Evolent (Austin, TX)
    …Reviewer , Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... Will Be Doing:** + Serve as the Physician Clinical Reviewer for Interventional Pain Management , reviewing cases... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
    Evolent (12/25/25)
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  • Director Case Management & Social Services…

    Houston Methodist (Houston, TX)
    …while providing excellent customer/patient service. + Plays a leadership role in utilization review committee which includes identification of opportunities for ... and trends in the areas of care coordination, evidence- based practice, utilization management , and service excellence. Disseminates information and focuses the… more
    Houston Methodist (11/18/25)
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  • Medical Reviewer LPN

    Health Care Service Corporation (Richardson, TX)
    …to obtain multi-state licenses. **PREFERRED JOB REQUIREMENTS** **:** + Utilization review or utilization management experience **Telecommute:** This is a ... reviews in accordance with the medical contract and regulations, medical criteria, utilization review , and quality of care. **JOB REQUIREMENTS** **:** +… more
    Health Care Service Corporation (12/16/25)
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  • Medical Director - IP Claims Management

    Humana (Austin, TX)
    …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, ...with prior experience participating in teams focusing on quality management , utilization management , case … more
    Humana (12/11/25)
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  • Senior Denials Mgmt Specialist

    Houston Methodist (Sugar Land, TX)
    …Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management ... years clinical nursing/patient care experience which includes three years in utilization review , case management or equivalent revenue cycle clinical role… more
    Houston Methodist (10/29/25)
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  • Medical Director (NV)

    Molina Healthcare (TX)
    …learn new programs. Preferred Qualifications * Experience with utilization /quality program management . * Managed care experience. * Peer review experience. * ... of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies… more
    Molina Healthcare (11/21/25)
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  • Medical Director, Medical Management

    Highmark Health (Austin, TX)
    …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... and DOL regulations at all times. In addition to utilization review , the incumbent participates as the...member of the multidisciplinary team for case and disease management . They will advise the multidisciplinary team on cases,… more
    Highmark Health (11/21/25)
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