- Houston Methodist (The Woodlands, TX)
- …state, local and federal programs + Comprehensive knowledge of discharge planning, utilization management , case management , performance improvement and ... is a registered nurse (RN) responsible for comprehensively planning for case management of a targeted patient population on a designated unit(s) and/or service… more
- Houston Methodist (Nassau Bay, TX)
- …state, local and federal programs + Comprehensive knowledge of discharge planning, utilization management , case management , performance improvement and ... position is a licensed registered nurse (RN) who comprehensively plans for case management of a target patient population on a designated unit(s). This position… more
- Highmark Health (Austin, TX)
- …triaging members to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, ... Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or… more
- Molina Healthcare (San Antonio, TX)
- …member care. Essential Job Duties * Performs audits of non-clinical staff in utilization management , care management , member assessment, and/or other teams ... Required Qualifications * At least 2 years health care experience, preferably in utilization management , care management , and/or managed care, or equivalent… more
- Evolent (Austin, TX)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management … more
- Houston Methodist (Nassau Bay, TX)
- …state, local and federal programs + Progressive knowledge of discharge planning, utilization management , case management , performance improvement and managed ... is a registered nurse (RN) responsible for comprehensively planning for case management , which includes care transitions and discharge planning of a targeted patient… more
- Centene Corporation (Austin, TX)
- …preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN - ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- 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
- CVS Health (Austin, TX)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... training.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health....lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- Health Care Service Corporation (Richardson, TX)
- …clinical staff involved in a variety of behavioral health clinical operations such as Utilization Management , Case Management and/or Disease Management . ... experience (post licensure) with direct clinical care to the consumer. + 2 years utilization review / managed care experience. + Leadership skills. + Knowledge of… more
Recent Jobs
-
Educational Technology Specialist
- Research Foundation CUNY (New York, NY)
-
Director of the Industrial Claims & Appeals Office
- State of Colorado (Denver, CO)
-
Health Support Specialist
- MyFlorida (Yulee, FL)
-
Nurse Practitioner (NNP Certified), Physician Assistant or Clinical Nurse Specialist - Pediatric Neonatal ICU III Part-Time
- Cleveland Clinic (Akron, OH)