• Physician (Diagnostic Radiologist)…

    Veterans Affairs, Veterans Health Administration (San Antonio, TX)
    …will be responsible for establishing imaging protocols; reviewing imaging requests; utilization management ; ensuring appropriate preps and medication are ... section, service or facility level committees/boards, when assigned. Serve as Peer Reviewer for the Protected Peer Review Committee, when assigned. Demonstrate… more
    Veterans Affairs, Veterans Health Administration (10/30/25)
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  • Case Manager Registered Nurse

    CVS Health (Austin, TX)
    …is subject to change based on business needs. **Preferred Qualifications** 6+ months Case Management or Utilization Management experience Case Management ... responsible for telephonically assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the… more
    CVS Health (01/01/26)
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  • VP & Medical Director

    Travelers Insurance Company (Austin, TX)
    …skills **What is a Must Have?** + Licensed MD + 5 years clinical and utilization management experience + Certified by the American Board of Medical Specialties ... to keep Travelers at the leading edge of the P&C industry. Develop medical management strategies that help injured employees return to work as soon as medically… more
    Travelers Insurance Company (10/24/25)
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  • Care Review Clinician (RN)

    Molina Healthcare (TX)
    …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member… more
    Molina Healthcare (12/24/25)
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  • Clinical Review Clinician - Appeals

    Centene Corporation (Austin, TX)
    …Knowledge of NCQA, 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
    Centene Corporation (01/09/26)
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  • Registered Nurse

    MTC (Livingston, TX)
    …the use of appropriate sanitation methods. + Practice basic cost containment and utilization management for detainee care and facility operations. + Maintain ... plan **Make a Difference Where It Matters!** Operated by Management & Training Corporation, the **IAH Detention Facility in...of all medical records. Observe applicable HIPAA rules. + Review medical files to determine all provided services are… more
    MTC (01/03/26)
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  • Field Medical Director, Oncology

    Evolent (Austin, TX)
    review roles that emphasize volume throughput, this position integrates utilization management with collaborative engagement and innovation. **Core ... Responsibilities** + **Clinical Review & Peer Collaboration** + Serve as the physician reviewer for oncology cases that do not initially meet medical necessity… more
    Evolent (12/18/25)
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  • Business Analyst Senior - Remote

    Prime Therapeutics (Austin, TX)
    …community settings and Pharmacy benefit management (PBM) experience in clinical utilization management Every employee must understand, comply with and attest ... result + Demonstrated verbal, written communication, facilitation skills, conflict management , consensus building, problem solving, analytical skills, and creative… more
    Prime Therapeutics (01/07/26)
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  • Registered Nurse III

    MTC (Raymondville, TX)
    …the use of appropriate sanitation methods. + Practice basic cost containment and utilization management for detainee care and facility operations. + Maintain ... of all medical records. Observe applicable HIPAA rules. + Review medical files to determine all provided services are...with an acceptable driving record required, unless waived by management . Management & Training Corporation (MTC) is… more
    MTC (01/01/26)
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  • Clinical Account Director - Remote

    Prime Therapeutics (Austin, TX)
    …specific clinical programs and drug strategy recommendations including drug formulary, Utilization Management programs, and other drug therapy related products ... stakeholders through effective consultative services. **Responsibilities** + Coordinate formulary management for the client including, client specific Pharmacy &Therapeutics… more
    Prime Therapeutics (12/07/25)
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