• 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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  • 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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  • Specialist, Digital Asset Management

    Merck (Austin, TX)
    …Content Creation, Copyright Compliance, Customer Journey Mapping, Customer Relationship Management (CRM) Utilization , Data Analysis, Design Thinking, ... **Job Description** The US Human Health Global Headquarters (HH GHQ) Asset Management Specialist's scope spans over three primary areas: + Responsible for approving… more
    Merck (01/08/26)
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  • Physician, Radiologist/Mammographer with EDRP…

    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 ... in the FPPE/OPPE process. Adhere to employee health requirements. Participate in peer review process. Time/Leave Management : Adhere to tour of duty. Timely… more
    Veterans Affairs, Veterans Health Administration (10/28/25)
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