• Manager, Business Standards and Oversight

    Centene Corporation (Austin, TX)
    …STRONGLY PREFERRED **Position Purpose:** Provides regulatory and contractually required document management oversight the Utilization Management , Care ... 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 (10/16/25)
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  • Field Reimbursement Manager

    Amgen (San Antonio, TX)
    …+ Offer office education during the access process, including formulary coverage/ utilization management criteria, insurance forms & procedures, benefits ... through payer prior authorization to appeals/denials requirements and forms + Review patient-specific information in cases where the site has specifically requested… more
    Amgen (10/02/25)
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  • Clinical Integrity Pharmacist- REMOTE

    Prime Therapeutics (Austin, TX)
    …with a health plan + Prior client-facing experience + Prior experience with utilization management + Strong MS Office skills, experience with databases and ... teams. + Triages clinical requests for existing and prospective opportunities for review and prioritization + Contribution and coordination of clinical team support… more
    Prime Therapeutics (09/27/25)
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  • Pharmacist

    Actalent (Texas City, TX)
    …Your main role will be utilizing your clinical skills to complete utilization management reviews (Prior authorizations, Coverage Exceptions, Quantity Limit ... may be an opportunity after peak season to complete training for and review specialized cases (ex: oncology, hepatitis C, and other complex conditions). +… more
    Actalent (10/13/25)
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  • Medical Director

    Health Care Service Corporation (Richardson, TX)
    …experience + Hematology and Oncology experience + Peer to peer experience + Utilization Management / review experience **This is a Telecommute (Remote) role: ... Must reside withing 250 miles of the office or anywhere within the posted state.** **Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!** **Pay Transparency Statement:** At Health Care Service… more
    Health Care Service Corporation (10/08/25)
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  • Medical Director - Medicare Grievances and Appeals…

    Humana (Austin, TX)
    …focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience, + working with health insurance ... of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents Humana at Administrative… more
    Humana (10/02/25)
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  • Medical Authorization Splst

    Methodist Health System (Dallas, TX)
    …works with physicians, clinic support staff, case managers, nurses, insurance utilization management staff, and patients to initiate pre-authorization and ... resolve issues that arise during the prior authorizations process. Supports and promotes the vision, mission, and strategic plans of Methodist Health System Your Job Requirements: * High School Graduate or equivalent. Some college preferred * 1 year of prior… more
    Methodist Health System (09/20/25)
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  • Corporate Medical Director - Medicare Grievances…

    Humana (Austin, TX)
    …focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience + Working with health insurance ... first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate Medical Director works on… more
    Humana (09/05/25)
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  • Telephonic Nurse Case Manager Senior

    Elevance Health (Grand Prairie, TX)
    …with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures, chairs and schedules meetings, as ... be required.** The **Telephonic Nurse Case Manager Senior** is responsible for care management within the scope of licensure for members with complex and chronic… more
    Elevance Health (10/18/25)
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  • Nurse Case Manager II

    Elevance Health (Grand Prairie, TX)
    …with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum requirements:** + Requires ... the criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care… more
    Elevance Health (10/16/25)
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