• National Accounts Medical Director

    Elevance Health (Grand Prairie, TX)
    …to clients/ members. The medical director provides clinical expertise in all aspects of utilization review and case management . Provides input on the ... means that the medical director is directly involved in Utilization Management and Case Management ....state or territory of the United States when conducting utilization review or an appeals consideration and… more
    Elevance Health (09/23/25)
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  • Chief Medical Officer

    HCA Healthcare (San Antonio, TX)
    …issues. Offers clinical support for appeals and denials process, discharge planning, case management , and utilization review / management . + Consults with ... of quality and cost improvement and develops systems to review utilization of resources and objectively measure...facility-level staff regarding delegated utilization management and disease management operations under managed… more
    HCA Healthcare (09/20/25)
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  • Director of Performance Improvement & Risk…

    Georgetown Behavioral Health Institute (Georgetown, TX)
    …system and treatment methods, with specific knowledge and skills in areas of risk management , infection control, and utilization review ; strong oral and ... The Director of PI & Risk Management is responsible for the development, planning, coordination...responsible for developing, implementing and monitoring of a quality review program. The essential duties of the Director of… more
    Georgetown Behavioral Health Institute (09/19/25)
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  • Manager, Healthcare Services

    Molina Healthcare (TX)
    …integrated) performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical ... an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high...years in one or more of the following areas: utilization management , case management , care… more
    Molina Healthcare (09/27/25)
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  • Registered Nurse Case Manager

    HCA Healthcare (Houston, TX)
    …other third party payers in accordance with procedures set forth in the Hospital Utilization Management Plan and the criteria and standards approved by the ... extended stays in accordance with criteria approved by the Utilization Management Committee and Medical Staff with...ancillary staff on individual nursing units to promote ongoing review of patient care activities related to provision of… more
    HCA Healthcare (09/04/25)
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  • Disease Management Nurse - Remote

    Sharecare (Austin, TX)
    …change techniques, the nurse helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is ... learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… more
    Sharecare (09/13/25)
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  • Case Management Analyst - Field in Collin,…

    CVS Health (Rockwall, TX)
    …Coordinator experience required. **Preferred Qualifications** - Crisis intervention skills - Managed care/ utilization review experience - Case management and ... experience -StarKids Experience **Education** Minimum of a Bachelor's degree in Behavioral /Mental Health or related field **Anticipated Weekly Hours** 40 **Time… more
    CVS Health (10/02/25)
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  • Registered Nurse Case Manager

    HCA Healthcare (Houston, TX)
    …planning, implementation and overall evaluation of individual patient needs. Care coordination, utilization review and management , as well as discharge ... for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services...care experience required. Minimum of two (2) years of utilization review /case management experience and… more
    HCA Healthcare (09/20/25)
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  • Registered Nurse Case Manager

    HCA Healthcare (Corpus Christi, TX)
    …at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical ... work to deliver clinical excellence behind the scenes in data science, case management or transfer centers. Unlock your potential at Corpus Christi Medical Center!… more
    HCA Healthcare (08/09/25)
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  • Registered Nurse Case Manager PRN

    HCA Healthcare (Corpus Christi, TX)
    …at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical ... to help patients achieve optimal health, access to care, and appropriate utilization of resources, balanced with the patient's resources and right to… more
    HCA Healthcare (09/19/25)
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