• Sr Service Line Clinical Value Analysis…

    Houston Methodist (Houston, TX)
    **on site- location 8100 Greenbriar, 77054** + ** Registered Nurse preferred** + ** RN with OR/Procedural experience preferred** At Houston Methodist, the ... clinicians in a financially responsible manner. Under the direction of department management and in collaboration with key stakeholders, the Clinical Value Analysis… more
    Houston Methodist (09/27/25)
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  • PRN Registered Nurse - Azura…

    Fresenius Medical Center (El Paso, TX)
    …and post procedure, under the direction of the Facility Manager and/or Charge Registered Nurse , utilizing standard nursing techniques to assist the physician in ... acting on adverse events and action thresholds in collaboration with facility management . + Maintains integrity of medical records and other FVC administrative and… more
    Fresenius Medical Center (09/23/25)
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  • Medical Claim Review Nurse ( RN )

    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. ... state/federal regulations **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:** Active, unrestricted State Registered Nursing ( RN ) license in good standing.… more
    Molina Healthcare (09/06/25)
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  • Care Review Clinician - Resident of NM or TX…

    Molina Healthcare (TX)
    …**JOB QUALIFICATIONS** **Required Education** Any of the following: Completion of an accredited Registered Nurse ( RN ), Licensed Vocational Nurse (LVN) ... medical clinic experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ), Licensed Vocational Nurse more
    Molina Healthcare (09/27/25)
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  • Care Review Clinician, Prior Authorization

    Molina Healthcare (Houston, TX)
    …**JOB QUALIFICATIONS** **Required Education** Any of the following: Completion of an accredited Registered Nurse ( RN ), Licensed Vocational Nurse (LVN) ... medical clinic experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ), Licensed Vocational Nurse more
    Molina Healthcare (09/18/25)
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  • Nurse Reviewer I

    Elevance Health (Houston, TX)
    …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... ** Nurse Reviewer I** **Location:** This role enables associates...required. **Preferred Experience, Skills, and Capabilities:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding,… more
    Elevance Health (09/26/25)
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  • Director, Clinical Systems

    Molina Healthcare (Fort Worth, TX)
    …skills. * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Registered Nurse ( RN ). License must be active and ... including design, development, implementation, and oversight of technology that drives core utilization management , care management , long-term services and… more
    Molina Healthcare (10/01/25)
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  • Care Review Clinician ( RN ) (Must reside…

    Molina Healthcare (Austin, TX)
    …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. **Required Qualifications** * At least 2… more
    Molina Healthcare (10/02/25)
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  • Quality Outcomes Specialist ( RN )

    Houston Methodist (Houston, TX)
    …+ Two years of leadership experience preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact ... care activities in a hospital setting + Two years of experience in Hospital Quality Improvement, Case Management or Utilization Management role preferred… more
    Houston Methodist (09/09/25)
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  • Transitions of Care - RN , 100% Virtual,…

    Elevance Health (TX)
    …patients with IDD and patients with special needs is preferred. + Home Health, Utilization Management or Case Management experience strongly preferred. + ... **Transitions of Care - RN , 100% Virtual, CareBridge** Location: This role enables...for participating in delivery of patient education and disease management interventions and for performing health coaching for members,… more
    Elevance Health (10/01/25)
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