• Payment Integrity Clinician

    Highmark Health (Austin, TX)
    …itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education ... education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment and… more
    Highmark Health (11/14/25)
    - Related Jobs

  • Certified Medication Aide - Crain Unit

    UTMB Health (Waco, TX)
    …Testing. + Assists with patient activities and care as assigned by the charge nurse /designee as indicated by the patient's plan of care. + Provides for patients' ... at all times. + Practices basic cost containment and utilization management for patient care and facility operations. +...extended or alternate shifts in situations deemed necessary by nurse manager. + Able to work under stress and… more
    UTMB Health (12/30/25)
    - Related Jobs

  • RN Float Pool Nights

    Baylor Scott & White Health (Waxahachie, TX)
    …White Health, your well-being is our top priority. **JOB SUMMARY** The Registered Nurse (RN) Float is a licensed professional who uses the BSWH nursing professional ... nursing sensitive indicators. Supports evidence-based practice changes through research utilization and experiential learning. Participates in quality/performance improvement initiatives.… more
    Baylor Scott & White Health (12/29/25)
    - Related Jobs

  • RN CVOR

    Baylor Scott & White Health (Dallas, TX)
    …3 - 12, 7:00am -7:00pm call requirement The Operating Room (OR) Registered Nurse (RN) is a licensed professional who uses the BSWH nursing professional practice ... nursing delicate indicators. Helps evidence-based practice changes through research utilization and experiential learning. Participates in quality/performance improvement initiatives.… more
    Baylor Scott & White Health (12/29/25)
    - Related Jobs

  • Pre/Post Cath Lab RN PRN

    Baylor Scott & White Health (College Station, TX)
    …PRN, 1-2 shifts every 6 weeks** **JOB SUMMARY** The Cath Lab Registered Nurse (RN) is a licensed professional who uses the BSWH nursing professional practice ... nursing delicate indicators. Helps evidence-based practice changes through research utilization and experiential learning. Participates in quality/performance improvement initiatives.… more
    Baylor Scott & White Health (12/28/25)
    - Related Jobs

  • Care Review Clinician (RN)

    Molina Healthcare (TX)
    For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity of high ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At least 2… more
    Molina Healthcare (12/24/25)
    - Related Jobs

  • RN Labor and Delivery Night PRN

    Baylor Scott & White Health (Lakeway, TX)
    …balance, evidenced based best practices, and AWHONN standards.** **JOB SUMMARY** The Registered Nurse (RN) Unit PRN is a licensed professional who uses the BSWH ... nursing sensitive indicators. Supports evidence-based practice changes through research utilization and experiential learning. Participates in quality/performance improvement initiatives.… more
    Baylor Scott & White Health (12/23/25)
    - Related Jobs

  • Behavioral Health Care Coordinator

    Health Care Service Corporation (Richardson, TX)
    …to acute in-patient to out-patient office visits. **JOB REQUIREMENTS:** *Registered Nurse (RN) or Masters-level Behavioral Health Professional (LPC, LMFT, LCSW, ... skills. *PC and database experience. **PREFERRED JOB REQUIREMENTS:** * Utilization review experience. *MUST be licensed to practice at...years) at the independent practice level *If a Registered Nurse (RN): must have at least 3 years psychiatric… more
    Health Care Service Corporation (12/23/25)
    - Related Jobs

  • RN Emergency Dept Night

    Baylor Scott & White Health (Lakeway, TX)
    …access to laboratory, X-ray and surgical services.** **JOB SUMMARY** The Registered Nurse (RN) is a licensed professional who uses the BSWH nursing professional ... nursing sensitive indicators. Supports evidence-based practice changes through research utilization and experiential learning. Participates in quality/performance improvement initiatives.… more
    Baylor Scott & White Health (12/23/25)
    - Related Jobs

  • Patient Navigator RN

    Baylor Scott & White Health (Temple, TX)
    …for places that are difficult to locate. Assists with on-boarding new nurse navigators to the program. **KEY SUCCESS FACTORS** Strong leadership, decision making ... and delegation skills. Knowledge of care management, resource and utilization management. Skilled in care management and patient assessments. Excellent verbal and… more
    Baylor Scott & White Health (12/23/25)
    - Related Jobs