- Humana (Austin, TX)
- …**3+ years of Skilled Nursing Facility experience and or Previous experience in utilization management** + Prior clinical experience preferably in an acute care, ... part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to support the… more
- Molina Healthcare (Houston, TX)
- …standing. **Preferred Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and ... and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare… more
- Molina Healthcare (Dallas, TX)
- …family include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... comply with CMS guidelines. These staff may also be involved in providing utilization management/ prior authorization services as needed. * Supervises the unit's… more
- Evolent (Austin, TX)
- …and stakeholders. + Familiarity with healthcare claims, reimbursement methodologies, and cost/ utilization KPIs, including prior authorization data and key ... : Analyze healthcare claims and authorization data to identify cost drivers, utilization trends, and population health opportunities using SAS, SQL, Excel, and Power… more
- Elevance Health (Grand Prairie, TX)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management, and/or call center ... unrestricted RN license in applicable state(s) required. + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care… more
- CVS Health (Austin, TX)
- …review, and appeal request. This position is primarily responsible for Utilization Management, including prior authorization and precertification as well ... - Family Medicine, Emergency Medicine, Internal Medicine-Pediatrics Specialty Preferred. - Prior UM experience working at Health Plan / Insurer or experience… more
- Evolent (Austin, TX)
- …with health care software development methodologies and lifecycles + Experience with utilization management and/or prior authorization processes is preferred + ... and implement intuitive, efficient, and engaging user interfaces for our Utilization Management health care workflow applications. User research and design system… more
- Houston Behavioral Healthcare Hospital (Houston, TX)
- …Healthcare Hospital (HBHH) currently has an opening for Full-time Lead Utilization Management Coordinator, Monday-Friday, 8a-4p. The Lead Utilization Management ... Coordinator will report to the Director of Utilization Review and will be responsible to provide quality...1 year experience in a medical related field and/or prior authorization experience preferred. 3 years behavioral health experience… more
- CenterWell (Austin, TX)
- …Nursing License + A minimum of three years clinical RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare +… more
- CenterWell (Austin, TX)
- …Nursing License + A minimum of three years clinical RN experience; + Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization ... procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare/Medicaid… more