• Utilization Review Nurse, 2nd shift

    Houston Methodist (Houston, TX)
    At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent ... Recent work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare, Medicaid, and Managed Care requirements… more
    Houston Methodist (08/26/25)
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  • Utilization Review Case Mgr - CMC…

    UTMB Health (Webster, TX)
    Utilization Review Case Mgr - CMC - Clear Lake Center **Webster, Texas, United States** **New** Nursing & Care Management UTMB Health Requisition # 2504557 The ... or observation in Community Hospitals and UTMB-TDCJ Hospital. + Performs utilization review procedures by prospectively, concurrently, and retrospectively… more
    UTMB Health (08/21/25)
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  • Utilization Review Assistant

    Medical Center Hospital (Odessa, TX)
    …processes, including the collection and analysis of various computer-based data related to Utilization Review , Care Coordination, and Commercial Insurance. ... + Position Summary: Assists UM Department with utilization reviews… more
    Medical Center Hospital (08/08/25)
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  • Supervisor, Care Review (RN)…

    Molina Healthcare (San Antonio, TX)
    …and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review , and/or other utilization management ... + Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of InterQual / MCG guidelines.… more
    Molina Healthcare (08/20/25)
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  • Utilization Management Administration…

    Humana (Austin, TX)
    …new systems (proficient to advanced) **Preferred Qualifications** + Experience with Utilization Review and/or Prior Authorization, preferably within a managed ... first** The UM Administration Coordinator contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities… more
    Humana (08/23/25)
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  • Sr Utiliz. Review Spclst Nurse

    Houston Methodist (Houston, TX)
    At Houston Methodist, the Sr Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) responsible for promoting the achievement of ... This position has achieved an expert level at all objectives delineated in the Utilization Review Nurse and Utilization Review Specialist Nurse job roles… more
    Houston Methodist (08/26/25)
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  • Care Review Clinician, Inpatient…

    Molina Healthcare (Houston, TX)
    …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... / MCG guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). MULTI STATE / COMPACT LICENSURE… more
    Molina Healthcare (08/20/25)
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  • Care Review Clinician, PA (RN)

    Molina Healthcare (TX)
    …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... / MCG guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT LICENSURE**… more
    Molina Healthcare (08/08/25)
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  • Non-Clinical Coding and OASIS Review

    BAYADA Home Health Care (Austin, TX)
    …+ Candidates should be available Monday-Friday from 8:30am-5:00pm. _Medicare, Coder, OASIS Review , Utilization Review , Quality Assurance, Remote, Home Health ... Home Health Care is hiring a full time OASIS Review and Coding Manager. The OASIS and Coding Review Manager provides support to all BAYADA Home Health Care… more
    BAYADA Home Health Care (08/15/25)
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  • Clinical Coding and OASIS Review Manager

    BAYADA Home Health Care (Austin, TX)
    …your career with an industry leader. Apply now for immediate consideration. OASIS Review , Utilization Review , Quality Assurance, Remote, Home Health Coding, ... Home Health Care has an immediate opening for a **Full Time,** OASIS and Coding Review Manager with OASIS and Coding certification to work remotely. RN, PT, OT, and… more
    BAYADA Home Health Care (08/15/25)
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