- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of ... this position is able to cover a multitude of utilization review functions through point of entry,...**LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure -… more
- Baylor Scott & White Health (Dallas, TX)
- **JOB SUMMARY** The Utilization Review Registered Nurse (RN) provides a clinical review of cases using medical necessity criteria to determine the ... outpatients) or type of service. Alerts and collaborates with appropriate Utilization Review , Physician leadership and/or Provider Team personnel concerning… more
- CenterWell (Austin, TX)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more
- CenterWell (Austin, TX)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to… more
- UTMB Health (Webster, TX)
- Utilization Review Case Mgr - CMC -...transfers and admissions from the prison facility. + Conducts nurse to nurse conference calls for all infirmary ... or observation in Community Hospitals and UTMB-TDCJ Hospital. + Performs utilization review procedures by prospectively, concurrently, and retrospectively… more
- Medical Center Hospital (Odessa, TX)
- + Position Summary: The Utilization Review Specialist/Outcomes Specialist conducts concurrent and retrospective review functions in support of the hospital ... Utilization Review Program and makes appropriate referrals to designated Physician...Education: Holds a current Texas license as a Registered Nurse OR a current Texas Licensed Vocational Nurse… more
- Centene Corporation (Austin, TX)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance abuse.… more
- Health Care Service Corporation (Richardson, TX)
- …decision making skills.** **PC and database experience.** **PREFERRED JOB REQUIREMENTS:** ** Utilization review experience.** **3 years clinical experience in ... Summary** This position is responsible for ensuring accurate and timely clinical review of behavioral health cases (Applied Behavior Analysis (ABA)) for medical… more
- Humana (Austin, TX)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Elevance Health (Grand Prairie, TX)
- …Finder and follows up with provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. + ... ** Utilization Management Representative II** **Virtual:** This role enables...Processes incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and… more