• Utilization Review Nurse…

    Houston Methodist (Sugar Land, TX)
    At Houston Methodist, the Utilization Review Nurse (URN) PRN position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact Licensure -...work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare,… more
    Houston Methodist (08/20/25)
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  • Utilization Review Case Mgr - CMC…

    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
    UTMB Health (08/21/25)
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  • Utilization Management Nurse

    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
    CenterWell (08/02/25)
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  • Care Review Clinician, Prior Auth (RN) Pega…

    Molina Healthcare (Houston, TX)
    …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or medical… more
    Molina Healthcare (07/12/25)
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  • Registered Nurse Case Manager

    HCA Healthcare (Houston, TX)
    …us apart from any other healthcare provider. We are seeking a(an) Registered Nurse Case Manager to join our healthcare family. **Benefits** The Woman's Hospital of ... nurses play a vital part. We know that every nurse 's path and purpose is unique. Do you want...in accordance with procedures set forth in the Hospital Utilization Management Plan and the criteria and standards approved… more
    HCA Healthcare (08/10/25)
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  • Registered Nurse , Community Living Center…

    Veterans Affairs, Veterans Health Administration (Big Spring, TX)
    …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... period. The duties and responsibilities for the Community Living Center, Registered Nurse include, but are not limited to the following: Provide competent,… more
    Veterans Affairs, Veterans Health Administration (07/31/25)
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  • Clinical Reviewer, Nurse

    Evolent (Austin, TX)
    …a mission with a company behind it. **What You'll Be Doing:** As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can ... better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer, Nurse , you will routinely interact with leadership and management...You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases, which do not… more
    Evolent (08/19/25)
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  • Clinical Reviewer, Nurse -Surgery

    Evolent (Austin, TX)
    …for the mission. Stay for the culture. **What You'll Be Doing:** As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We ... better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer, Nurse , you will routinely interact with leadership and management...You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases, which do not… more
    Evolent (08/19/25)
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  • Registered Nurse - Special Procedures…

    Veterans Affairs, Veterans Health Administration (Austin, TX)
    …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... education, orientation, competencies and providing quality improvement and outcomes utilization . Demonstrates leadership in delivering and improving holistic, specialty… more
    Veterans Affairs, Veterans Health Administration (08/22/25)
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  • Registered Nurse - Mental Health Intensive…

    Veterans Affairs, Veterans Health Administration (El Paso, TX)
    …determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply. ... Responsibilities The Registered Nurse - Mental Health Intensive Case Management(MHICM) position is responsible for providing competent, evidence-based care to… more
    Veterans Affairs, Veterans Health Administration (08/15/25)
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