- 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
- 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
- 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
- Baylor Scott & White Health (Austin, TX)
- …Note: Benefits may vary based on position type and/or level **Job Summary** As the Utilization Review RN you will review patient cases for medical necessity ... and the provider's care coordination departments. Your expertise is needed to review medical necessity. Working with the team, you'll verify medical records reflect… 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
- Elevance Health (Grand Prairie, TX)
- …prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification ... ** Utilization Management Representative I** **Location:** This role enables...responsible for coordinating cases for precertification and prior authorization review . **How will you make an impact:** + Managing… more
- 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
- 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
- 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
- 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