• Case Manager Certified - Transition in Care

    Houston Methodist (The Woodlands, TX)
    At Houston Methodist, the Case Manager (CM) Certified position is a registered nurse (RN) responsible for comprehensively planning for case management of a targeted ... engagement, ie peer-to-peer accountability. **SERVICE ESSENTIAL FUNCTIONS** + Performs review for medical necessity of admission, continued stay and resource… more
    Houston Methodist (10/11/25)
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  • Director of Nursing Throughput

    HCA Healthcare (Austin, TX)
    …and improve the patient flow program effectiveness as it relates to utilization review , resource management, and discharge planning and care coordination. ... leader to physicians and employees as it relates to utilization review , resource management and patient flow....program preferred + Currently licensed as a registered professional nurse in the state(s) of practice and/or has an… more
    HCA Healthcare (12/07/25)
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  • Director of Clinical Informatics

    HCA Healthcare (Dallas, TX)
    …related to the electronic health record (EHR) including: + standardization + utilization + integration + optimization The DCI is responsible for development, ... AND DUTIES:** + Implementation and support of facility-wide standardization, utilization , integration, and optimization activities related to the EHR and… more
    HCA Healthcare (10/30/25)
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  • Care Manager RN (Delaware)

    Highmark Health (Austin, TX)
    …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... care services, application of criteria to ensure appropriate resource utilization , identification of opportunities for referral to a Health Coach/case management,… more
    Highmark Health (12/12/25)
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  • PRN UR Coordinator

    San Antonio Behavioral Health (San Antonio, TX)
    The Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors ... from insurers. Responsible for monitoring adherence to the hospital's utilization review plan to ensure the effective...Essential Duties: + Collaborate and set standards with registered nurse (RN) case managers (CMs) and outcome managers to… more
    San Antonio Behavioral Health (11/26/25)
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  • Supv Comprehensive Care RN

    Baylor Scott & White Health (College Station, TX)
    …coordinating patient care across the continuum to include case management, social work, utilization review and care coordination to achieve optimal clinical and ... FACTORS** Knowledge of Care Coordination, discharge planning, case management and utilization review . Knowledge of human behavior and performance; individual… more
    Baylor Scott & White Health (10/25/25)
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  • Case Manager - Inpatient Rehab - PRN

    Texas Health Resources (Dallas, TX)
    …available resources. Assesses patient information utilizing psychological and medical knowledge. Utilization Review and Management * Performs effective ... case management experience is preferred. * RN - Registered Nurse Upon Hire Req or LMSW - Licensed Master...utilization review according to department identified criteria to determine the… more
    Texas Health Resources (10/23/25)
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  • Payment Integrity Clinician

    Highmark Health (Austin, TX)
    …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
    Highmark Health (11/14/25)
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  • Denials Prevention Specialist, Clinician PRN

    Datavant (Austin, TX)
    …healthcare. The purpose of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical ... expertise successfully. Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in...letter Identification of referrals to the medical director for review + Select appropriate preferred and contracted providers +… more
    Datavant (11/12/25)
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  • Coding Quality Auditor, HEDIS *Remote - Many…

    Providence (Plainview, TX)
    …in a medical record. + 2 years - HEDIS, Quality management/quality improvement/ utilization review auditing experience, including experience in auditing within ... and Data Information Set (HEDIS) program + Conduct Audits inclusive of review of outpatient medical records, hospital records, clinical lab and pharmacy records… more
    Providence (12/04/25)
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