- Evolent (Austin, TX)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- MTC (Raymondville, TX)
- …The **El Valle Detention Facility in Raymondville, TX** is seeking a dedicated RN to provide compassionate care and support to individuals in our detention center. ... use of appropriate sanitation methods. + Practice basic cost containment and utilization management for detainee care and facility operations. + Maintain absolute… more
- Molina Healthcare (Houston, TX)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual… more
- UTMB Health (Webster, TX)
- Utilization Review Case Mgr - CMC...**_REQUIRED EDUCATION/EXPERIENCE_** **:** + Current Texas licensure as a Registered Nurse ( RN ).with a minimum ... observation in Community Hospitals and UTMB-TDCJ Hospital. + Performs utilization review procedures by prospectively, concurrently, and...transfers and admissions from the prison facility. + Conducts nurse to nurse conference calls for all… more
- CenterWell (Austin, TX)
- …and the healthcare industry as a whole. Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed ... medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part...skills to make an impact** **Role Essentials** + Active RN license + Possession of or ability to obtain… more
- Houston Methodist (Sugar Land, TX)
- …experience + Occupational health nursing experience preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... At Houston Methodist, the Occupational Health Nurse PRN position provides expert, integrated, cost-effective, quality patient care through the coordination of… more
- Molina Healthcare (San Antonio, TX)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/medical reviews of previously denied… more
- Molina Healthcare (Dallas, TX)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual… more
- HCA Healthcare (Dallas, TX)
- …1 weekend shift. Shift length may vary and could be from 6-8 hours *_** The Registered Nurse ( RN ) CM is responsible for promoting patient-centered care by ... from any other healthcare provider. We are seeking an RN Case Manager PRN Inpatient Rehab to join our...pertaining to federally funded programs as they relate to utilization review , discharge planning and financial reimbursement.… more
- Select Medical (Fort Worth, TX)
- …State RN License required. + Two or more years of experience as a Registered Nurse ; one or more years experience in a managerial or supervisory capacity is ... May Apply** **Responsibilities** Under the direction of the Chief Nursing Officer (CNO)/ Nurse Manager (if position applies within hospital), the Nurse Supervisor… more