• Utilization Review Specialist…

    Houston Methodist (Houston, TX)
    At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse ( RN ) who comprehensively conducts ... this position is able to cover a multitude of utilization review functions through point of entry,...and/or case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… more
    Houston Methodist (11/02/25)
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  • Utilization Review Case Mgr - CMC…

    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
    UTMB Health (11/21/25)
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  • Utilization Review Specialist

    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...A. Education: Holds a current Texas license as a Registered Nurse OR a current Texas Licensed… more
    Medical Center Hospital (10/18/25)
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  • SNF Utilization Management RN…

    Humana (Austin, TX)
    …an impact** **Use your skills to make an impact** **Required Qualifications** + **​Licensed Registered Nurse ( RN )** in the (appropriate state) with no ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...in an acute care setting + Previous experience in utilization management/ utilization review for a… more
    Humana (09/12/25)
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  • Utilization Management Nurse…

    CVS Health (Austin, TX)
    …established goals and expectations. **Preferred Qualifications:** + 1+ years' experience Utilization Review experience + 1+ years' experience Managed Care ... with heart, each and every day. **Position Summary** This Utilization Management (UM) Nurse Consultant role is...sit for long periods of time. **Required Qualifications** + RN with active and unrestricted state licensure in their… more
    CVS Health (11/21/25)
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  • Care Review Clinician ( RN )

    Molina Healthcare (San Antonio, TX)
    …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... unit (ICU) or emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG… more
    Molina Healthcare (11/21/25)
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  • Care Review Clinician, PA ( RN )

    Molina Healthcare (Fort Worth, 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
    Molina Healthcare (10/26/25)
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  • Registered Nurse Case Manager

    HCA Healthcare (El Paso, TX)
    …at Las Palmas Medical Center have the opportunity to make a real impact. As a(an) Registered Nurse Case Manager you can be a part of change. **Benefits** Las ... improve positive outcomes for your patients as a (an) Registered Nurse Case Manager. We want your...review of patient medical records for purposes of utilization review , compliance with requirements of external… more
    HCA Healthcare (11/14/25)
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  • Registered Nurse Case Manager PRN

    HCA Healthcare (El Paso, TX)
    …**Are you passionate about delivering patient-centered care?** Submit your application for Registered Nurse Case Manager PRN position and spend more time ... review of patient medical records for purposes of utilization review , compliance with requirements of external...in your career! We are interviewing candidates for our Registered Nurse Case Manager PRN opening. **Apply… more
    HCA Healthcare (11/06/25)
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  • Senior Denials Mgmt Specialist

    Houston Methodist (Sugar Land, TX)
    …care for government and nongovernmental payers preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... the Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management… more
    Houston Methodist (10/29/25)
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