• Utilization Review Specialist…

    Houston Methodist (Sugar Land, 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,...in case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… more
    Houston Methodist (07/29/25)
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  • Utilization Review Nurse

    Houston Methodist (Houston, TX)
    At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse ( RN ) who comprehensively conducts point of entry ... in case management **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -...work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare,… more
    Houston Methodist (07/25/25)
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  • Supervisor, Care Review ( RN )

    Molina Healthcare (Fort Worth, TX)
    …and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review , and/or other utilization management ... leadership skills. **Required License, Certification, Association** + Active, unrestricted State Registered Nursing ( RN ) in good standing. + MULTI STATE… more
    Molina Healthcare (07/27/25)
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  • Care Review Clinician, PA ( RN )

    Molina Healthcare (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 (08/08/25)
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  • Medical Claim Review Nurse

    Molina Healthcare (San Antonio, TX)
    …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... state/federal regulations **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:** Active, unrestricted State Registered Nursing ( RN ) license in good standing.… more
    Molina Healthcare (08/08/25)
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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 (07/17/25)
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  • Concurrent Review Nurse

    Actalent (Houston, TX)
    …case management, and discharge planning. + Proficiency with InterQual. + Active Compact RN License. + Utilization Management/Concurrent Review experience. + ... Job Title: Review Nurse Job Description The ...Job Title: Review Nurse Job Description The Review ...Skills + Experience in utilization management, concurrent review , prior authorization, utilization review ,… more
    Actalent (08/08/25)
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  • Care Review Clinician, Inpatient…

    Molina Healthcare (Houston, TX)
    **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in the state of Texas. You will be hired to join the inpatient review team doing ... acute care/medical experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. Must… more
    Molina Healthcare (08/08/25)
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  • Clinical Coding and OASIS Review Manager

    BAYADA Home Health Care (Austin, TX)
    …your career with an industry leader. Apply now for immediate consideration. OASIS Review , Utilization Review , Quality Assurance, Remote, Home Health Coding, ... immediate opening for a **Full Time,** OASIS and Coding Review Manager with OASIS and Coding certification to work...Manager with OASIS and Coding certification to work remotely. RN , PT, OT, and SLP's with certifications will be… more
    BAYADA Home Health Care (07/01/25)
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  • Program Mgr UR/Case Management - CMC - Clear Lake…

    UTMB Health (Friendswood, TX)
    …from an accredited school of Professional Nursing + Current Texas Nursing Licensure as a Registered Nurse ( RN ). + Minimum of five (5) years full-time wage ... quality, cost, and service/outcomes. Supports and actualizes the UTMB Utilization Review /Case Management program by utilizing clinical...earning experience as a professional nurse in a healthcare setting with at least two… more
    UTMB Health (08/01/25)
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