- CVS Health (Austin, TX)
- …care. + Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse ( RN ) with at least 1 year of experience ... in a hospital setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- 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
- HCA Healthcare (El Paso, TX)
- …set us apart from any other healthcare provider. We are seeking a(an) Registered Nurse Rehabilitation Case Manager to join our healthcare family. **Benefits** ... - and empowers their passion for patient care. Apply today for our Registered Nurse Rehabilitation Case Manager opportunity. **Job Summary and Qualifications**… more
- Houston Methodist (Houston, TX)
- …with HM performance that demonstrates leadership responsibility **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... while providing excellent customer/patient service. + Plays a leadership role in utilization review committee which includes identification of opportunities for… more
- CenterWell (Lubbock, TX)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- Molina Healthcare (Fort Worth, TX)
- **JOB DESCRIPTION** For this position we are seeking a ( RN ) Registered Nurse who must be licensed for the state they reside This position will support ... Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support,… more
- Prime Healthcare (Mesquite, TX)
- Overview We are seeking an RN Case Manager , also referred to as a Registered Nurse Case Manager or RN Clinical Case Manager . An RN Case Manager ... RN Case Managers also conduct discharge planning, utilization review , and helping patients navigate insurance...an accredited school of nursing and a current state Registered Nurse license. Additional Required Knowledge, Skills… more
- CVS Health (Austin, TX)
- …it all with heart, each and every day. **Position Summary** This Case Manager - Registered Nurse ( RN ) position is with Aetna's National Medical Excellence ... to apply, however, preference is for candidates in compact Registered Nurse ( RN ) states. This...is a blended role doing both Case Management and Utilization Management. The RN Case Manager is… more
- Amergis (Temple, TX)
- …develops care plans, and evaluates patient progress. + Integrates case management, utilization review , and discharge planning to enhance care quality and ... Salary: $2126 / Week The RN Case Manager is responsible for coordinating continuum...of care activities for assigned patients and ensuring optimum utilization of resources, service delivery, and compliance with medical… more
- Fresenius Medical Center (Marble Falls, TX)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more