• Care Review Clinician - Resident of NM…

    Molina Healthcare (TX)
    **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN (preferred) or LPN with a compact license who resides in New Mexico or Texas. This team ... Education** Any of the following: Completion of an accredited Registered Nurse ( RN ), Licensed Vocational...social work or clinical counselor (for Behavioral Health Care Review Clinicians only). **Required Experience** 1-3 years of hospital… more
    Molina Healthcare (09/27/25)
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  • Care Review Clinician, Prior Authorization

    Molina Healthcare (Houston, TX)
    …**JOB QUALIFICATIONS** **Required Education** Any of the following: Completion of an accredited Registered Nurse ( RN ), Licensed Vocational Nurse (LVN) ... medical clinic experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ), Licensed Vocational Nurse … more
    Molina Healthcare (09/18/25)
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  • Utilization Management Nurse

    Actalent (Houston, TX)
    Clinical Review Nurse ( Utilization Management) 100% Remote Job Description The role of the Utilization Management Nurse involves performing ... setting of care. Essential Skills + 2+ years of utilization management experience + Active Texas RN ...+ Bachelor's or Associate's degree in Nursing. + Texas Registered Nurse License. + Strong multitasking and… more
    Actalent (09/19/25)
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  • Registered Nurse Case Manager

    HCA Healthcare (Houston, TX)
    …service organizations, agencies and healthcare facilities. **What qualifications you will need:** + ( RN ) Registered Nurse + Associate Degree, or Bachelors ... from any other healthcare provider. We are seeking a(an) Registered Nurse Case Manager to join our...and overall evaluation of individual patient needs. Care coordination, utilization review and management, as well as… more
    HCA Healthcare (09/20/25)
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  • Case Manager, Registered Nurse…

    CVS Health (Austin, TX)
    …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse 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
    CVS Health (08/15/25)
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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 (07/31/25)
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  • Director Case Management & Social Services…

    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
    Houston Methodist (08/20/25)
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  • Registered Nurse RN Case…

    HCA Healthcare (Webster, TX)
    …Healthcare Clear Lake we support our colleagues in their positions. Join our Team as a(an) Registered Nurse RN Case Manager PRN and access programs to assist ... gain certifications and job skills. Apply today for our Registered Nurse RN Case Manager...utilization **What qualifications you will need:** + Current Registered Nurse License in the State of… more
    HCA Healthcare (08/31/25)
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  • Care Manager RN

    Covenant Health (Lubbock, TX)
    …**Required Qualifications:** + Associate's Degree - Nursing degree/diploma upon hire + Texas Registered Nurse License upon hire - if practicing within this ... **Description** **Care Manager RN ** **The Care Manager RN provides...Inpatient setting. + IRR or annual competency testing in Utilization Review . **Preferred Qualifications:** + Bachelor's Degree… more
    Covenant Health (09/24/25)
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  • Registered Nurse RN Case…

    HCA Healthcare (Tomball, TX)
    …Healthcare Tomball we support our colleagues in their positions. Join our Team as a(an) Registered Nurse RN Case Manager PRN and access programs to assist ... gain certifications and job skills. Apply today for our Registered Nurse RN Case Manager...utilization **What qualifications you will need:** + Current RN License in the State of Texas or Multi-State… more
    HCA Healthcare (09/25/25)
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