• 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 ... 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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  • Registered Nurse Clinical…

    HCA Healthcare (Round Rock, TX)
    …Center we support our colleagues in their positions. Join our Team as a(an) Registered Nurse Clinical Informatics Coordinator and access programs to assist with ... more affordable to gain certifications and job skills. Apply today for our Registered Nurse Clinical Informatics Coordinator opening and continue to learn! **Job… more
    HCA Healthcare (08/09/25)
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  • Clinical Documentation Specialist RN

    Houston Methodist (Houston, TX)
    … utilization review experience preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- Compact ... At Houston Methodist, the Clinical Documentation Specialist is responsible for improving the overall quality and completeness of clinical documentation. This… more
    Houston Methodist (08/13/25)
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  • Appeals and Grievances Clinical Specialist…

    Healthfirst (TX)
    …in clinical practice with experience in appeals & grievances, claims processing, utilization review or utilization management/case management. + Demonstrated ... and Suspension of services. The end-to-end process requires the Specialist to independently: + Research issues + Quality of...understanding of Utilization Review Guidelines (NYS ART 44 and 49 PHL), InterQual,… more
    Healthfirst (08/19/25)
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  • Senior Denials Mgmt Specialist

    Houston Methodist (Sugar Land, TX)
    …Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management and ... clinical nursing/patient care experience which includes three years in utilization review , case management or equivalent revenue...nongovernmental payers preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse -… more
    Houston Methodist (07/31/25)
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  • Clinical Manager RN Sign On Bonus

    HCA Healthcare (San Antonio, TX)
    …DeterminationsSupervisory experience preferredCertifications, Licenses, and other Special RequirementsCurrent/Active Registered Nurse ( RN ) License within ... regarding deficiencies or OASIS corrections (with feedback from Quality Review Specialist ) to ensure the medical records...we encourage you to apply for our Clinical Manager RN opening. We promptly review all applications.… more
    HCA Healthcare (06/21/25)
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  • Occupational Health RN PRN (Flu Vaccination…

    Houston Methodist (Sugar Land, TX)
    …experience + Occupational health nursing experience preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... Health Nurse (ABOHN) **OR** + COHN/S - Certified Occupational Health Nurse Specialist (ABOHN) **KNOWLEDGE, SKILLS, AND ABILITIES** + Demonstrates the skills… more
    Houston Methodist (07/25/25)
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  • Occupational Health RN PRN - Temporary Flu…

    Houston Methodist (Houston, TX)
    …experience + Occupational health nursing experience preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure -- ... Health Nurse (ABOHN) **OR** + COHN/S - Certified Occupational Health Nurse Specialist (ABOHN) **KNOWLEDGE, SKILLS, AND ABILITIES** + Demonstrates the skills… more
    Houston Methodist (07/12/25)
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  • Clinical Appeals Nurse ( RN )

    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 (08/15/25)
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  • Clinical Pharmacist Specialist BMT

    HCA Healthcare (Dallas, TX)
    …this opportunity compelling, we encourage you to apply for our Clinical Pharmacist Specialist BMT opening. We promptly review all applications. Highly qualified ... **Description** **Clinical Pharmacist Specialist BMT** **Full Time Day Shift Position, rotating...in daily multidisciplinary and bedside rounds + Completes drug utilization reviews to promote rational drug therapy and implement… more
    HCA Healthcare (07/14/25)
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