- Evolent (Austin, TX)
- …the mission. Stay for the culture. **What You'll Be Doing:** To ensure the appropriate utilization of services act as an advocate for our members and to ensure the ... **Collaboration Opportunities** : As a Radiation Technologist in the Utilization Management department, you will work closely with other...medical necessity, the request is sent to a physician reviewer . At no time can a URN recommend an… more
- Elevance Health (Houston, TX)
- …unless an accommodation is granted as required by law._ The **Psychologist Reviewer ** is responsible for collaborating with providers and Medical Directors to ... staff and external Behavioral Health Providers to ensure appropriate and consistent utilization of plan benefits, out of network services, and clinical guidelines… more
- Health Care Service Corporation (Richardson, TX)
- …reviews in accordance with the medical contract and regulations, medical criteria, utilization review , and quality of care. **JOB REQUIREMENTS** **:** + ... not required to obtain multi-state licenses. **PREFERRED JOB REQUIREMENTS** **:** + Utilization review or utilization management experience **Telecommute:**… more
- Centene Corporation (Austin, TX)
- …appeals, and occasional peer-to-peer consultations, as well as participating in Utilization Management clinical rounds. We welcome applicants who **hold one of ... with network practitioners to provide education on best practice models and utilization management processes + Interact with the Medical Director, or designee, to… more
- Evolent (Austin, TX)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... the URN, this position is able to cover a multitude of utilization review functions through point of entry, observation progression of care management,… more
- UTMB Health (Webster, TX)
- Utilization Review Case Mgr - CMC - Clear Lake Center - Compressed weekend night shift Friday - Sunday **Webster, Texas, United States** **New** Nursing & Care ... or observation in Community Hospitals and UTMB-TDCJ Hospital. + Performs utilization review procedures by prospectively, concurrently, and retrospectively… more
- Centene Corporation (Austin, TX)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance abuse.… more
- Dallas Behavioral Healthcare Hospital (Desoto, TX)
- The Utilization Review Case Manager is responsible for working with insurance companies and managed care systems for the authorization, concurrent and ... help patients access the full range of their benefits through the utilization review process. + Conducts admission reviews. + Conducts concurrent and extended… more
- Elevance Health (Houston, TX)
- …prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer . + Responsible for the identification ... **Title: Utilization Management Representative I** **Virtual:** This role enables...responsible for coordinating cases for precertification and prior authorization review . **How you will make an impact:** + Managing… more