• Clinical Review Nurse

    Centene Corporation (Austin, TX)
    …needed to discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member ... approve medical determinations or provide recommendations based on requested services and concurrent review findings + Assists with providing education to… more
    Centene Corporation (07/19/25)
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  • Utilization Review Nurse - Case…

    Houston Methodist (The Woodlands, TX)
    At Houston Methodist, the Utilization Review Nurse (URN) PRN position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... concurrent medical record review for medical necessity...regarding any claim issues or concerns that may require clinical review during the pre-bill, audit, or… more
    Houston Methodist (07/12/25)
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  • Nurse Manager RN Woman Services

    HCA Healthcare (Tomball, TX)
    …Tomball we support our colleagues in their positions. Join our Team as a Nurse Manager RN Women's Services and access programs to assist with every stage of ... and more affordable to gain certifications and job skills. Apply today for our Nurse Manager RN Women's Services opening and continue to learn! **Job Summary and… more
    HCA Healthcare (06/21/25)
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  • Registered Nurse Quality Coordinator

    HCA Healthcare (Houston, TX)
    …to you, we encourage you to apply for our Registered Nurse Clinical Reviewer opening. Our team will promptly review your application. Highly qualified ... in their positions. Join our Team as a(an) Registered Nurse Clinical Reviewer and access programs to...resource to Hospital and Medical Staff + Responsible for concurrent audits of patient charts. Inputs data for tracking,… more
    HCA Healthcare (07/09/25)
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  • Registered Nurse Trauma Coordinator

    HCA Healthcare (Conroe, TX)
    …database to ensure adequate documentation as required by regulatory agencies. + Complete concurrent review of cases to identify quality, timelines and systems of ... you passionate about delivering patient-centered care?** Submit your application for Registered Nurse Trauma Coordinator position and spend more time at the bedside… more
    HCA Healthcare (06/21/25)
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  • Trauma Nurse Specialist

    AdventHealth (Burleson, TX)
    …winning facility and departments including Great Place to Work by Beckers Hospital Review and Gallup. + Work with the latest technology and top experts including ... Patient Safety (PIPS) Program which include patient care coordination, improvement of clinical process through active participation in the evaluation of patient care… more
    AdventHealth (07/08/25)
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  • Manager - Case Management & Social Services

    Houston Methodist (Sugar Land, TX)
    …competent and engaged employee group by conducting regular department meetings to review policies and procedures and operational matters, rounding on all employees, ... leadership to ensure operational effectiveness and efficiency of admission, concurrent and retrospective utilization management and medical claims functions to… more
    Houston Methodist (04/24/25)
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  • Program Mgr UR/Case Management - CMC - Clear Lake…

    UTMB Health (Friendswood, TX)
    …a mechanism for the review of quality of care issues arising during concurrent review , and identifies areas of potential medical liability. + Educates the ... quality, cost, and service/outcomes. Supports and actualizes the UTMB Utilization Review /Case Management program by utilizing clinical knowledge, expertise,… more
    UTMB Health (07/22/25)
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  • Pharmacist-Part time

    Centene Corporation (Houston, TX)
    …complete for allergies, height, weight, current and past medical history, clinical laboratory results and concurrent medications (including over-the-counter or ... + Assess responses to therapy, patient compliance, and ongoing review of drug regimens; report and manage adverse events...report and manage adverse events + Assist the physician, nurse and patient with clinical and technical… more
    Centene Corporation (06/22/25)
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  • Medical Director (CT)

    Molina Healthcare (Fort Worth, TX)
    …requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care ... national, state, and local laws and regulatory requirements affecting the medical and clinical staff. MD licenses required for the following states: WA FL, MI, MS,… more
    Molina Healthcare (07/11/25)
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