- CenterWell (Austin, TX)
- …our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical ... **Required Qualifications** + Must be a licensed Registered Compact Nurse license (RN) with no disciplinary action and ability...Lung or Critical Care Nursing experience required + Prior clinical experience preferably in an acute care, skilled or… more
- Molina Healthcare (Houston, TX)
- …**Job Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for verifying that services ... are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through… more
- CVS Health (TX)
- … Nurse Consultant** Fully Remote- WFH- 8A-5P in EST or CST **Position Summary** UM Nurse Consultant Utilizes clinical experience and skills in a ... options to facilitate appropriate healthcare services/benefits for members. Gathers clinical information and applies the appropriate clinical criteria/guideline,… more
- Evolent (Austin, TX)
- …coordinating with UM staff to ensure timely and accurate communication of clinical decisions. + Responsible for completion of UM projects and participation ... the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Practitioner/Physician Assistant (ARNP/NP/PA) Vascular Surgey is responsible for support and… more
- Evolent (Austin, TX)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member...medical management activities in a managed care environment + UM /UR experience + Clinical experience in Oncology,… more
- Actalent (San Antonio, TX)
- Remote Clinical Review Nurse - Prior Authorization Location: Must be located in Central or Eastern time zones Employment Type: Full‑Time About the Role We are ... seeking an experienced Registered Nurse to join our team within a leading Managed...This role is fully remote and focuses on reviewing clinical documentation to determine medical necessity, appropriateness of care,… more
- Humana (Austin, TX)
- …us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation… more
- Highmark Health (Austin, TX)
- …experience, or provider operations and/or health insurance experience + 1 year in a clinical setting **Preferred** + 5 years in UM /CM/QA/Managed Care + 1 year ... panel of members that range in health status/severity and clinical needs; and assesses health management needs of the...RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) or WV or DE or… more
- Houston Methodist (Katy, TX)
- …for strategic, administrative, and operational leadership for the Utilization Management ( UM ) department across the Houston Methodist system. This position oversees ... technology, evidence-based criteria, and performance analytics to achieve superior clinical , operational, and financial outcomes. The Director position responsibilities… more
- Molina Healthcare (TX)
- …RN with Utilization Management experience to join our Inpatient reviewing team. Previous UM experience with MCG/Interqual guidelines as well as working within UM ... MCO is highly preferred, but we will also consider UM experience within a hospital as well. Schedule is...Teams, and One Note. Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying… more
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