- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure and/or Compact State Licensure...work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare,… more
- Adecco US, Inc. (Houston, TX)
- Adecco Healthcare & Life Sciences is assisting a client hire a Utilization Review Nurse in Houston, TX! This role is in person / on site. Please read below ... 8am to 5pm **Pay:** $85,00 to $110,000 yearly **Responsibilities of the Utilization Review Nurse :** . ** Review Medical Records:** Thoroughly evaluate… more
- Adecco US, Inc. (Houston, TX)
- Adecco Healthcare & Life Sciences is assisting a client hire a Utilization Management Nurse in Houston, TX! This role is hybrid with a mix of work from home and ... 5pm **Pay:** $85,00 to $110,000 yearly **Responsibilities of the Utilization Management Nurse :** . Responsible for the...and institutes a care management plan . Provides concurrent review on members who are hospitalized at all levels… more
- Houston Methodist (The Woodlands, TX)
- At Houston Methodist, the Case Manager (CM) position is a registered nurse (RN) responsible for comprehensively planning for case management, which includes care ... patient satisfaction and safety measures. **FINANCE ESSENTIAL FUNCTIONS** + Performs review for medical necessity of admission, continued stay and resource use,… more
- Catholic Health Initiatives (Houston, TX)
- …perform other duties as assigned. **Qualifications** **Required:** -Associate's Degree -Registered Nurse (RN) -Two (2) years of experience -Knowledge of case ... management, working of Medicare, Medicaid and private insurance -Ability to interact professionally with case management staff, physicians and payers + If offered the position, you will have 90 days to pass the MCG competency test. However, training and… more
- Elevance Health (San Antonio, TX)
- …+ Obtains intake (demographic) information from caller. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. ... and personalized support throughout the consumer's treatment journey. **Title:** Utilization Management Representative II - Prior Authorization **Location:** TX-SAN… more
- ChenMed (Houston, TX)
- …years' clinical work experience required. + A minimum of 1 year of utilization review and/or case management, home health, discharge planning experience ... we need great people to join our team. The Nurse Case Manager 1 (RN) is responsible for achieving...with patient and family. + Facilitates patient/family conferences to review treatment goals and optimize resource utilization ;… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Case Manager (CM) Certified position is a registered nurse (RN) responsible for comprehensively planning for case management of a targeted ... engagement, ie peer-to-peer accountability. **SERVICE ESSENTIAL FUNCTIONS** + Performs review for medical necessity of admission, continued stay and resource… more
- Evolent (Austin, TX)
- …Stay for the culture. **What You'll Be Doing:** Job description: As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We ... better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer, Nurse , you will routinely interact with leadership and management...You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases, which do not… more
- AdventHealth (Mansfield, TX)
- …and services of selected patient populations across the continuum of illness. The Nurse Manager promotes effective utilization of health care resources, monitors ... and/or coordinates programs such as Shared Governance Program, which may include Nurse Advisory Council, Peer Review , Evidence-Based Practice (EBP), and… more