- Actalent (San Antonio, TX)
- …complete cases. Qualifications: + 3+ years of utilization management, concurrent review , prior authorization, utilization review , case management, and ... Immediate Hiring for " Remote Clinical Review Nurses" Job Description: + Review approximately 20 cases a day for medical necessity. + Advocate for and protect… more
- CVS Health (Austin, TX)
- …+ Requisition Job Description **Position Summary** This Utilization Management (UM) Nurse Consultant role is 100% remote and the candidate can live ... care experience is in behavioral health) **Preferred Qualifications** + 1+ years' experience Utilization Review experience + 1+ years' experience Managed Care +… more
- CVS Health (Austin, TX)
- …with heart, each and every day. **Position Summary** This Utilization Management (UM) Nurse Consultant role is 100% remote and the candidate can live in any ... care experience is in behavioral health) **Preferred Qualifications** + 1+ years' experience Utilization Review experience + 1+ years' experience Managed Care +… 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 ... competitive benefits including a fresh perspective on workplace flexibility. POSITION IS REMOTE WITH POTENTIAL FOR WEEKEND AND HOLIDAY HOURS MUST HAVE INDIANA… more
- Humana (Austin, TX)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...Weekly Hours: 40 + Travel: While this is a remote position, occasional travel to Humana's offices for training… more
- Molina Healthcare (Houston, TX)
- …At least 2 years clinical nursing experience, including at least 1 year of utilization review , medical claims review , long-term services and supports (LTSS), ... **Job Summary** Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory… more
- Actalent (Dallas, TX)
- "Immediate Hiring for " Utilization Review RN" Job Description: + Perform concurrent reviews to assess member's overall health. + Review the type of care ... setting of care. Qualifications: + 4+ years experience in utilization management and utilization review ...or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to… more
- TEKsystems (Dallas, TX)
- …8 AM-5 PM CST Quality Assurance Responsibilities: + Perform quality assurance review of peer review reports, correspondences, addendums, or supplemental reviews. ... and specifications are followed and all questions addressed. + Verify each review is supported by current clinical citations and references from reputable medical… more
- Centene Corporation (Austin, TX)
- …discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in ... health management systems according to utilization management policies and guidelines + Works with healthcare...or provide recommendations based on requested services and concurrent review findings + Assists with providing education to providers… 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 ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more