- Actalent (Fort Worth, 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)
- …substance abuse addiction disorders experience is required. + Direct experience with Utilization Review or Utilization Management related to Behavioral ... fully licensed for TX** **Position Purpose:** Performs a clinical review and assesses care related to mental health and...Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members… 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 ... benefits including a fresh perspective on workplace flexibility. **100% Remote ** **Must be licensed in the state of TX**...LCSW, LPC, LMHC, LMHP** **Position Purpose:** Performs a clinical review and assesses care related to mental health and… more
- Centene Corporation (Austin, TX)
- …for Holidays and Weekends** **Position Purpose:** Supervises the behavioral health (BH) utilization review clinicians to ensure appropriate care for members and ... utilization management team. + Monitors behavioral health (BH) utilization review clinicians and ensures compliance with...and Family Therapist required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… 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 (Houston, 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
- Highmark Health (Austin, TX)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and… more