- Actalent (Houston, TX)
- Immediate Hiring for " Remote Clinical Review RN" Job Description: + Perform concurrent reviews to assess member's overall health. + Review the type of care ... appropriate setting of care. Qualifications: + 2+ Years of Utilization Management Experience is Mandatory + Active Compact RN...or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to… 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 ... a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance abuse.… more
- Texas Health Resources (Arlington, TX)
- Director Utilization Management-Clinical Review _Are you looking for a rewarding career with family-friendly hours and top-notch benefits? We're looking for ... Arlington, TX + Core work hours: Monday-Friday 8:00a-5:00p. This position is hybrid remote /onsite. Vast majority of time will be remote , but there will… 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
- CVS Health (Austin, TX)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... each and every day. **Position Summary** **This is a remote work from home role anywhere in the US...is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that… more
- Sharecare (Austin, TX)
- … utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification ... more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… more
- Molina Healthcare (San Antonio, TX)
- …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... that has a current active unrestricted license This a remote role and can sit anywhere within the United...Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge… more
- HCA Healthcare (Mcallen, TX)
- …satisfaction and personal growth, we encourage you to apply for our Registered Nurse Case Manager PRN opening. We review all applications. Qualified candidates ... you have the PRN career opportunities as a(an) Registered Nurse Case Manager PRN you want with your current...patients achieve optimal health, access to care, and appropriate utilization of resources, balanced with the patient's resources and… more
- Providence (Lubbock, TX)
- …in a medical record. + 2 years - HEDIS, Quality management/quality improvement/ utilization review auditing experience, including experience in auditing within ... and Data Information Set (HEDIS) program + Conduct Audits inclusive of review of outpatient medical records, hospital records, clinical lab and pharmacy records… more
- Molina Healthcare (Houston, TX)
- …nursing experience in claims auditing, quality assurance, recovery auditing, DRG/clinical validation, utilization review and/or medical claims review , or ... quality audits experience. Work hours are: Monday- Friday 8:00am - 5:00pm Remote position Essential Job Duties * Develops diagnosis-related group (DRG) validation… more