• Pyramid Consulting, Inc. (Wolfforth, TX)
    …is a 06+months contract opportunity with long-term potential and is located in Lubbock TX ( Remote ) . Please review the job description below and contact me ASAP ... of case management experience in a managed care setting. Knowledge of utilization management principles and healthcare managed care. Experience with medical decision… more
    Upward (06/27/25)
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  • Utilization Review RN

    Baylor Scott & White Health (Austin, TX)
    …priority. Note: Benefits may vary based on position type and/or level **Job Summary** As the Utilization Review RN you will review patient cases for ... provider's care coordination departments. Your expertise is needed to review medical necessity. Working with the team, you'll verify...experience is required. + You must hold a valid Registered Nurse License ( RN ). As… more
    Baylor Scott & White Health (07/23/25)
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  • Clinical Coding and OASIS Review Manager

    BAYADA Home Health Care (Austin, TX)
    …with an industry leader. Apply now for immediate consideration. OASIS Review , Utilization Review , Quality Assurance, Remote , Home Health Coding, Coder, ... immediate opening for a **Full Time,** OASIS and Coding Review Manager with OASIS and Coding certification to work...Manager with OASIS and Coding certification to work remotely. RN , PT, OT, and SLP's with certifications will be… more
    BAYADA Home Health Care (07/01/25)
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  • Case Manager, Registered Nurse

    CVS Health (Austin, TX)
    …care. + Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse ( RN ) with at least 1 year of experience ... in a hospital setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
    CVS Health (07/18/25)
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  • Utilization Review Clinician…

    Centene Corporation (Austin, TX)
    …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and… more
    Centene Corporation (07/23/25)
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  • Utilization Management Nurse

    CVS Health (Austin, TX)
    …care **Preferred Qualifications** + NICU experience highly preferred + Managed care/ utilization review experience + Ability to multitask, prioritize and ... remote role open to candidates with an active RN licensure in the state in which they reside....to promote quality effectiveness of healthcare services and benefit utilization . **Required Qualifications** + Active and unrestricted RN more
    CVS Health (07/23/25)
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  • Care Manager RN - ( Remote )

    Highmark Health (Austin, TX)
    …Health **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... care services, application of criteria to ensure appropriate resource utilization , identification of opportunities for referral to a Health Coach/case management,… more
    Highmark Health (07/12/25)
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  • Clinical Appeals Nurse ( RN )

    Molina Healthcare (TX)
    **JOB DESCRIPTION** _For this position we are seeking a ( RN ) Registered Nurse who must be licensed for the state of UTAH or have a compact license._ _This ... Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support,… more
    Molina Healthcare (07/20/25)
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  • Disease Management Nurse - Remote

    Sharecare (Austin, TX)
    …to enable individuals with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the state in which they ... utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification… more
    Sharecare (07/12/25)
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  • Clinical Review Nurse - Prior…

    Centene Corporation (Austin, TX)
    …+ **_Ability to work PST hours remotely_** + **_Prior authorization or utilization review experience (preferred)_** **Position Purpose:** Analyzes all prior ... benefits including a fresh perspective on workplace flexibility. **_This is a fully remote position; however, candidates must be able to work on a Pacific Standard… more
    Centene Corporation (07/23/25)
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