- 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
- Molina Healthcare (Austin, TX)
- …and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review , and/or other utilization management ... skills. **Required License, Certification, Association** + Active, unrestricted State Registered Nursing ( RN ) in good standing. +...in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management… more
- Molina Healthcare (Austin, TX)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual… more
- Molina Healthcare (Austin, TX)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... acute care/medical experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. Must… more
- Molina Healthcare (Austin, TX)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual… more
- BAYADA Home Health Care (Austin, TX)
- …your career with an industry leader. Apply now for immediate consideration. OASIS Review , Utilization Review , Quality Assurance, Remote, Home Health Coding, ... 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
- CVS Health (Austin, TX)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse 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
- Molina Healthcare (Austin, TX)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/medical reviews of previously denied… more
- Molina Healthcare (Austin, TX)
- …Care Plan compliance. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Licensed Registered Nurse ( RN ), Licensed Vocational Nurse ... role must complete courses required to obtain licensure in all states. + Utilization Review Lead responsibilities also include but not limited to, collaborate… more
- Fresenius Medical Center (Marble Falls, TX)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- CenterWell (Austin, TX)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- HCA Healthcare (Austin, TX)
- …opportunity. We want your knowledge and expertise! **Job Summary and Qualifications** The Registered Nurse ( RN ) CM is responsible for promoting ... discharge plan in collaboration with the multidisciplinary team. The RN CM facilitates the progression and transition of care...encourage you to apply for our Registered Nurse Case Manager PRN opening. We review … more
- HCA Healthcare (Austin, TX)
- …Medical Center we support our colleagues in their positions. Join our Team as a(an) Registered Nurse Case Manager and access programs to assist with every stage ... gain certifications and job skills. Apply today for our Registered Nurse Case Manager opening and continue...Nurse Case Manager opening. Our team will promptly review your application. Highly qualified candidates will be contacted… more
- HCA Healthcare (Round Rock, TX)
- …at St. David's Round Rock Medical Center! **Job Summary and Qualifications** **The Registered Nurse ( RN ) CM is responsible for promoting patient-centered ... discharge plan in collaboration with the multidisciplinary team. The RN CM facilitates the progression and transition of care...encourage you to apply for our Registered Nurse Case Manager PRN opening. We review … more
- HCA Healthcare (Austin, TX)
- …in your career path, we encourage you to apply for our Registered Nurse Case Manager opening. We review all applications. Qualified candidates will be ... **Introduction** Do you have the career opportunities as a Registered Nurse Case Manager you want in...supporting a balance of optimal care and appropriate resource utilization .** + **You will provide case management services for… more
- HCA Healthcare (Austin, TX)
- …in your career path, we encourage you to apply for our Registered Nurse Case Manager PRN opening. We review all applications. Qualified candidates will be ... **Introduction** Do you have the career opportunities as a Registered Nurse Case Manager PRN you want...supporting a balance of optimal care and appropriate resource utilization .** + **You will provide case management services for… more
- Evolent (Austin, TX)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Veterans Affairs, Veterans Health Administration (Austin, TX)
- …equivalent to a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion ... determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply.… more
- Prime Therapeutics (Austin, TX)
- …Patient Programs. **Education & Experience** + Associates - Nursing + Bachelors - Nursing + RN - Registered Nurse , State and/or Compact State Licensure - ... for work visa or residency sponsorship. **Additional Qualifications** + Registered Nurse ( RN ). + 5...Experience in managed care, specialty drugs, care management and utilization review . + Meets Credentialing criteria. +… more
- Evolent (Austin, TX)
- …quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on ... + Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current,… more