• Utilization Review Nurse

    Houston Methodist (Houston, TX)
    At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... determinations + Recent work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare, Medicaid, and Managed… more
    Houston Methodist (05/15/25)
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  • Consultant, Nurse Disability

    Lincoln Financial (Austin, TX)
    …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred ... Nurse Disability Consultant to our clinical organization. This position will be responsible for reviewing, analyzing, and interpreting...in a career at Lincoln, we encourage you to review our current openings and apply on our website.… more
    Lincoln Financial (05/22/25)
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  • Utilization Management Nurse

    CVS Health (Austin, TX)
    …operation. Work schedules may include weekends and holidays and evening rotations._ As a Utilization Management Nurse Consultant you will be responsible for the ... to promote quality effectiveness of Healthcare Services and benefit utilization + Consults and lends expertise to other internal...positions in the job grade within which this position falls. The actual base salary offer will depend… more
    CVS Health (05/22/25)
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  • AVP, Utilization Review & Pharmacy

    Zurich NA (Austin, TX)
    AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is seeking an AVP, Utilization Review & Pharmacy. This is a fully remote position , ... offering the flexibility of a home-based office. As the AVP of Utilization Review & Pharmacy, you will lead and direct a team of Utilization Review and… more
    Zurich NA (05/22/25)
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  • Case Manager and Utilization Review

    Scottish Rite for Children (Dallas, TX)
    …giving children back their childhood! Job Posting Title: Case Manager and Utilization Review Coordinator Location: Dallas - Hospital Additional Posting Details: ... and other areas as assigned + Serve on the Utilization Review Committee for the Scottish +...holds a temporary permit from the Texas Board of Nurse Examiners to practice professional nursing + Minimum 2… more
    Scottish Rite for Children (05/23/25)
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  • Case Manager (RN) - Full Time - Utilization

    Houston Methodist (The Woodlands, TX)
    At Houston Methodist, the Case Manager (CM) position is a registered nurse (RN) responsible for comprehensively planning for case management, which includes care ... targeted patient population on a designated unit(s) and/or service lines. This position works with the physicians and interprofessional health care team to… more
    Houston Methodist (05/16/25)
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  • Utilization Review Clinician…

    Centene Corporation (Austin, TX)
    …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... START BETWEEN 2PM - 4PM TO WORK 10 HOURS.** ** Position Purpose:** Performs a clinical review and...Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members… more
    Centene Corporation (05/23/25)
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  • Utilization Review RN

    Catholic Health Initiatives (Houston, TX)
    …perform other duties as assigned. **Qualifications** **Required:** -Associate's Degree -Registered Nurse (RN) -Two (2) years of experience -Knowledge of case ... interact professionally with case management staff, physicians and payers + If offered the position , you will have 90 days to pass the MCG competency test. However,… more
    Catholic Health Initiatives (05/11/25)
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  • RN Medical Claim Review Nurse

    Molina Healthcare (Fort Worth, TX)
    …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... DESCRIPTION** **Job Summary** Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level… more
    Molina Healthcare (05/21/25)
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  • Director of Simulation Laboratory / Clinical…

    Texas State University (Round Rock, TX)
    …Information Position TitleDirector of Simulation Laboratory / Clinical Nurse Faculty (Open Rank) Job Posting Number2025042NTL Job LocationRound Rock ... College/DivisionCollege of Health Professions Department/SchoolSt. David's School of Nursing Position Description TheSt. David's School of Nursing (http://www.nursing.txstate.edu/) at… more
    Texas State University (04/24/25)
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  • Licensed Vocational Nurse - CLC-A - Edrp…

    Veterans Affairs, Veterans Health Administration (Amarillo, TX)
    Summary This position is eligible for the Education Debt Reduction Program (EDRP), a student loan payment reimbursement program. You must meet specific individual ... by the VHA Education Loan Repayment Services program office after complete review of the EDRP application. Responsibilities This vacancy will remain open until… more
    Veterans Affairs, Veterans Health Administration (05/01/25)
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  • Case Manager Certified | Registered Nurse

    Houston Methodist (Houston, TX)
    At Houston Methodist, the Case Manager (CM) Certified position is a registered nurse (RN) responsible for comprehensively planning for case management of a ... targeted patient population on a designated unit(s) and/or service line. This position works with the physicians and interprofessional healthcare team to facilitate… more
    Houston Methodist (04/22/25)
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  • Emergency Nurse Manager Days, Mansfield,…

    AdventHealth (Mansfield, TX)
    …and services of selected patient populations across the continuum of illness. The Nurse Manager promotes effective utilization of health care resources, monitors ... and/or coordinates programs such as Shared Governance Program, which may include Nurse Advisory Council, Peer Review , Evidence-Based Practice (EBP), and… more
    AdventHealth (05/21/25)
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  • Appeals Licensed Practical Nurse

    Evolent (Austin, TX)
    …adjudication of processed appeals. **What You Bring:** + 1-3 years' experience in clinical Appeals Review or Utilization Management Review as an LPN or LVN ... the mission. Stay for the culture. **What You'll Be Doing:** The Evolent Appeals Nurse team offers candidates the opportunity to make a meaningful impact as part of… more
    Evolent (05/16/25)
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  • Registered Nurse , Case Manager - Oncology…

    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 - 1+ ... is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that...positions in the job grade within which this position falls. The actual base salary offer will depend… more
    CVS Health (05/16/25)
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  • Case Manager, Registered Nurse - Oncology

    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. + ... is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that...positions in the job grade within which this position falls. The actual base salary offer will depend… more
    CVS Health (05/16/25)
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  • Registered Nurse Case Manager

    HCA Healthcare (Kingwood, TX)
    …us apart from any other healthcare provider. We are seeking a(an) Registered Nurse Case Manager to join our healthcare family. **Benefits** HCA Houston Healthcare ... nurses play a vital part. We know that every nurse 's path and purpose is unique. Do you want...patients achieve optimal health, access to care, and appropriate utilization of resources, balanced with the patient's resources and… more
    HCA Healthcare (05/23/25)
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  • Registered Nurse Case Manager

    HCA Healthcare (Houston, TX)
    …satisfaction and personal growth, we encourage you to apply for our Registered Nurse Case Manager opening. We promptly review all applications. Highly qualified ... integrity. We care like family! Jump-start your career as a(an) Registered Nurse Case Manager today with HCA Houston Healthcare Northwest. **Benefits** HCA Houston… more
    HCA Healthcare (05/04/25)
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  • Transplant Recovery Nurse

    Houston Methodist (Houston, TX)
    At Houston Methodist, the Transplant Recovery Nurse position leads organ procurement services required for transplantation and manages the peri-operative phase ... serves as a mentor and resources for team members. The Transplant Recovery Nurse position reviews cadaveric donor organ offers, assesses clinical diagnostics,… more
    Houston Methodist (05/13/25)
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  • Registered Nurse Case Manager PRN

    HCA Healthcare (Corpus Christi, TX)
    …Do you want to join an organization that invests in you as a(an) Registered Nurse Case Manager PRN? At Corpus Christi Medical Center, you come first. HCA Healthcare ... a difference. We are looking for a dedicated Registered Nurse Case Manager PRN like you to be a...patients achieve optimal health, access to care, and appropriate utilization of resources, balanced with the patient's resources and… more
    HCA Healthcare (04/13/25)
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