- Christus Health (Cedar Park, TX)
- …years of clinical nursing experience required 5 years of case management experience required Experience working in primary care value-based care organization is ... not wait to send your CV. Summary: The Registered Nurse Navigator Population Health Senior is accountable for coordinating...Senior will manage the length of service, promote efficient utilization of resources, and ensure that a well-organized and… more
- Christus Health (Cedar Park, TX)
- …Requirements: Education/Skills Bachelor's Degree in Nursing preferred Experience 3 years of clinical experience required 2 years of case management experience ... care plans. The RN Navigator will manage the length of service, promote efficient utilization of resources, and ensure that a well-organized and safe plan of care is… more
- Humana (Austin, TX)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- CVS Health (Austin, TX)
- …all with heart, each and every day. **Position Summary** Medicare Precertification Utilization Management Nurse Consultant position: _Utilization ... with occasional holiday rotation.** **Preferred Qualifications** + Prior Authorization or Utilization Management experience + Managed care experience +… more
- CVS Health (Austin, TX)
- …Must have active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include ... in med surg or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing in MST/PST zones… more
- CVS Health (Austin, TX)
- … clinical experience in acute or post-acute setting,and 1+ years of Utilization Management / CareManagementExperience + Must have active current and ... obtainadditionalNursing Licenses as business needsrequire. * **Preferred Qualifications** - Utilization Management experience preferred - **Anticipated Weekly… more
- CVS Health (Austin, TX)
- …Nursing Licenses as business needs require **Preferred Qualifications** + Utilization Management experience preferred **Education** Diploma RN acceptable; ... degree/BSN preferred, 3+ years of experience as a Registered Nurse , 1+ years of clinical experience in...in acute or post-acute setting, and 1+ years of Utilization Management / Care Management … more
- CenterWell (Austin, TX)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- CenterWell (Austin, TX)
- … clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... Orthopedic procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare… more
- Centene Corporation (Austin, TX)
- …be the one who changes everything for our 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, ... including a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance… more
- Evolent (Austin, TX)
- … Reviewer, Nurse , you will routinely interact with leadership and management staff, other CR's ( Clinical Reviewers), providers, office staff and Field ... culture. **What You'll Be Doing:** Job Description As a Clinical Reviewer, Nurse , you will be a..., you will be a key member of the utilization management team. We can offer you… more
- Actalent (Austin, TX)
- …member care decisions + Document review findings, discharge plans, and actions in health management systems per utilization management policies + Work with ... Clinical Review Nurse - Concurrent Review...Trucare Cloud preferred) + Knowledge of Medicaid regulations and utilization management processes preferred + Proficiency in… more
- Evolent (Austin, TX)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Actalent (Austin, TX)
- …Trucare Cloud preferred) + Knowledge of Medicaid or Medicare regulations and utilization management processes + Proficiency in Microsoft Word, Excel, and ... Clinical Review Nurse - Concurrent Review...systems + Medicaid, Medicare or insurance-related knowledge + Prior utilization management experience What We Offer +… more
- AccentCare, Inc. (Austin, TX)
- …as needed, etc. + Reporting and management of case management model with focus on paraprofessional utilization - including correct ... visit types selected, continuity of clinical team, capacity management , etc. + Maintain clinician productivity within organization standard parameters (defined… more
- Molina Healthcare (Austin, TX)
- …recommendations for denial or modification of payment decisions. + Serves as a clinical resource for utilization management , CMOs, physicians and ... ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS)… more
- HCA Healthcare (Austin, TX)
- …patient throughput while supporting a balance of optimal care and appropriate resource utilization .** + **You will provide case management services for both ... opportunity to make a real impact. As a(an) Registered Nurse Case Manager NICU PRN you can be a...are appropriate.** **Experience** + **2+ years' experience in case management OR 3+ years' experience in clinical … more
- HCA Healthcare (Austin, TX)
- …patient throughput while supporting a balance of optimal care and appropriate resource utilization . + You will provide case management services for both ... opportunity to make a real impact. As a(an) Registered Nurse Case Manager PRN you can be a part...you will need:** + 2+ years' experience in case management OR 3+ years' experience in clinical … more
- Molina Healthcare (Austin, TX)
- …reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. + Participates as needed in joint ... **JOB DESCRIPTION** **Job Summary** The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for… more
- HCA Healthcare (Austin, TX)
- …Required + Bachelor's Degree in Nursing Preferred + 2+ years experience in case management OR 3+ years experience in clinical nursing Required + InterQual ... passionate about delivering patient-centered care?** Submit your application for Seasonal Registered Nurse Case Manager position and spend more time at the bedside… more
