- Humana (Austin, TX)
- …help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… 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)
- …9:30-6CST.** **No travel is required.** As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and ... of healthcare resources. Applies clinical expertise and knowledge of utilization management principles to influence stakeholders and networks of healthcare… more
- CVS Health (Austin, TX)
- …And we do it all with heart, each and every day. **Position Summary** Utilization Management is a 24/7 operation and work schedules will include weekends, ... holidays, and evening hours. * Utilizes clinical experience and skills in a collaborative process to...and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and… 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
- 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
- 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
- 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
- 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
- CVS Health (Austin, TX)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… 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)
- …health care experience preferred. + Working knowledge of case management philosophy/process/role, needs assessment, principles of utilization review/quality ... opportunity to make a real impact. As a(an) Registered Nurse Case Manager Inpatient Rehab you can be a...**Job Summary and Qualifications** Performs and provides professional case management services in the Rehabilitation Unit in order to… 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