RN-Utilization Review

Details Department: UR ReviewSchedule: FT - DaysLocation: Austin, TX - Remote after 4 weeks of training onsiteBenefits Paid time off (PTO) Various health insurance options & wellness plans Retirement benefits including employer match plans Long-term & short-term disability Employee assistance programs (EAP) Parental leave & adoption assistance Tuition...

Details Department: UR ReviewSchedule: FT - DaysLocation: Austin, TX - Remote after 4 weeks of training onsiteBenefits Paid time off (PTO) Various health insurance options & wellness plans Retirement benefits including employer match plans Long-term & short-term disability Employee assistance programs (EAP) Parental leave & adoption assistance Tuition...

Job Summary: We are seeking a highly skilled Nurse III to join our team as a Managed Care Nurse Analyst - Clinical Review. This senior-level position reports to the Acute Care Utilization Review Unit's (ACUR) Managed Care Clinical Review Manager. As a key member of our team, you will perform complex assessments and analyses of Medicaid MCO utilization...

Job Summary:This position reports to the Acute Care Utilization Review Manager in the Office of the Medical Director, Medicaid and CHIP Services Department. The Behavioral Health Analyst (Program Specialist VI) performs complex behavioral health managed care utilization review oversight and consultation related to the prior authorization (PA) and...

Job Summary: We are seeking a skilled Utilization Manager to join our team at Integral Care. As a Utilization Manager, you will be responsible for conducting utilization reviews, granting authorizations, and monitoring compliance with various contracts entered into by Integral Care and Tejas Behavioral Health.Key Responsibilities:Conduct utilization reviews...

You could 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, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Drafts correspondence letters based on review outcomes in...

Job Summary:The Utilization Manager will be responsible for conducting utilization reviews, granting authorizations, and monitoring compliance with various contracts entered into by Integral Care and Tejas Behavioral Health. This includes contracts with departments of the State of Texas, the City of Austin, Travis County, and managed care health plans. The...

SUMMARY The Manager of Medical Management and Utilization Management oversees the coordination and execution of daily operations within the Medical Management and UM teams. This role is responsible for driving performance, ensuring compliance with regulatory requirements, optimizing patient care pathways, and maintaining operational efficiencies. The...

Job Summary:Centene Corporation is seeking a skilled Clinical Review Specialist to join our Medical Management/Health Services team. As a key member of our team, you will play a critical role in ensuring the medical appropriateness of care and services related to mental health and substance abuse.Key Responsibilities:Perform clinical reviews and assessments...

Job Title: Document ReviewerKLDiscovery, a leading eDiscovery provider, is seeking attorneys with active licenses in any U.S. jurisdiction to join our team as Document Reviewers.Job Summary:We are looking for highly skilled and detail-oriented attorneys to review documents for complex litigation matters using our electronic review platform. As a Document...

Job SummaryWe are seeking a highly organized and detail-oriented Application Review Specialist to join our team at the Department of Computer Science. As a key member of our admissions team, you will be responsible for reviewing and evaluating a high volume of graduate applications.Key ResponsibilitiesReview and evaluate applications for graduate admission,...

Job Opportunity: Utility Engineer/CoordinatorBGE, Inc. is seeking a highly skilled Utility Engineer/Coordinator to join our team in the Central Texas Region. As a key member of our Transportation Team, you will be responsible for providing technical support and coordination for utility adjustment efforts to resolve conflicts with utilities impacted by...

Job SummaryWe are seeking a highly organized and detail-oriented Application Review Specialist to join our team at the Department of Computer Science. As a key member of our admissions team, you will be responsible for reviewing and evaluating a high volume of graduate applications.Key ResponsibilitiesReview and evaluate applications for graduate admission,...

Job Title: Document ReviewerKLDiscovery, a leading eDiscovery provider, is seeking attorneys with active licenses in any U.S. jurisdiction to join our team as Document Reviewers.Job SummaryWe are looking for highly skilled attorneys to review documents for complex litigation matters using our electronic review platform. As a Document Reviewer, you will code...

Job Title: Clinical Utilization SpecialistJoin Centene Corporation, a leading healthcare company, as a Clinical Utilization Specialist. In this role, you will play a critical part in ensuring the quality and appropriateness of mental health and substance abuse services for our 28 million members.Key Responsibilities:Perform clinical reviews and assessments...

Job Title: Utility CoordinatorAt Whitman Requardt and Associates, we are committed to delivering exceptional results through our people-focused and project-driven approach. With over 105 years of experience, we have established ourselves as a leader in the industry, known for our quality work and quality employees.Job Summary:We are seeking a highly skilled...

Job Title: Clinical Review NurseJoin Centene Corporation, a leading healthcare company, as a Clinical Review Nurse and play a vital role in ensuring the quality and cost-effectiveness of medical care for our 28 million members.Job Summary:We are seeking a highly skilled and experienced Clinical Review Nurse to join our Medical Management/Health Services...

Job Summary: We are seeking a skilled Clinical Utilization Specialist to join our Medical Management/Health Services team. As a key member of our team, you will play a critical role in ensuring the quality and appropriateness of care for our members. Key Responsibilities: Perform clinical reviews and assessments of care related to mental health and...

Job Summary:We are seeking a skilled Clinical Nurse to join our HEDIS Review Team. As a member of this team, you will work under the supervision of the HEDIS Coordinator to review medical records and ensure accuracy and compliance with NCQA guidelines.Key Responsibilities:Accurately review medical records to identify errors and discrepanciesUtilize software...

Job Title:Project Manager IIIJob Summary:The Texas Health and Human Services Commission (HHSC) Medicaid/CHIP Services (MCS) department seeks a highly qualified candidate with excellent project management, process improvement, and interpersonal skills to fill the position of Project Manager III for Managed Care Utilization Review Operations Team (MCUR...