Top 41 utilization review Jobs in austin tx

Utilization Management Nurse
TEXAS INDEPENDENCE HEALTH PLAN INC —Austin, TX
- Weekends as needed
- Hybrid work
- Nursing
- Microsoft Excel
- Microsoft Outlook
Quick Apply
(CEM) - Psychiatrist
Loyal Source —Texas
- $225.83 an hour
- Full-time
- Medicine
- Microsoft Excel
- Microsoft Outlook
Quick Apply
Client Registration Coordinator - Austin, TX
Cenikor Foundation —Austin, TX
- Full-time
- Background check
- Microsoft Outlook
- Public speaking
- AD&D insurance
- Disability insurance
Quick Apply
Nurse Reviewer
Health & Human Services Comm —Austin, TX
- $5,833.33 - $6,666.67 a month
- Online Application
- Nursing
- RN License
- HIPAA
- Health insurance
- Opportunities for advancement
Quick Apply
Director of Revenue Operations
Release Recovery —Austin, TX
- $125,000 - $165,000 a year
- Full-time
- HIPAA
- Residential
- Analysis skills
- Dental insurance
- Vision insurance
Quick Apply
Transition of Care Coordinator Behavioral Health
CVS Health —Austin, TX
- $60,522 - $129,615 a year
- Full-time
- LMFT
- Microsoft Outlook
- Computer literacy
- Health insurance
- Dental insurance
9d
Acute Care Utilization Review (ACUR) Clinical Lead
Health & Human Services Comm —Austin, TX
- $6,377.50 - $10,785.83 a month
- Online Application
- Nursing
- Microsoft Excel
- Microsoft Outlook
- Health insurance
- Opportunities for advancement
Quick Apply
3d
Transition of Care Coordinator RN
CVS Health —Austin, TX
- $60,522 - $129,615 a year
- Full-time
- Nursing
- Microsoft Outlook
- Mid-level
- Health insurance
- Dental insurance
Medical Director, Utilization Review
Curative HR LLC —Austin, TX
- $260,000 - $280,000 a year
- Full-time
- Remote
- Medicine
- BC/BE
- Analysis skills
- Paid parental leave
- Paid holidays
Quick Apply
Accounts Receivable Supervisor
Advanced Pain Care —Austin, TX
- $24 - $27 an hour
- Full-time
- HIPAA
- Research
- Mentoring
Quick Apply
Medical Review Nurse -UM/Post Appeals (Michigan RN license req)
Molina Healthcare —Austin, TX
- $29.05 - $67.97 an hour
- Full-time
- RN License
- Mid-level
- Pediatrics
- Health insurance
Research Specialist V
Health & Human Services Comm —Austin, TX
- $5,425.33 - $7,155.75 a month
- Online Application
- Office
- Master's degree
- Analysis skills
- Health insurance
- Opportunities for advancement
Quick Apply
Home Health Clinical Manager
Centerwell —Austin, TX
- $84,900 - $116,800 a year
- Full-time
- CPR Certification
- Nursing
- RN License
- Paid parental leave
- Paid holidays
Case Manager, Registered Nurse
CVS Health —Austin, TX
- $54,095 - $155,538 a year
- Full-time
- Spanish
- Nursing
- Addiction Medicine
- Health insurance
- Dental insurance
Case Manager - PRN
Texas NeuroRehab Center —Austin, TX
- PRN
- Writing skills
- Adults
- Mid-level
- Paid time off
- 401(k) matching
Clinical Management Manager
Accenture —Austin, TX
- $87,400 - $293,800 a year
- Full-time
- Bachelor's degree
- Travel
- US work authorization
- Paid holidays
- Disability insurance
Clinical Operations Domain Consultant
Tata Consultancy Services —Austin, TX
- $134,300 - $181,700 a year
- Nursing
- Management
- RN License
10d
Case Manager - FT Days | Round Rock Rehab
PAM Health, LLC —Round Rock, TX
- Full-time
- RN License
- BLS Certification
- Physical & Rehabilitation Medicine
- Health savings account
- Disability insurance
Quick Apply
Registered Nurse Case Manager
Health & Human Services Comm —Austin, TX
- $7,532.75 - $8,886.16 a month
- Extended hours
- 18 years or older
- CPR Certification
- Nursing
- Health insurance
- Opportunities for advancement
Quick Apply
Supv Comprehensive Care SW
Baylor Scott & White Health —Round Rock, TX
- Full-time
- Master of Social Work
- Management
- Licensed Clinical Social Worker
- Health insurance
- Tuition reimbursement

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utilization review jobs near austin tx

Utilization Management Nurse

TEXAS INDEPENDENCE HEALTH PLAN INC -
Austin, TX

Quick Apply

Job Details

Full-time

Qualifications

Nursing
Microsoft Excel
Microsoft Outlook
Medicare
LVN
RN License
Managed care organization experience
Word embeddings
Medicaid health insurance
Utilization management
Resource utilization in healthcare
Acute care

Full Job Description

Primary Responsibilities

The Utilization Management Nurse will determine the medical appropriateness of inpatient and outpatient services by evaluating medical guidelines, benefit determination and compliance with state mandated regulations.

Essential Functions

Perform concurrent, retroactive and pre-service authorization reviews for inpatient and outpatient services.
Follow and maintain compliance with CMS requirements, may include after-hours, holiday and weekend coverage.
Collaborate with staff, physicians, care/service coordinators, and medical directors to coordinate and provide the level of care necessary to meet member’s health need.

Educational/Training Requirements

Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred. 2+ years of clinical nursing experience.
Payor Utilization Management: 3 years recommended experience
Proficiency with Microsoft Office applications, specifically Word, Excel, and Outlook
Proficiency using Milliman Care Guidelines (MCG) and/ or InterQual criteria.

Licensing Requirements

Current unencumbered LVN or RN license in Texas or compact license.

Experience Requirements

2+ years Utilization management experience with a health insurance company (managed care/payer experience required).
UM for Medicare Advantage, Managed Medicaid, Dual SNP Lines of Business, on the payer side.
5+ years of acute clinical experience.
The ability to effect change, perform critical analyses, promote positive outcomes, and facilitate empowerment for members/families.

Location

This position is remote, but requires the employee to live within our service area which can include any of the following areas within Texas: Rio Grande Valley, DFW, greater Austin, greater Houston, greater San Antonio, Coastal Bend, or Laredo.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk and hear. Specific vision abilities required by this job include close vision, distance vision, and ability to adjust focus. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Work Location: Hybrid remote in Austin, TX 78789

Quick Apply

Refine Your Search

utilization review jobs in austin tx

Utilization Management Nurse

(CEM) - Psychiatrist

Client Registration Coordinator - Austin, TX

Nurse Reviewer

Director of Revenue Operations

Transition of Care Coordinator Behavioral Health

Acute Care Utilization Review (ACUR) Clinical Lead

Transition of Care Coordinator RN

Medical Director, Utilization Review

Accounts Receivable Supervisor

Medical Review Nurse -UM/Post Appeals (Michigan RN license req)

Research Specialist V

Home Health Clinical Manager

Case Manager, Registered Nurse

Case Manager - PRN

Clinical Management Manager

Clinical Operations Domain Consultant

Case Manager - FT Days | Round Rock Rehab

Registered Nurse Case Manager

Supv Comprehensive Care SW

I want to receive the latest job alert for utilization review in austin tx

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