HiringCafe
Join our community

78 utilization management nurse jobs at 44 companies in Texas

1w
Save
Mark Applied
Hide
Utilization Management Review Nurse
Harris County, Texas, United States
RemoteFull Time
Harris Health System
Harris Health System: Public healthcare safety-net provider for Harris County, Texas.
5+ YOEBachelor's in Nursing, Texas RN license, BLS, and 5 years of clinical experience including 2 years in case, quality, utilization management, or coding; ACM or CCM required within 2 years.
Microsoft Word, PC, Microsoft Excel, Microsoft PowerPoint, MCG, Change Healthcare, InterQual
Job PostingView all
5d
Save
Mark Applied
Hide
Utilization Management Nurse Consultant
Texas or Idaho or Georgia or Minnesota or Montana or Iowa or Michigan or California or Wisconsin or Oregon or Washington or Kansas or Indiana or Nebraska or New Jersey or Nevada or Louisiana or Tennessee or Kentucky or Mississippi or Ohio or Oklahoma or South Carolina or Alabama or Missouri or Arizona or Illinois or North Carolina or Colorado or Florida or Pennsylvania or Wyoming
$29-$62/hr RemoteFull Time
CVS Health
CVS HealthNYSE: CVS: Diversified healthcare integrating retail, pharmacy, and insurance services.
3+ YOEActive unrestricted RN license, 3+ years of RN experience including 1+ year in Med/Surg, ADN, clinical assessment skills, and Microsoft Office proficiency. BSN and utilization management experience preferred.
Microsoft Office, Microsoft Outlook, Microsoft Teams, Microsoft Excel, Microsoft Word, Microsoft PowerPoint, Google Workspace, VPN, EHR
Job PostingView all
1w
Save
Mark Applied
Hide
Utilization Management Senior Manager
San Antonio, Texas, United States
$41-$59/hr OnsiteFull Time
University Health
University Health: Public academic health system in San Antonio, Texas.
5+ YOE2+ MgmtRequires BSN, Texas RN license, 5+ years of utilization management experience, 2+ years of management experience, and CCM, ACM, utilization management, or related certification.
Job PostingView all
1mo
Save
Mark Applied
Hide
Supervisor, Utilization Management
Phoenix or Alaska or Arkansas or Arizona or Colorado or Florida or Hawaii or Iowa or Idaho or Illinois or Kansas or Louisiana or Maryland or Minnesota or Missouri or Montana or Nebraska or Nevada or New Mexico or North Carolina or North Dakota or Oklahoma or Oregon or South Carolina or South Dakota or Tennessee or Texas or Utah or Virginia or District of Columbia or Washington or Wisconsin or Wyoming
$91k-$107k/yr RemoteFull Time
TriWest Healthcare Alliance
TriWest Healthcare Alliance: Privately held healthcare administrator connecting military families and Veterans with community care under federal contracts.
3+ YOE3+ MgmtCurrent RN license, 3+ years healthcare experience, 3+ years supervisory experience, 2+ years utilization review/case management, U.S. citizenship and favorable DoD background investigation required.
InterQual, ICD, DSM, CPT, HCPCS, American Dental codes, Microsoft Office, Microsoft Word, Microsoft Outlook, TriWest Intranet
Job PostingView all
2w
Save
Mark Applied
Hide
Utilization Management Manager – Remote Nonprofit Role
Oregon or Arizona or Florida or Idaho or Kentucky or Maine or North Carolina or Oklahoma or Pennsylvania or Tennessee or Texas or Virginia or Washington
$111k-$143k/yr RemoteFull Time
Yamhill Community Care
Yamhill Community Care: Nonprofit coordinated care organization managing Medicaid healthcare for Oregon Health Plan members in Yamhill and nearby counties.
2+ YOE3+ MgmtBachelor’s degree in nursing or healthcare-related field, 2+ years of utilization management experience, and 3+ years supervising or leading teams; healthcare, regulatory, analytical, and communication skills required.
McKesson InterQual, Microsoft Windows, Microsoft Word, Microsoft Excel, Microsoft Outlook
Job PostingView all
2mo
Save
Mark Applied
Hide
Utilization Management LVN (Hybrid)
Dallas, Texas, United States
HybridFull Time
TexasConnect, Inc.
TexasConnect, Inc.: Healthcare management services organization providing IT, billing, and medical coding support to medical practices and hospital systems.
2+ YOEActive LVN licensure (or willingness to obtain, CA), 2+ years case management experience, knowledge of payer requirements, strong communication and organizational skills, proficiency with Microsoft Word/Excel/PowerPoint/Outlook, and ability to apply UM criteria.
Microsoft Word, Microsoft Excel, Microsoft PowerPoint, Microsoft Outlook, Milliman Care Guidelines (MCG)
Job PostingView all
2w
Save
Mark Applied
Hide
Director, Utilization Management - CMC - Clear Lake Center
Galveston, Texas, United States
OnsiteFull Time
University of Texas Medical Branch
University of Texas Medical Branch: Academic health science center providing education, research, and care.
5+ YOE5+ MgmtMaster's degree, five years of progressive healthcare leadership and clinical experience including four years in utilization management, and an unrestricted Texas RN license are required.
InterQual
Job PostingView all
3mo
Save
Mark Applied
Hide
Utilization Management Director, El Paso Health
El Paso, Texas, United States
OnsiteFull Time
El Paso Health
El Paso Health: Nonprofit HMO administering Medicaid, CHIP, and Medicare health plans for El Paso and Hudspeth counties.
5+ MgmtRN in Texas with 5+ years supervisory experience in managed care; bachelor of nursing; BLS/CPR common; strong leadership, analytical, and Microsoft Office skills.
Microsoft Excel, Power Point, Microsoft Word
Job PostingView all
1w
Save
Mark Applied
Hide
Manager, Utilization Review Nursing
Austin, Texas, United States
RemoteFull Time
Sendero Health Plans
Sendero Health Plans: Nonprofit, community-based HMO providing affordable health insurance to Central Texas residents, especially people with low incomes.
5+ YOE1+ MgmtAssociate degree in nursing, healthcare management, administration, or related field; 5 years utilization management experience in a health plan, 1 year leadership experience, and active Texas or compact-state LPN or RN license.
InterQual Clinical Care Guidelines, Microsoft Office Suite
Job PostingView all
3d
Save
Mark Applied
Hide
Managed Care Utilization Review LTSS Nurse (SAN ANTONIO, TX)
San Antonio or Alamo or Alice or Alvin or Aransas Pass or Beeville or Boerne or Brownsville or Carrizo Springs or Corpus Christi or Crystal City or Eagle Pass or Edinburg or Elsa or Falfurrias or Floresville or Goliad or Harlingen or Hondo or Karnes City or Kingsville or Laredo or McAllen or Mercedes or Mission or New Braunfels or Pearsall or Pharr or Port Lavaca or Raymondville or Refugio or Rio Grande City or Robstown or San Benito or San Juan or San Marcos or Sinton or Victoria or Weslaco or Zapata
$5k-$7k/mo HybridFull Time
Texas Health and Human Services Commission
Texas Health and Human Services Commission: Texas government agency delivering Medicaid, nutrition aid, behavioral health, disability supports, and health-care regulation to Texans.
Texas RN license in good standing and nursing experience required. Nursing degree or accredited nursing program required; utilization review, LTSS, managed care, pediatric, adult, or geriatric experience preferred.
Microsoft Office, Microsoft Outlook, fax machine, copier
Job PostingView all
2mo
Save
Mark Applied
Hide
Utilization Review RN
Portland or Washington or Alaska or California or Montana or New Mexico or Texas
$50-$78/hr HybridPart Time, Full Time
Providence
Providence: Non-profit Catholic health system serving the Western United States.
5+ YOEBachelor's degree in nursing, or associate degree with 2+ years related experience; Oregon RN license; five years acute adult medical-surgical, utilization review, or case management experience.
Job PostingView all
1w
Save
Mark Applied
Hide
Director, Utilization Management, RN - ONSITE - Kelsey Seybold Clinics
Pearland, Texas, United States
$113k-$193k/yr OnsiteFull Time
Optum Health
Optum HealthNYSE: UNH: Patient-centered healthcare organization providing primary, specialty, surgical, behavioral and home care to communities nationwide.
Bachelor’s degree, active Texas or multistate compact RN license, 10+ years in managed care health insurance, 5 years in management, and experience analyzing complex regulations and government contracts.
Job PostingView all
2mo
Save
Mark Applied
Hide
Utilization Management Registered Nurse
Alabama or Oklahoma or Ohio or New Mexico or New Jersey or New Hampshire or Nebraska or Montana or Missouri or Mississippi or Maryland or Maine or Louisiana or Kentucky or Kansas or Iowa or Indiana or Idaho or Georgia or Florida or Delaware or Colorado or Arkansas or Arizona or Wyoming or Wisconsin or West Virginia or Washington or Virginia or Vermont or Utah or Texas or Tennessee or South Dakota or South Carolina or Rhode Island or Pennsylvania or United States
$71k-$98k/yr RemoteFull Time
Humana
HumanaNYSE: HUM: Health insurance and care services provider.
1+ YOECompact RN in state of residence, >1 year clinical RN experience (hospital/SNF/home health/acute), ability to apply medical necessity criteria and complete timely determinations in a remote, metrics-focused role.
Milliman Care Guidelines, Interqual
Job PostingView all
3w
Save
Mark Applied
Hide
Dir Utilization Mgmt CMC - Clear Lake Center - Full-Time
Webster or Galveston
OnsiteFull Time
University of Texas Medical Branch
University of Texas Medical Branch: Academic health science center providing education, research, and care.
4+ YOE5+ MgmtRequires an accredited RN program, unrestricted Texas RN license, 5 years clinical experience, 5 years healthcare management, 4 years utilization management, and a master's degree.
InterQual
Job PostingView all
2w
Save
Mark Applied
Hide
Director of Utilization Review
Midland or Odessa or New Mexico
OnsiteFull Time
Signet Health
Signet Health: Private healthcare management that runs behavioral health, addiction recovery, and rehabilitation programs for U.S. hospitals.
2+ YOERequires an unencumbered Texas RN license or qualifying behavioral health license, 2+ years psychiatric nursing experience, and 2+ years utilization review, case management, or managed care experience.
InterQual, MCG, Electronic Medical Record (EMR)
Job PostingView all
1w
Save
Mark Applied
Hide
Utilization Review (UR) Author - RN Required
United States or Georgia or Mississippi or North Carolina or Tennessee or Arkansas or Florida or Kentucky or Alabama or Indiana or Texas
$65k-$97k/yr RemoteFull Time
R1 RCM
R1 RCM: Technology-driven revenue cycle management solutions for healthcare organizations.
Current RN license, bachelor's degree, 3+ years clinical nursing experience, and Medicare utilization review knowledge required; hospital utilization review or case management, InterQual, or MCG experience preferred.
InterQual, MCG, HIPAA
Job PostingView all
2w
Save
Mark Applied
Hide
Director of Utilization Review
Midland, Texas, United States
OnsiteFull Time
Signet Health
Signet Health: Private healthcare management that runs behavioral health, addiction recovery, and rehabilitation programs for U.S. hospitals.
2+ YOERequires a current Texas RN license or qualifying behavioral health license, 2+ years of psychiatric nursing and utilization review, case management, or managed care experience, plus EMR and clinical criteria proficiency.
InterQual, MCG, Electronic Medical Record (EMR), Medicare, Texas Medicaid
Job PostingView all
1w
Save
Mark Applied
Hide
Director of Utilization (100% onsite)
Center Point, Texas, United States
OnsiteFull Time
Acadia Healthcare
Acadia HealthcareNASDAQ: ACHC: Provider of behavioral healthcare and addiction treatment services.
4+ YOE3+ MgmtBachelor's degree in nursing or another clinical field required; master's preferred. Requires 4+ years utilization management and 3+ years supervisory experience; clinical licensure or certification may be required.
Job PostingView all
2mo
Save
Mark Applied
Hide
Clinical Quality & Utilization Review Specialist
Austin, Texas, United States
OnsiteFull Time
Central Health
Central Health: Public healthcare district for Travis County, Texas.
3+ YOEBSN or doctoral APP required, unrestricted Texas RN license, 3+ years clinical nursing experience, 2+ years utilization management experience, peer review and quality improvement experience, proficiency with electronic health records and Microsoft Office.
Electronic Health Records, Microsoft Office Suite, PDSA, Lean, Six Sigma
Job PostingView all
2mo
Save
Mark Applied
Hide
Utilization Review Coordinator - PRN position
Georgetown, Texas, United States
OnsitePart Time
Georgetown Behavioral Health Institute
Georgetown Behavioral Health Institute: Private 118-bed acute-care psychiatric hospital providing inpatient and outpatient mental-health treatment for children, adolescents, adults, and seniors.
Prefer bachelor\u0002s (nursing) and 3-5 years admitting/financial counseling experience; 2 years clinical experience preferred. Previous utilization review or case management desirable. Must obtain CPR and facility de-escalation/crisis management certification within 30 days.
Job PostingView all

Explore Jobs

Expand Your Job Search