Utilization Review Nurse Jobs in San Antonio, Texas

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203 San Antonio, TX Utilization Review Nurse jobs found on Monster.

Jobs 1 to 20 of 203
Judge Healthcare is currently seeking Utilization Review - Registered Nurses (UR RN) in San Antonio, TX for one of our best managed care clients!! Job duties will include (but not limited to): Utilization review activities including precertification, concurrent, and retrospective reviews. Determine medical necessity of each request. Answer Utilization Management related calls. Refers cases to...
Molina Healthcare Inc San Antonio, TX
Job Summary Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorization...
Molina Healthcare Inc San Antonio, TX
Job Summary Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorization...
sunbeltstaffing San Antonio, TX
Full time job for Utilization Management/Review RN in San Antonio Texas. Job is short term - five to six months; but could be temp to perm opportunity. Full time; 8 hour days; Monday through Friday; 9am to 6pm. Duties: Responsible for reviewing proposed hospitalization, home care, and inpatient/outpatient treatment plans for medical necessity and efficiency in accordance with CMS coverage guid...
Description: There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Can you feel it? Bring that energy to a role that helps us offer a higher level of care than you'll find anywhere else. Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. As a Utilization Management Nurse you wi...
Description: There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Can you feel it? Bring that energy to a role that helps us offer a higher level of care than you'll find anywhere else. Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. As a Utilization Management Nurse you wi...
Description: Under the supervision of the Director of Utilization Management, the supervisor is responsible for the daily operations of the UM department. Daily coordination with Medical Directors, UM Nurses, UM Coordinators, provider network and other various WellMed departments and staff to deliver cost effective, quality of care services to members, in accordance with WellMed's policies and pr...
Description: Under the supervision of the Director of Utilization Management, the supervisor is responsible for the daily operations of the UM department. Daily coordination with Medical Directors, UM Nurses, UM Coordinators, provider network and other various WellMed departments and staff to deliver cost effective, quality of care services to members, in accordance with WellMed's policies and pr...
Description: At Optum, we share what might be seen as a surprisingly simple goal: making the health system work better for everyone. We look for people who relentlessly push themselves to go farther. For these high performers, a position on a team at Optum, a business of UnitedHealth Group, is a natural fit. We offer more than the talent, resources and can-do cultureâwe offer a place to improve t...
Aetna Inc. San Antonio, TX
Job Description Candidates must have at least 3 years of clinical nursing experience. POSITION SUMMARY Positions include Precertification, Concurrent Review, and Retro Review. Must be Texas Based as required by the Plan. This position requires an RN with an unrestricted active license. The Utilization Manager gathers clinical information, applies appropriate clinical criteria/guidelines, polic...
UnitedHealth Group Inc San Antonio, TX
Position Description WellMed provides concierge-level medical care and service for seniors, delivered by physicians and clinic staff that understand and care about the patient's health. WellMed's proactive approach focuses on prevention and the complete coordination of care for patients. WellMed is now part of the Optum division under the greater UnitedHealth Group umbrella. Do you have compassi...
Aetna Inc. San Antonio, TX
Candidate should be highly motivated and have good communication skills. Position is in a Managed care environment which involves working in both telephonic and computer duties. Nursing skills and critical thinking are utilized on a daily basis. Position utilizes clinical skills to coordinate, document and communicate all aspects of teh utilization/benefit management program. Experience in either ...
Molina Healthcare Inc San Antonio, TX
Job Summary Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorization...
The Judge Group San Antonio, TX
[444484] Responsible for reviewing proposed treatment plans for medical necessity. The UM Nurse determines medical appropriateness following evaluation of medical guidelines and benefit determination. 1. Performs utilization review activities 2. Determines medical necessity of each request 3. Utilizes decision-making and critical-thinking skills 4. Answers Utilization Management directed telephon...
Molina Healthcare Inc San Antonio, TX
Job Summary Oversees the integrated Care Access and Monitoring team responsible for prior authorizations, inpatient and outpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Monitors information daily as appropriate including member metrics and staff product...
Molina Healthcare Inc San Antonio, TX
Job Summary Oversees the integrated Care Access and Monitoring team responsible for prior authorizations, inpatient and outpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Monitors information daily as appropriate including member metrics and staff product...
UnitedHealth Group Inc San Antonio, TX
Position Description Be a part of a growing team! This position will have to rotate Saturdays as part of the schedule. The Supervisor Utilization Management is responsible for utilization management which includes Concurrent Review and Prior Authorizations. (Telephonic Inpatient Care Management). Performs reviews of current inpatient services. Determines medical appropriateness of inpatient an...
Molina Healthcare Inc San Antonio, TX
Job Summary Works with the Utilization Management team and is primarily responsible for prior authorizations. According to guidelines provides inpatient and outpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Assesses services for Molina Members to ensure ...
Molina Healthcare Inc San Antonio, TX
Job Summary Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorization...
Molina Healthcare Inc San Antonio, TX
Job Summary Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorization...

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