Utilization management Jobs in Texas

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Registered Nurse | Utilization Management Appeals Nurse | Remote | Contract

Walker Healthforce

Remote

Contract

Utilization Management Appeals Nurse | 3 years | Remote | Contract Walker Healthforce is seeking a Utilization Management Appeals Nurse with 3 years of experience to support a healthcare client based out of New Jersey. This is a 6-month contract opportunity. START DATE: ASAP WORKER TYPE: W2 CORE REQUIREMENTS:Minimum of 3 years clinical experience.3 years experience in the health care delivery system/industry.Must have effective verbal and written communication skills and demonstrate the abilit

Medical Director

Pyramid Consulting, Inc.

Remote

Contract

Immediate need for a talented Medical Director. This is a 06+months contract opportunity with long-term potential and is located in U.S(Remote). Please review the job description below and contact me ASAP if you are interested. Job ID: 25-77682 Pay Range: $100 - $115/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location). Key Responsibilities: "Provides medical leadership of all for util

Care Manager - Behavioral Health

EnpowerTek

Remote

Full-time

Job Title: Care Manager - Behavioral HealthLocation: California (must reside and be licensed in California)Schedule: Monday Friday, 8:00 5:00 pm Job Overview:We are seeking experienced Care Managers with a behavioral health focus to join a growing team supporting mental health and substance abuse programs. You will monitor inpatient and outpatient services, conduct concurrent reviews, and ensure medical necessity and quality of care for members. This role will also engage in crisis intervention,

Care Manager - Health Plan

EnpowerTek

Remote

Full-time

Job Title: Care Manager - Health PlanLocation: Remote (CST hours)Schedule: Monday Friday, 8:00 5:00 pm CST Job Overview:This position focuses on comprehensive care management, including assessment, care planning, and coordination of services for members with moderate to high behavioral health needs. The Care Manager will oversee the delivery of person-centered care plans, monitor outcomes, and collaborate with internal and external resources to ensure quality, cost-effective services. Key Respon

PBM Sr Clinical Manager, Preferred Drug List

Gainwell Technologies LLC

Austin, Texas, USA

Full-time

It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you've honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you'll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work

PBM Sr Clinical Manager, Preferred Drug List

Gainwell Technologies LLC

Dallas, Texas, USA

Full-time

It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you've honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you'll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work

PBM Sr Clinical Manager, Preferred Drug List

Gainwell Technologies LLC

Houston, Texas, USA

Full-time

It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you've honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you'll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work

Agile Product Owner Senior Advisor

Cigna

Remote

Full-time

Role Summary: This role is for an Agile Product Owner within the Clinical IT Product Management team. This position will specifically be filling a Product Owner role within Agile/Scrum and the Scaled Agile Framework (SaFe) delivery process for primarily support of the UM/CM applications and any supporting or extension applications. This position will support up to 3 scrum teams. The Product Owner will be tasked with working with our business partners to understand and prioritize scope, engage i

Data Analyst II Medical Economics

Centene Corporation

Florida, USA

Full-time

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Analyze integrated and extensive datasets to extract value, which directly impacts and influences business decisions. Work collaboratively with key business stakeholders to identify areas of v

Solutions Architect

Gainwell Technologies LLC

Dallas, Texas, USA

Full-time

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. Summary Gainwell is a leader in providing technology and business solutions to health and human services clients. Our solutions are ent

Solutions Architect

Gainwell Technologies LLC

Austin, Texas, USA

Full-time

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. Summary Gainwell is a leader in providing technology and business solutions to health and human services clients. Our solutions are ent

Solutions Architect

Gainwell Technologies LLC

Houston, Texas, USA

Full-time

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. Summary Gainwell is a leader in providing technology and business solutions to health and human services clients. Our solutions are ent

TEAMS Apps Engineer

Apex Systems

Irving, Texas, USA

Full-time

Job#: 2079281 Job Description: TEAMS ENGINEER/ARCHITECT using a developmental portal and writing some code they need a TEAMS subject matter expert. The biggest part is the apps part if they dont know it skip. Being a part of a pod and doig TEAMS work is different. They dont have to be a sme with messaging but need someone with TEAMS phone side. Most of the time the custom code part the customer is building an app and they wanted to verify the code laid out was correct or could they do something

UM Nurse/Prior Auth Nurse

Pyramid Consulting, Inc.

Remote

Contract

Immediate need for a talented UM Nurse/Prior Auth Nurse. This is a 06+months contract opportunity with long-term potential and is located in Phoenix, AZ (Remote). Please review the job description below and contact me ASAP if you are interested. Job ID:25-77859 Pay Range: $30 - $32/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location). Key Responsibilities: Nurses review case files, add,

Clinical Review Nurse - Prior Authorization

Pyramid Consulting, Inc.

Remote

Contract

Immediate need for a talented Clinical Review Nurse - Prior Authorization. This is a 07+months contract opportunity with long-term potential and is located in US(Remote). Please review the job description below and contact me ASAP if you are interested. Job ID: 25-77808 Pay Range: $33 - $39/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location). Key Responsibilities: Shift Time & Working