Utilization management Jobs in Texas

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Registered Nurse | Utilization Management Appeals Nurse | Remote | Contract

Walker Healthforce

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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
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Posted 7 days ago

Medical Director

Pyramid Consulting, Inc.

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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
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Posted 3 hours ago

Care Manager - Behavioral Health

EnpowerTek

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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,
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Posted 7 days ago

Care Manager - Health Plan

EnpowerTek

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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
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Posted 7 days ago

CARE UMR Senior Data Analyst - Remote in New York or New Jersey

UnitedHealth Group

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Remote or New York, New York, USA

Full-time

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. The CARE Sr. Data Analyst is responsible for supporting clinical report analysis and creation and deli
Posted 10 days ago | Updated moments ago

PBM Sr Clinical Manager, Preferred Drug List

Gainwell Technologies LLC

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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
Posted 14 days ago | Updated 8 hours ago

PBM Sr Clinical Manager, Preferred Drug List

Gainwell Technologies LLC

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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
Posted 14 days ago | Updated 8 hours ago

PBM Sr Clinical Manager, Preferred Drug List

Gainwell Technologies LLC

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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
Posted 14 days ago | Updated 8 hours ago

Agile Product Owner Senior Advisor

Cigna

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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
Posted 5 days ago | Updated moments ago

Data Visualization Lead

Humana Inc

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Remote

Full-time

Become a part of our caring community and help us put health first Are you passionate about transforming complex data into actionable insights that drive strategic decisions? Do you thrive at the intersection of technology, analytics, and leadership? Join Humana's innovative Visual Insights and Automation team within Pharmacy Analytics and Consulting as a Data Visualization Lead. In this role, you will consult with a variety of business partners and stakeholders, leading the development of inter
Posted 9 days ago | Updated moments ago

Solutions Architect

Gainwell Technologies LLC

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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
Posted 60+ days ago | Updated 8 hours ago

Solutions Architect

Gainwell Technologies LLC

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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
Posted 60+ days ago | Updated 8 hours ago

Solutions Architect

Gainwell Technologies LLC

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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
Posted 60+ days ago | Updated 8 hours ago

Clinical Data Governance/Informatics Lead - Cigna Healthcare - Hybrid

Cigna

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Remote or Bloomfield, Connecticut, USA

Full-time

Role Summary: Effective execution of good data governance principles and practices minimizes risk and ensures the data is available and fit for purpose. As part of The Cigna Group's Enterprise Clinical & Health Organization (ECHO), the Clinical Data Governance Lead is responsible for overseeing the integrity, quality, and governance of clinical data critical to ECHO operations, programs, and strategies. The ideal candidate should have a strong health care payer, clinical operations, and/or clini
Posted 9 days ago | Updated moments ago

TEAMS Apps Engineer

Apex Systems

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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
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Posted 13 days ago | Updated 1 hour ago

Senior GoLang Application Developer

Galaxy Infotech INC

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Remote

Contract

Primary SkillsSenior GoLang Applic..Job DescriptionT+S RemoteNeed SSN, DOB, Linkedin, DL and VisaHealthcare backgound requiredCTHclient is in CA so no EST candidates Job Title: GoLang Senior Application Development Engineer Through 12/31/25 with potential to Extend or Convert Remote - Must reside in US Qualifications/Skills Needed: Required: A Bachelor's degree in a quantitative or business field Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and
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Posted 51 days ago | Updated 3 hours ago

Clinical Review Nurse - Prior Authorization

Pyramid Consulting, Inc.

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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