Utilization management Jobs in Texas

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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
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Posted 8 days ago

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
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Posted 15 days ago

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
Posted 23 days ago | Updated moments ago

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
Posted 23 days ago | Updated moments ago

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
Posted 23 days ago | Updated moments ago

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
Posted 13 days ago | Updated 4 hours ago

Senior Process Engineer (NA/ONPT) - Cigna Healthcare

Cigna

•

Remote or Bloomfield, Connecticut, USA

Full-time

WORK LOCATION: HYBRID / REMOTE The National Ancillary and Out of Network Protection Team (NA/ONPT) plays a significant role in Cigna's Enterprise Affordability strategy. Our team manages over 400 national contracts across US Commercial and US Government lines of business and roughly $9B in annual medical spend across National Ancillary, Direct Provider and Non-Par Cost Containment partnerships. The Program Management Senior Advisor is a key role in driving implementations, process improvements
Posted 2 days ago | Updated 4 hours ago

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
Posted 7 days ago | Updated 4 hours ago

Data Analyst IV Medical Economics

Centene Corporation

•

Missouri, 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
Posted 5 days ago | Updated 4 hours ago

Data Analyst II Medical Economics

Centene Corporation

•

Michigan, 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
Posted 19 days ago | Updated 4 hours ago

Data Analyst III Medical Economics

Centene Corporation

•

Missouri, 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
Posted 28 days ago | Updated 4 hours ago

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
Posted 60+ days ago | Updated moments ago

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
Posted 60+ days ago | Updated moments ago

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
Posted 60+ days ago | Updated moments ago

Registered Nurse | Field Case Manager | Hybrid | Essex County, NJ | Contract

Walker Healthforce

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Remote

Contract

Field Case Manager Registered Nurse | 2+ years | Onsite | New Jersey | Contract Walker Healthforce is seeking a Field Case Manager Registered Nurse with 2+ years of experience to support a healthcare client based out of New Jersey. This is a 6-month contract opportunity. START DATE:8/4/2025 RATE RANGE: $43-$53 HOURS/SCHEDULE: Will be in the field 5 days a week (8am-5pm/9am-5pm) seeing on average 3-4 members a day in their homes for assessment in Essex and Passaic Counties. A scheduler will be p
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Posted 5 hours ago | Updated 4 hours ago

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
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Posted 21 days ago | Updated 4 hours ago

Clinical Review Nurse - Concurrent Review

Pyramid Consulting, Inc.

•

Remote

Contract

Immediate need for a talented Clinical Review Nurse - Concurrent Review. This is a 06+months contract opportunity with long-term potential and is located in TX(Remote). Please review the job description below and contact me ASAP if you are interested. Job ID: 25-78309 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: Performs concurrent rev
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Posted 3 days ago

Medical Director -Remote- Fulltime/Direct Hire

Pegasus Knowledge Solutions

•

Remote

Full-time

Summary The Medical Director serves a clinical leader across all Client companies and is responsible for medical oversight of the physical medicine network and utilization review, telephonic triage, first notification of loss, bill review and case management services. This role ensures that injured worker care is medically appropriate, evidence-based, cost-effective, and compliant with jurisdictional guidelines. Key Responsibilities Clinical Oversight Provide medical guidance on complex or high-
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Posted 1 day ago

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