Days Job Type: Full Time The individual in this position is responsible to facilitate effective ... Utilization Management services supporting medical necessity and denial prevention; Coordination ...
Days Job Type: Full Time The individual in this position is responsible to facilitate effective ... Utilization Management services supporting medical necessity and denial prevention; Coordination ...
... full-time administrative physician role serving Good Shepherd Hospital - Longview and its ... and under-utilization of resources, medical necessity, compliance rules and regulations ...
... full-time administrative physician role serving Good Shepherd Hospital - Longview and its ... and under-utilization of resources, medical necessity, compliance rules and regulations ...
... care management process. * Provides crisis intervention, individual and family therapy where ... Full Time
... care management process. * Provides crisis intervention, individual and family therapy where ... Full Time
... care management process. * Provides crisis intervention, individual and family therapy where ... Full Time
... care management process. * Provides crisis intervention, individual and family therapy where ... Full Time
... care management process. * Provides crisis intervention, individual and family therapy where ... Full Time
... care management process. * Provides crisis intervention, individual and family therapy where ... Full Time
... care management process. * Provides crisis intervention, individual and family therapy where ... Full Time
... care management process. * Provides crisis intervention, individual and family therapy where ... Full Time
This position is responsible for working with insurance companies and managed care systems for the ... Benefits Full-time employees are eligible for medical, dental, vision, company paid disability ...
This position is responsible for working with insurance companies and managed care systems for the ... Benefits Full-time employees are eligible for medical, dental, vision, company paid disability ...
This position is responsible for working with insurance companies and managed care systems for the ... Benefits Full-time employees are eligible for medical, dental, vision, company paid disability ...
Quick apply
This position is responsible for working with insurance companies and managed care systems for the ... Benefits Full-time employees are eligible for medical, dental, vision, company paid disability ...
Certification in Case Management (CCM) or Utilization Review (ACM) strongly preferred * Familiarity with EPIC and MCG Indicia preferred * Minimum of 3 years of previous case management experience is ...
Certification in Case Management (CCM) or Utilization Review (ACM) strongly preferred * Familiarity with EPIC and MCG Indicia preferred * Minimum of 3 years of previous case management experience is ...
Certification in Case Management (CCM) or Utilization Review (ACM) strongly preferred * Familiarity with EPIC and MCG Indicia preferred * Minimum of 3 years of previous case management experience is ...
Certification in Case Management (CCM) or Utilization Review (ACM) strongly preferred * Familiarity with EPIC and MCG Indicia preferred * Minimum of 3 years of previous case management experience is ...
Certification in Case Management (CCM) or Utilization Review (ACM) strongly preferred * Familiarity with EPIC and MCG Indicia preferred * Minimum of 3 years of previous case management experience is ...
Certification in Case Management (CCM) or Utilization Review (ACM) strongly preferred * Familiarity with EPIC and MCG Indicia preferred * Minimum of 3 years of previous case management experience is ...
Utilization Review Nurse
Dallas, TX · Remote
$35 - $45.94/hr
Previous experience conducting concurrent or inpatient reviews for a managed care plan This is an ... Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 ...
Quick apply
Utilization Review Nurse
Dallas, TX · Remote
$35 - $45.94/hr
Previous experience conducting concurrent or inpatient reviews for a managed care plan This is an ... Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 ...
Supervisory Medical Director, National Physical Health Appeals Outpatient UM
Mirando City, TX · On-site +1
$236K - $449K/yr
Participates in utilization review studies, performance management and trend analysis. * Handles ... full-time or part-time status. Total compensation may also include additional forms of incentives.
Supervisory Medical Director, National Physical Health Appeals Outpatient UM
Mirando City, TX · On-site +1
$236K - $449K/yr
Participates in utilization review studies, performance management and trend analysis. * Handles ... full-time or part-time status. Total compensation may also include additional forms of incentives.
Supervisory Medical Director, National Physical Health Appeals Outpatient UM
Carlton, TX · On-site +1
$236K - $449K/yr
Participates in utilization review studies, performance management and trend analysis. * Handles ... full-time or part-time status. Total compensation may also include additional forms of incentives.
Supervisory Medical Director, National Physical Health Appeals Outpatient UM
Carlton, TX · On-site +1
$236K - $449K/yr
Participates in utilization review studies, performance management and trend analysis. * Handles ... full-time or part-time status. Total compensation may also include additional forms of incentives.
Supervisory Medical Director, National Physical Health Appeals Outpatient UM
Bexar, TX · On-site +1
$236K - $449K/yr
Participates in utilization review studies, performance management and trend analysis. * Handles ... full-time or part-time status. Total compensation may also include additional forms of incentives.
Supervisory Medical Director, National Physical Health Appeals Outpatient UM
Bexar, TX · On-site +1
$236K - $449K/yr
Participates in utilization review studies, performance management and trend analysis. * Handles ... full-time or part-time status. Total compensation may also include additional forms of incentives.
Supervisory Medical Director, National Physical Health Appeals Outpatient UM
Ladonia, TX · On-site +1
$236K - $449K/yr
Participates in utilization review studies, performance management and trend analysis. * Handles ... full-time or part-time status. Total compensation may also include additional forms of incentives.
Supervisory Medical Director, National Physical Health Appeals Outpatient UM
Ladonia, TX · On-site +1
$236K - $449K/yr
Participates in utilization review studies, performance management and trend analysis. * Handles ... full-time or part-time status. Total compensation may also include additional forms of incentives.
Supervisory Medical Director, National Physical Health Appeals Outpatient UM
Afton, TX · On-site +1
$236K - $449K/yr
Participates in utilization review studies, performance management and trend analysis. * Handles ... full-time or part-time status. Total compensation may also include additional forms of incentives.
Supervisory Medical Director, National Physical Health Appeals Outpatient UM
Afton, TX · On-site +1
$236K - $449K/yr
Participates in utilization review studies, performance management and trend analysis. * Handles ... full-time or part-time status. Total compensation may also include additional forms of incentives.
Physician Advisor
Texarkana, TX · On-site
... full-time administrative role, providing teaching, consulting, and advising to the Care Management ... This position focuses on physician practice patterns, documentation, resource utilization, medical ...
Physician Advisor
Texarkana, TX · On-site
... full-time administrative role, providing teaching, consulting, and advising to the Care Management ... This position focuses on physician practice patterns, documentation, resource utilization, medical ...
Job Type Full-time Description JOB SUMMARY The Director is responsible for improving the health ... The Director is responsible for utilization management across the care continuum to reduce overall ...
New
Job Type Full-time Description JOB SUMMARY The Director is responsible for improving the health ... The Director is responsible for utilization management across the care continuum to reduce overall ...
New
Physician Advisor
Beaumont, TX · On-site
Elizabeth is seeking a full-time, in-person Physician Advisor to join their team in Beaumont, TX. ... Served on or chaired a Utilization Management Committee * Demonstrated cost-efficient practice
Physician Advisor
Beaumont, TX · On-site
Elizabeth is seeking a full-time, in-person Physician Advisor to join their team in Beaumont, TX. ... Served on or chaired a Utilization Management Committee * Demonstrated cost-efficient practice
Full Time Utilization Management information
What is utilization management?
Utilization Management (UM) in a full-time role involves evaluating the necessity, appropriateness, and efficiency of the use of healthcare services, procedures, and facilities. Professionals in this field, often nurses or healthcare administrators, review patient cases, coordinate with healthcare providers, and ensure that care meets established guidelines while controlling costs. Their goal is to optimize patient outcomes by ensuring the right level of care is provided at the right time, while also helping organizations comply with regulations and insurance requirements.
What are the key skills and qualifications needed to thrive as a full time utilization management professional?
To thrive in Full Time Utilization Management, you need a background in healthcare (often as an RN or other clinical license), strong knowledge of medical necessity criteria, and familiarity with insurance guidelines. Expertise in case management software, electronic health records (EHRs), and certifications such as Certified Case Manager (CCM) or Accredited Case Manager (ACM) are typically required. Attention to detail, critical thinking, effective communication, and negotiation skills help you advocate for appropriate patient care while managing costs. These skills ensure efficient resource allocation, compliance with regulations, and optimal patient outcomes within healthcare organizations.
How does a full time utilization management role typically interact with clinical and administrative teams?
In a Full Time Utilization Management position, you will regularly collaborate with both clinical staff, such as physicians and nurses, and administrative teams, like case managers and billing specialists. Your main responsibility is to review patient care requests, ensure services are medically necessary, and coordinate approvals or denials based on established guidelines. Effective communication and teamwork are essential, as you’ll often facilitate discussions between departments to optimize patient outcomes and resource use. This collaborative environment helps you build a broad understanding of healthcare processes and strengthens your problem-solving skills.
What is the difference between Full Time Utilization Management vs Utilization Review Nurse?
| Aspect | Full Time Utilization Management | Utilization Review Nurse |
|---|---|---|
| Credentials | RN license, certifications in case management or utilization review | RN license, certifications in utilization review or case management |
| Work Environment | Typically full-time, office-based, healthcare organizations | Often part-time or per review, hospital or insurance settings |
| Employer & Industry | Health insurance companies, healthcare providers | Hospitals, insurance companies, third-party review organizations |
Full Time Utilization Management professionals oversee the entire utilization review process, often in a full-time capacity, focusing on managing patient care and resource utilization. Utilization Review Nurses perform specific review tasks, usually on a case-by-case basis, and may work part-time or per review. Both roles require RN licensure and related certifications, but Full Time Utilization Management roles involve broader responsibilities and continuous oversight.
What are the most commonly searched types of Utilization Management jobs in Texas? The most popular types of Utilization Management jobs in Texas are:
What cities in Texas are hiring for Full Time Utilization Management jobs? Cities in Texas with the most Full Time Utilization Management job openings:
Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Posted 5 days ago
Tenet Healthcare rating
6.2
Based on 351 frontline employees who took The Breakroom Quiz
698th of 887 rated healthcare providers
Job description
Job Shift: Days
Job Type: Full Time
The individual in this position is responsible to facilitate effective resource coordination to help patients achieve optimal health, access to care, and appropriate utilization of resources, balanced with the patient's resources and right to self-determination. The individual in this position has overall responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity. This position manages medical necessity process for accurate and timely payment for services which may require negotiation with a payer on a case-by-case basis. This position integrates national standards for case management scope of services including: Utilization Management services supporting medical necessity and denial prevention; Coordination with payers to authorize appropriate level of care and length of stay for medically necessary services required for the patient; Compliance with state and federal regulatory requirements, TJC accreditation standards, and Tenet policy; and Education provided to payers, physicians, hospital/office staff, and ancillary departments related to covered services and administration of benefits.
Join our dedicated healthcare team where compassion meets innovation! As a Registered Nurse with us, you'll have the opportunity to make a meaningful impact in patients' lives while enjoying a supportive work environment that fosters professional growth and work-life balance. Ready to be a vital part of our mission? Apply today and bring your passion for nursing to a place where it truly matters!
At Tenet Healthcare, we understand that our greatest asset is our dedicated team of professionals. That’s why we offer more than a job – we provide a comprehensive benefit package that prioritizes your health, professional development, and work-life balance. The available plans and programs include:
- Medical, dental, vision, and life insurance
- 401(k) retirement savings plan with employer match
- Generous paid time off
- Career development and continuing education opportunities
- Health savings accounts, healthcare & dependent flexible spending accounts
- Employee Assistance program, Employee discount program
- Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance
Note: Eligibility for benefits may vary by location and is determined by employment status
The Hospitals of Providence have faithfully been serving our community since 1902. Generations of families have chosen our hospitals to be a steward of health in the El Paso community. Our five hospitals include a childrens hospital committed to providing the care patients need, when they need it. Today, the Hospitals of Providence are comprised of our region's most trusted hospitals, each dedicated to meeting our families specific healthcare needs. Join our team!
Education:
Required: Graduate of an accredited school of nursing
Preferred: Academic degree in nursing (bachelor's or master's)
Experience:
Required: 2 years of acute hospital or behavioral health patient care experience with at least 1 year utilization review in an acute hospital or commercial/managed care payer setting
Certifications:
Required: RN. Must be currently licensed, certified or registered to practice profession as required by law or regulation in state of practice or policy. Active RN license for state(s) covered.
Preferred: Accredited Case Manager (ACM)
Responsible for providing accurate medical necessity screening and submission for Physician Advisor review. Securing and documenting authorization for services from payers. Managing concurrent disputes. Collaborating with payers, physicians, office staff, and ancillary departments. Timely, complete, and concise documentation in the Tenet Case Management documentation system. Maintenance of accurate patient demographic and insurance information. Identification and documentation of potentially avoidable days. Identification and reporting over and underutilization.
What Tenet Healthcare employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About Tenet Healthcare
Sourced by ZipRecruiter
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Dallas, TX, US
Year founded
1969