151 Results for

Utilization Management Nurse Jobs in Dallas, TX

Jobs

New!

Dallas, TXToday

The Utilization Management (UM) RN performs utilization review activities, including, but not limited to, precertification, ensures appropriate level of care and status (Inpatient, Outpatient, and Observation) throughout admission and performs initial reviews, concurrent reviews, and retrospective reviews according to guidelines. UM RN delegates accordingly to LVN and works in conjunction with a multi-disciplinary team to manage the care of patients in an ethical and fiduciary responsible manner.

New!

Irving, TX1 day ago

Perform provider outreach to address post-hospital discharge services, redirection to in-network providers for appropriate steerage, durable equipment usage, and utilization of other medical services and/or procedures and other necessary telephonic follow-up. This nurse effectively communicates with internal and external clinical professionals, efficiently organizes the financial insurance care of the patients, and relays clinical data to insurance providers and vendors to obtain approved certification for services.

New!

Dallas, TXToday

$1,508–$1,508

Benefits: Day 1 Insurance Cigna medical, MetLife dental and vision insurance License reimbursement for new licenses needed for each assignment Discounts with hotels and rental cars A dedicated recruiter and support team that will help you every step of the way to sure you start on time and have an exceptional experience Referral bonus up to $700 About the Company: As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership.

New!

Dallas, TX1 day ago

Must have 8 years of experience to include 3 years of operational leadership experience including experiences such as directly or indirectly leading teams, quality and process improvement initiatives, strategic initiatives with organizational implications, and/or providing oversight of staff and resources for efficient and effective patient care required. Must have one of the following, upon hire or transition into the role:AWHONN (Association of Women's Health, Obstetric and Neonatal Nurses) Intermediate Electronic Fetal Monitoring Certificate OR, AWHONN (Association of Women's Health, Obstetric and Neonatal Nurses) Advanced Electronic Fetal Monitoring Certificate OR, NCC (National Corporation Certification (NCC) Electronic Fetal Monitoring Certification.

New!

Dallas, TX5 days ago

The EPR-RN performs, and supervises the EPRN-LVN, in utilization review with a prominent level of expertise by using approved criteria that demonstrates medical necessity to achieve appropriate authorization and reimbursement for services for the appropriate level of care and status (Inpatient, Observation, or Outpatient). EPR-RN conducts emergency physician-to-emergency physician discussions of members and provides authorization for post-stabilization care of PHP members presenting at a non-PIH facility and is required to assist in making other appropriate arrangements to promote/enhance continuity of care.

New!

Dallas, TX1 day ago

Stays abreast of the latest developments, advancements and trends in the specialty area by attending seminars or workshops, reading professional journals, actively participating in professional organizations and maintaining Texas RN licensure. Responsible for the daily management of assigned unit to include staff supervision and development, planning, budget, quality, and facility operations and coordinating patient services to ensure high quality patient care and optimal outcomes.

New!

Dallas, TX1 day ago

Responsible for the daily management of assigned unit to include staff supervision and development, planning, budget, quality, and facility operations and coordinating patient services to ensure high quality patient care and optimal outcomes. Stays abreast of the latest developments, advancements and trends in the specialty area by attending seminars or workshops, reading professional journals, actively participating in professional organizations and maintaining Texas RN licensure.

New!

Dallas, TX1 day ago

Provides safe medication administration using the patient's 6 rights, provides maintenance, maintenance and management of IV access, performs POC monitoring and demonstrates safe infection control practices. Electronic Fetal MonitoringMust have completed RELIAS or AWHONN (Association of Women's Health, Obstetric and Neonatal) endorsed Basic Electronic Fetal Monitoring Certificate within 90 days of hire or reclassification into the role.

New!

Dallas, TX1 day ago

Provides care to assigned patient population in accordance with established protocols and multidisciplinary plan of care utilizing independent, dependent, and interdependent interventions to restore stability, prevent complications, and achieve and maintain optimal patient responses for all patients through patient centered/patient valued care. Provides safe medication administration using the patients 6 rights, provides maintenance, maintenance and management of IV access, performs POC monitoring and demonstrates safe infection control practices.

Dallas, TX8 days ago

Responsible for assisting in the daily management of unit activities including staff supervision and development, planning, budget, quality and facility operations and coordinating patient services to ensure high quality patient care and optimal outcomes. Provides patient care, assessing patient needs, planning discharge and arranging support services to ensure effective, high quality patient care.

New!

Dallas, TX1 day ago

Provides safe medication administration using the patient's six (6) rights, provides maintenance and management of intra-venous (IV) access, performs Point of Care (POC) testing, demonstrates safe infection control practices, invasive hemodynamic monitoring and provides emergency resuscitation management of patient. Current/Valid American Heart Association Advanced Cardiovascular Life Support (ACLS) or Advanced Life Support (ALS) certification card at time hire, and the ability to maintain thereafter from one of the following: American Heart Association; American Red Cross; or Military Training Network.

New!

Dallas, TX1 day ago

Performs patient assessments related to cancer care and other medical diagnosis to include allergies and hypersensitivity reactions, physical, signs and symptoms, changes in activities of daily living, psychosocial, support network and financial dimensions across the continuum of care (diagnosis, treatment, surveillance, and end of life). Will maintain current Commission on Cancer specific certification in the nurses specialty by an accredited certification program or will continue ongoing education by earning 12 cancer-related continuing education nursing contract hours per year or 36 cancer-related continuing education nursing contract hours each accreditation cycle (3 years).

New!

Dallas, TX1 day ago

Dallas, TX12 days ago

Must retake every two years from completion date of previous certificate:AWHONN (Association of Women's Health, Obstetric and Neonatal Nurses) Intermediate Electronic Fetal Monitoring OR, AWHONN (Association of Women's Health, Obstetric and Neonatal Nurses) Advanced Electronic Fetal Monitoring, National Electronic Fetal Monitoring Certification must be renewed every three years. Intermediate Electronic Fetal Monitoring Certificate OR, AWHONN (Association of Women's Health, Obstetric and Neonatal Nurses) Advanced Electronic Fetal Monitoring Certificate OR, NCC (National Corporation Certification (NCC) Electronic Fetal Monitoring Certification.

New!

Dallas, TX1 day ago

New!

DALLAS, TXToday

In the past 5 years, practiced as an Advanced Practitioner for at least: 2 years in an outpatient primary care setting seeing patients of all ages (0+), OR 1 year in an outpatient primary care setting seeing patients of all ages (0+), coupled with either a 1 year primary care fellowship or 1+ year in an urgent care setting seeing patients of all ages (0+). Our seamless in-office and 24/7 virtual care services, on-site labs, and programs for preventive care, chronic care management, common illnesses and mental health concerns have been delighting people for the past fifteen years.

New!

DALLAS, TXToday

Our seamless in-office and 24/7 virtual care services, on-site labs, and programs for preventive care, chronic care management, common illnesses and mental health concerns have been delighting people for the past fifteen years. Employee Assistance Program - Free confidential services for team members who need help with stress, anxiety, financial planning, and legal issues.

New!

Irving, TX1 day ago

Care Coordination of Complex/Chronic conditions: Manages and coordinates care for patients with chronic conditions, complex medical needs, and assists with Discharge Planning: Helps plan and coordinate the discharge process for members leaving hospitals or long-term care facilities, ensuring a smooth transition to home or another care setting. Care Coordination - Transitions of Care: Outreach to patients that qualify for Transitions of Care (IP Discharge) and ensure they understand their medications, educate patients on managing their conditions and knowing when to seek help, stressing the importance of scheduling and attending follow up appointments, and teaching them to recognize the signs that their condition might be worsening.

New!

Venus, TX1 day ago

$89,680–$134,520 Per Year

The Home Health Patient Care Manager and RN Hybrid is responsible for the supervision and coordination of clinical services and provides and directs provisions of nursing care to patients in their homes as prescribed by the physician and in compliance with applicable laws, regulations, and agency policies. Coordinates and supervises an interdisciplinary team of staff to assure the continuity of high quality care to home health patients assigned to the team's area in accordance with physician prescribed plan of care, and all applicable state and federal laws and regulations.

New!

Dallas, TXToday

$1,422–$1,580

Works in collaborative practice with Physicians and Physician extenders to actively support the delivery of cost effective, outcome oriented, quality care in the appropriate health care setting to meet patient specific, age and cultural needs. Works in collaborative practice with the physician and other members of the health care team to meet patient specific and age-related needs linking cost and quality to patient care.

McKinney, TX9 days ago

The BSWH system includes 47 hospitals, more than 900 access points, over 6,600 physicians and 43,500 employees, plus a state certified Health Maintenance Organization, the Scott and White Health Plan (Health Plan), and Baylor Quality Health Care Alliance LLC (BSWQA) – a high performing network of clinical providers and facilities focused on improving quality, managing the health of patient populations, and reducing the overall cost of care. BSWH includes a robust spectrum of owned, operated, ventured and affiliated hospitals; satellite outpatient clinics; free standing ambulatory surgery centers; free standing emergency medical centers; free standing imaging centers; numerous retail pharmacies; and geographically dispersed physician’s clinics in the North Texas and Central Texas regions.

Irving, TX30+ days ago

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Fort Worth, TX15 days ago

Description: The Nurse Case Manager - Inpatient is responsible for coordinating the care and service of assigned patients with physicians, nurses, social workers and other members of the healthcare team to facilitate the progression of care from hospital admission through discharge. The Nurse Case Manager- Inpatient is also responsible for ensuring that the patient is placed in the appropriate level of care while monitoring the utilization of healthcare resources and discharge planning to achieve the desired clinical, financial, and resource utilization outcomes.

New!

Fort Worth, TX4 days ago

Dallas, TX18 days ago

In this role, you will: Perform prospective & concurrent utilization reviews and first level determination approvals for members admitted to facilities using BSC evidenced based guidelines, policies and nationally recognized clinal criteria across lines of business or for a specific line of business such as Medicare as needed. The Behavioral Health Utilization Management team performs prospective & concurrent utilization reviews and first level determinations for members using BSC evidenced based guidelines, policies, and nationally recognized clinal criteria across multiple lines of business.

New!

Plano, TX4 days ago

Referral services for child, elder and pet care, home and auto repair, event planning and moreeConsumer discounts through Abenity and Consumer DiscountsRetirement readiness, rollover assistance services and preferred banking partnershipsEducation assistance (tuition, student loan, certification support, dependent scholarships)Colleague recognition programTime Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.

Richardson, TX20 days ago

Action Rarely Occasionally Frequently Lifting - 1-25 lbs X Lifting - 25-50 lbs X Lifting - 50+ lbs X Carrying - 1-25 lbs X Carrying - 25-50 lbs X Carrying - 50+ lbs X Pushing/Pulling - 1-25 lbs X Pushing/Pulling - 25-50 lbs X Pushing/Pulling - 50+ lbs X Sliding/Transferring - 1-25 lbs X Sliding/Transferring - 25-50 lbs X Sliding/Transferring - 50+ lbs X Standing X Sitting X Walking X Speaking X Driving X Balancing/Climbing X Stooping/Kneeling X Crouching/Crawling X Reaching X Hearing/Listening X Seeing X Turning/Twisting/Leaning X. Tracks Skilled (MRA/MCO/MCG/MMP) customers utilizing Case Management Tools to determine continued and appropriate Medicare/Managed Care eligibility and benefit period through regular communications with Regional Care Management Specialist, Business Office and external Case Managers.

ARLINGTON, TX12 days ago

$4,801.16–$7,761.50

Based on the in-person, teleconference or telephoneinterview assessment, desk review and evaluation of services, the UR nurse uses program knowledge and nursing expertise todetermine appropriateness and quality of services, cost effectiveness of the service plan, validates determinations of health serviceneeds, and makes service authorization decisions. Reviews, evaluates, and documents services provided to aged and disabled persons and persons withintellectual disability to validate service needs, service provision, determines appropriateness, quality, and cost effectiveness ofservices.

Irving, TX30+ days ago

Serving North Texas:Covering the expansive North Texas region, we provide a wide range of medical and surgical services across 7 Operating Rooms, 12 private inpatient rooms, and a 3-bed Emergency Department. Welcome toBaylor Scott & White Surgical Hospital Las Colinas, Irving, TX, where innovation, collaboration, and patient-centered care converge to create an exceptional workplace!

Mesquite, Texas30+ days ago

New!

Frisco, TX6 days ago

$64,168–$96,262 Per Year

Excellent verbal communication skills with the ability to communicate with members and communicate professionally with individuals who serve in a variety of functions, i.e. physicians, client managers, customer service staff, CCCS executive management, other CCCS Medical Management nurses, hospital utilization review nurses, etc. The PHN performs the Personal Health Management process: assess the member; work with the member, family and physician to identify problems; establish goals and develop plans of care; coordinate services; educate members; and empower members to independently self-manage and to make knowledgeable health care decisions.

New!

Frisco, TX5 days ago

Remote

$64,168–$96,262 Per Year

McKinney, TX30+ days ago

Provide leadership and operational oversight for the Medical-Surgical unit, Intensive Care Unit, and Case Management department. Provide leadership, mentorship, and supervision to nurse managers, supervisors, and case management leaders.

Plano, TX11 days ago

This role will support the continuity of care across the continuum by advocating for the needs of the patient and family and working with identified care team members to promote access to care, facilitate communication and provide effective resource coordination during care transitions to ensure continuity, quality and closure of gaps in care. Uses clinical judgment based on nursing skills acquired through formal and informal experiential knowledge and evidence based guidelines to globally assess the patient's situation and through critical thinking and clinical decision making, develop an appropriate plan of care for the patient, with the aim of promoting best outcomes.

Sunnyvale, TX30+ days ago

Responsible for performing assessments on Medicare, Medicaid, Private Pay, Commercial insured and high-risk patients to determine discharge planning needs, always documents assessments. Baylor Scott & White Medical Center - Sunnyvale is seeking a Case Manager, RN - Discharge Planner to assess, plan, implement and evaluate the needs of patients for discharge planning and utilization review.

Grand Prairie, TX30+ days ago

$79,464–$119,196 Per Year

The Telephonic Nurse Case Manager II is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

Grand Prairie, TX13 days ago

New!

Dallas, TX3 days ago

The LTSS Service Coordinator RN Clinician is responsible for overall management of member's case within the scope of licensure; provides supervision and direction to non-RN clinicians participating in the member's case in accordance with applicable state law and contract; develops, monitors, evaluates, and revises the member's care plan to meet the member's needs, with the goal of optimizing member health care across the care continuum. Minimum Requirements: Requires an RN and minimum of 3 years of experience in working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, or similar role; or any combination of education and experience, which would provide an equivalent background.

New!

Grand Prairie, TX4 days ago

Frisco, TX30+ days ago

Coordinates improvement activities for successful accrediting, licensing and certification surveys (e.g., Joint Commission, Department of Health, Centers for Medicare/Medicaid Services). Identifies the cost-effective systems needed to support the business of the department taking into account business trends, resource availability and changes in customers.

New!

TX3 days ago

Collaborating closely with the Rehab Program Director, Facility Case Management Director, and interdisciplinary team to ensure seamless, patient-centered care. Completing psychosocial assessments and discharge planning evaluations, clearly documenting findings and communicating needs across the care team.

Plano, TX10 days ago

The RN Case Manager is responsible for promoting patient-centered care by coordinating the plan of care for the patient stay, managing the length of stay, ensuring appropriate resource management, and developing a safe appropriate discharge plan in collaboration with the multidisciplinary team. Considers patient’s readmission status or risk of readmission and develops strategies to mitigate including education on appropriately accessing healthcare resources, preventative education, and community based resources.

Dallas, TX20 days ago

Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. The RN Case Manager is responsible for promoting patient-centered care by coordinating the plan of care for the patient stay, managing the length of stay, ensuring appropriate resource management, and developing a safe appropriate discharge plan in collaboration with the multidisciplinary team.

Garland, TX30+ days ago

Part-time

Your Tailor Made Senior Service is seeking Registered Nurses with prior OASIS/Medicare Certified Visits for Adult home health assignments in Garland and close surrounding areas. Performs nursing assessments and develops, implements and evaluates plans of care in conjunction with the physician, patient and caregivers per agency policy and procedure.

Dallas, TX30+ days ago

Part-time

Your Tailor Made Senior Service is seeking Registered Nurses with prior OASIS/Medicare Certified Visits for Adult home health assignments in Dallas and close surrounding areas. Performs nursing assessments and develops, implements and evaluates plans of care in conjunction with the physician, patient and caregivers per agency policy and procedure.

Arlington, TX30+ days ago

Part-time

Your Tailor Made Senior Service is seeking Registered Nurses with prior OASIS/Medicare Certified Visits for Adult home health assignments in Arlington and close surrounding areas. Performs nursing assessments and develops, implements and evaluates plans of care in conjunction with the physician, patient and caregivers per agency policy and procedure.

Trophy Club, TX11 days ago

Registered Nurse Case Manager at Baylor Scott & White Medical Center - Trophy Club: The Case Manager will be responsible for coordinating patient care throughout the continuum of care using approved criteria to determine patients' criteria for the ordered level of care and status on admission. USPI Partnership: Baylor Scott & White Medical Center - Trophy Club stands as a testament to collaborative excellence, as a partnership between Baylor Scott & White and USPI.

garland, TX30+ days ago

Full-time

Perimeter Behavioral Hospital of Dallas is a premier behavioral health facility providing inpatient psychiatric treatment for adolescents, adults, and senior adults. The Intake Registered Nurse (RN) plays a vital role in the admissions process, managing inbound calls, coordinating referrals, and ensuring timely patient placement.

garland, TX30+ days ago

Full-time

North Richland Hills, TX30+ days ago

$102,107–$135,000 Per Year

The Director ensures staff compliance with organizational policies and external regulatory agencies and takes leadership responsibility to coordinate the integration of the department's patient care and discharge planning processes with related hospital departments and external agencies to ensure continuity of care and optimal clinical resource utilization. This position is a subject matter expert in case management that requires solid leadership, trust building, team building, as well as change management skills to ensure success of the department and case management initiatives.

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Utilization Management Nurse Jobs in Dallas, TX

Utilization Management RN (Hybrid) TEXASCONNECT INC

Utilization Review Nurse Health Plans - HP Utilization Management Christus Health

Travel Nurse RN - Utilization Review - $1,508 per week in Dallas, TX TravelNurseSource

Nurse Director - Labor and Delivery - Perinatal Parkland Health and Hospital System

Transfer Center RN (Onsite) TEXASCONNECT INC

Nurse Manager - Neonatal Intensive Care Unit Parkland Health and Hospital System

Nurse Manager - Oncology Services Clinic Parkland Health and Hospital System

Registered Nurse - Labor and Delivery Parkland Health and Hospital System

Registered Nurse - Centralized Staffing Office - Labor and Delivery - PRN Parkland Health and Hospital System

Assoc Mgr., Nursing Parkland Health and Hospital System

Senior Registered Nurse - Emergency Department Parkland Health and Hospital System

Senior Registered Nurse - Parkland Health Cancer Center Parkland Health and Hospital System

Associate Nurse Manager - Medicine Surgery Parkland Health and Hospital System

Senior Registered Nurse - Triage Labor and Delivery Parkland Health and Hospital System

Senior Registered Nurse - Labor and Delivery Parkland Health and Hospital System

Family Nurse Practitioner or Physician Assistant One Medical

Per Diem Family Medicine Physician Assistant or Nurse Practitioner (Casual Employee) One Medical

Registered Nurse Navigator Population Health - Population Health Admin Christus Health

Patient Care Manager / Field RN - Fort Worth area Optum

Travel Nurse RN - Case Manager - $1,422 to $1,580 per week in Dallas, TX TravelNurseSource

Hospitalist Medical Director Baylor Scott & White Health

Utilization Management Nurse II - Case Management - Full Time Christus Health

Nurse Case Manager - Utilization Review - Mon, Tue, Sat, Sun JPS Health Network

Nurse Case Manager - Utilization Review - Nights (Fri-Sun, 7p-7a) JPS Health Network

Behavioral Health Utilization Mgmt Clinician, Senior Blue Cross and Blue Shield Association

Nurse Manager of Case Management HCA Healthcare Inc

Care Management Specialist - LVN (84368) Regency Integrated Health Services LLC

Nurse II Texas Health and Human Services Commission

RN Case Manager PRN Days United Surgical Partners International

Case Manager RN Dallas Regional Medical Center

Personal Health Nurse Tenet Healthcare Corp

Personal Health Nurse - Remote Tenet Healthcare Corp

Director of Inpatient Services (Med/Surg, ICU, and Case Management) Surgery Partners Inc

Care Coordinator (RN) Children's Medical Center

Case Manager, RN - Discharge Planner Baylor Scott & White Medical Center - Sunnyvale

Telephonic Nurse Case Manager II Elevance Health Inc

Nurse Case Manager II Elevance Health Inc

LTSS Service Coordinator - RN Clinician Elevance Health Inc

Nurse Case Manager II (US) Elevance Health Inc

Director of Quality Management United Surgical Partners International

Registered Nurse Case Manager Methodist Healthcare System

Registered Nurse Case Manager PRN HCA Healthcare

RN Case Manager HCA Healthcare

Home Health RN Your Tailor Made Senior Service

PRN Home Health RN in White Rock Lake Your Tailor Made Senior Service

PRN Home Health RN Your Tailor Made Senior Service

Registered Nurse Case Manager United Surgical Partners International Inc

Intake Registered Nurse (PRN) (7p-7a) Perimeter Healthcare

Intake Registered Nurse (PRN) (7a-7p) Perimeter Healthcare

Director Case Management (998298) Generis Tek Inc.

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