92 Results for

Utilization Management Nurse Jobs in San Antonio, TX

Jobs

New!

New Braunfels, TX6 days ago

Appropriately reviews patient assessment, treatment, and/or care methods performed by nursing to accommodate the unique physical, psychosocial, cultural, spiritual, age specific and other developmental needs of each patient served. Collaborates effectively with physicians, administrators, patients, families, other departments, and the community to provide quality patient care and enhance patient outcomes.

New!

Cibolo, TX1 day ago

In addition to transplant care, Methodist Hospital Specialty and Transplant is a full service hospital with over 260 beds that provides specialized services for liver cancer care, emergency care, weight loss surgery, urology surgery, vascular surgery, inpatient rehabilitation, colorectal surgery and behavioral health care. According to the United Network of Organ Sharing database, the center reached a major milestone in 2019 by performing 231 living donor kidney transplants in a single year setting a new national record - that’s 65 more transplants than the second center on the list.

Schertz, TX9 days ago

Seeking a Nurse Manager of Med/Surg who is responsible to the Director, Vice President and/or the Chief Nursing Officer for facilitating, coordinating and delegating the delivery of patient care to a defined group of patients during their entire hospitalization period. S/he is responsible 24 hours a day for the staffing and management of patient care in each of his/her units, for promoting the practice of professional nursing in a specified patient care area, and for the acquisition, development, and utilization of resources (human and material) needed to fulfill those responsibilities.

Live Oak, TX9 days ago

S/he is responsible 24 hours a day for the staffing and management of patient care in each of his/her units, for promoting the practice of professional nursing in a specified patient care area, and for the acquisition, development, and utilization of resources (human and material) needed to fulfill those responsibilities. The Nurse Manager is responsible to the Director, Vice President and/or the Chief Nursing Officer for facilitating, coordinating and delegating the delivery of patient care to a defined group of patients during their entire hospitalization period.

Cibolo, TX9 days ago

Schertz, TX9 days ago

New!

Live Oak, TXToday

Collaborating closely with the Rehab Program Director, Facility Case Management Director, and interdisciplinary team to ensure seamless, patient-centered care . By partnering with physicians, nurses, and department leaders, you will help ensure safe transitions, clear communication, and consistent quality across the continuum of care.

San Antonio, TX10 days ago

Seeking a Nurse Manager of Critical Care ICU who is responsible to the Director, Vice President and/or the Chief Nursing Officer for facilitating, coordinating and delegating the delivery of patient care to a defined group of patients during their entire hospitalization period. S/he is responsible 24 hours a day for the staffing and management of patient care in each of his/her units, for promoting the practice of professional nursing in a specified patient care area, and for the acquisition, development, and utilization of resources (human and material) needed to fulfill those responsibilities.

Live Oak, TX9 days ago

Seeking a Nurse Manager of Surgery / Operating Room who is responsible to the Director, Vice President and/or the Chief Nursing Officer for facilitating, coordinating and delegating the delivery of patient care to a defined group of patients during their entire hospitalization period. S/he is responsible 24 hours a day for the staffing and management of patient care in each of his/her units, for promoting the practice of professional nursing in a specified patient care area, and for the acquisition, development, and utilization of resources (human and material) needed to fulfill those responsibilities.

San Antonio, TX9 days ago

New!

San Antonio, TX1 day ago

Live Oak, TX9 days ago

San Antonio, TX9 days ago

New!

New Braunfels, TX5 days ago

Innovative equipment and procedures are utilized, including an Outpatient Imaging Center, orthopedic and surgical services, rehabilitation, a renovated birthing center, including 24/7 neonatal coverage, emergency care, wound care/hyperbaric center, 3D mammography, and comprehensive heart care, from diagnostics to open-heart surgery. CHRISTUS Santa Rosa Hospital - New Braunfels (CSRH-NB), nestled in the heart of downtown New Braunfels, is a full-service, 94-private bed facility that continues to expand to meet the needs of New Braunfels’ strong population growth.

New!

San Antonio, TX3 days ago

Specialized care includes orthopedic and surgical care with advanced spine surgery, Intensive Care, complex neurology for treating stroke and other neurovascular issues, comprehensive cardiovascular care from diagnostics to open heart surgery, vascular lab, sleep center, women’s services, a newborn nursery, the CHRISTUS Weight Loss Institute, wound care, rehabilitation, emergency services, and more. The campus also boasts an Outpatient Imaging Center, an Ambulatory Surgery Center, and four medical plazas, one of which houses our CHRISTUS Santa Rosa Family Medicine Residency Program and CHRISTUS Santa Rosa Family Health Center.

New!

New Braunfels, TX2 days ago

New!

San Antonio, TX4 days ago

Implementing and monitoring programs and practices for the delivery of safe and efficient quality nursing care for patients and their families. Remains knowledgeable and shares main considerations and issues related to laws and regulations in the implementation of healthcare practices.

San Antonio, TX11 days ago

The Utilization Review Nurse (RN) supports care coordination by reviewing clinical documentation, evaluating medical necessity, and facilitating communication between providers and care teams to ensure appropriate, timely, and patient-centered care. This role impacts patient outcomes across the care continuum by ensuring appropriate utilization of healthcare services, supporting referral processes, and promoting adherence to care coordination and patient-centered medical home principles.

San Antonio, TX30+ days ago

$75,772–$113,658 Per Year

How you will make an impact: Utilizes nursing judgment and reasoning to analyze members' clinical information, interface with healthcare providers, make assessments based on clinical presentation, and apply clinical guidelines and/or policies to evaluate medical necessity. The Medical Management Nurse is responsible for review of the most complex or challenging cases that require nursing judgment, critical thinking, and holistic assessment of member's clinical presentation to determine whether to approve requested service(s) as medically necessary.

San Antonio, TX12 days ago

Our system of care includes six full-service hospitals, a specialized childrens hospital with a dedicated pediatric emergency unit, a comprehensive cancer care network, fitness and rehabilitation centers, a physician network, imaging centers, ambulatory services and the Baptist School of Health Professions. Responsible to facilitate care along a continuum through effective resource coordination to help patient achieve optimal health, access to care and appropriate utilization of resources balanced with the patient’s resources and right to self-determination.

San Antonio, TX11 days ago

san antonio, TX30+ days ago

$36–$66 Per Hour

He/she proactively facilitates interventions to assure timely delivery of services, evaluates the effectiveness of interventions, tracks variances and/or barriers in the plan of care, and functions as the patient advocate to identify and communicate health care needs. The nurse case manager coordinates, in collaboration with the patient and interdisciplinary team, the treatment/plan of care for a patient within the acute episode of care.

San Antonio, TX14 days ago

Complete and or maintain working knowledge of daily Utilization Review tasks in accordance with hospital policy and InterQual guidelines to include prospective, admission, concurrent, retrospective reviews; correct admission status; avoidable days; medical necessity; continued stay criteria; LOS; Coding and DRG criteria; discharge readiness. Provide clinical documentation and requested information to payors in accordance with, but not limited to, appropriate admission status, clinical updates, admission/discharge notifications, post-acute care referrals and pre-authorization requests.

San Antonio, TX30+ days ago

POSITION SUMMARY/RESPONSIBILITIES Manages the care coordinators (case managers), home health coordinators and clerical staff to insure a smooth patient flow from preadmission to discharge and follow up in accordance with the patients and the payers requirements. Required experience: minimum of two years recent management experience; three years of hospital clinical nursing experience and one year experience in case management, utilization review or hospital quality assurance.

San Antonio, TX21 days ago

REQUIRED QUALIFICATIONS: At least 2 years clinical nursing experience, including at least 1 year of utilization review (prospective, retrospective and concurrent clinical review), medical claims review, long-term services and supports (LTSS), claims auditing, medical necessity review and/or coding experience, or equivalent combination of relevant education and experience. Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines, billing and coding regulations, and Molina policies; validates the medical record and claim submitted support correct coding to ensure appropriate reimbursement to providers.

San Antonio, TX18 days ago

Live Oak, TX18 days ago

S/he is responsible 24 hours a day for the staffing and management of patient care in each of his/her units, for promoting the practice of professional nursing in a specified patient care area, and for the acquisition, development, and utilization of resources (human and material) needed to fulfill those responsibilities. *RNs hired as of 01/01/2013 that do not have a BSN upon hire must do all of the following: Enroll in a BSN or higher degree nursing program within two years of hire date and submit documentation to facility CNO (or designated representative).

San Antonio, TX13 days ago

$33–$35 Per Hour

Ensures that the following information/instruction is given in writing to the patient/caregiver/representative: Visit schedule with frequency of visits, complete Medication Profile, any treatments to be administered by agency staff (POC), any other pertinent instruction related to the patient's care needs, and name and contact information of the agency's Clinical Manager. Join Team Select Home Care as a Registered Nurse (RN), where you'll bring comfort and confidence to families by delivering compassionate one-on-one care to medically complex children and adults in the comfort of their homes.

New!

Live Oak, TX6 days ago

San Antonio, TX16 days ago

We have an exciting opportunity for you to join Methodist Hospital Texsan which is part of the nation's leading provider of healthcare services, HCA Healthcare. Methodist Hospital Texsan has been deemed one of Modern Healthcare’s Best Places to Work in Healthcare for 3 years in a row.

San Antonio, TX17 days ago

San Antonio, TX14 days ago

In addition, Methodist Hospital not only received a Primary Stroke Center designation from The Joint Commission, but has also received a Comprehensive Stroke Center Certification from DNV GL Healthcare, designating the facility as offering the most advanced stroke treatment available in a given geographic area. We are proud to be the largest provider of the lifesaving ECMO Program in San Antonio, are home to the largest robotics program in the world, and our Adult Blood Cancer and Stem Cell Transplant unit has become the first program to receive FACT Accreditation in North America.

San Antonio, TX19 days ago

Live Oak, TX18 days ago

New!

Live Oak, TX4 days ago

San Antonio, TX19 days ago

$41.35–$62.03 Per Hour

The fraudulent LinkedIn messages and emails, which do not originate from any Executives LinkedIn account or of UnitedHealth Group's email domains, or those of any of its operating divisions, supposedly conducts an interview via a Zoom meeting, offers a work from home job at Optum, emails an application, sends a fake check by next day delivery through USPS and asks recipients to pay a vendor a large dollar amount. Makes initial and/or comprehensive nursing evaluation visits, ensures patients meet home health eligibility and medical necessity guidelines, determines primary focus of care, develops the plan of care within State guidelines with the physician, and submits accurate documentation.

New Braunfels, TX27 days ago

Innovative equipment and procedures are utilized, including an Outpatient Imaging Center, orthopedic and surgical services, rehabilitation, a renovated birthing center, including 24/7 neonatal coverage, emergency care, wound care/hyperbaric center, 3D mammography, and comprehensive heart care, from diagnostics to open-heart surgery. Graduate of an accredited school of nursing (BSN preferred) or Masters Degree in Social Work (MSW) required or demonstrated success in CHRISTUS Care Manager I Position for at least 5 years on top of the required experience in lieu of education required.

San Antonio, TX18 days ago

San Antonio, TX30+ days ago

$71,100–$97,800 Per Year

Proactively identify recently discharged inpatient, observation and emergency department patients and coordinate timely post-discharge follow-up in alignment with TOC and Transitional Care Management (TCM) requirements, with the aim of addressing root causes of utilization and supporting patients to prevent avoidable readmissions or return visits. Analyze clinical data and trends from platforms such as Athena EMR and DataHub to identify gaps in care related to Stars and HEDIS measures and Transitions of Care and post-hospitalization needs, prioritizing high-impact opportunities.

New Braunfels, TX30+ days ago

Resolute Baptist Hospital offers a full range of comprehensive healthcare, including emergency services, cardiology and cardiovascular care, orthopedics, primary care, rehabilitation services, Womens Health, Labor & Delivery / Obstetrics, Neonatal and the areas only Level III Neonatal Intensive Care Unit (NICU). Responsible to facilitate care along a continuum through effective resource coordination to help patient achieve optimal health, access to care and appropriate utilization of resources balanced with the patient’s resources and right to self-determination.

New!

San Antonio, TXToday

San Antonio, TX13 days ago

Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security. In addition to demonstrating clinical leadership on the unit, the Registered Nurse IV serves as a resource and system-wide consultant to staff and participates in endeavors to increase nursing knowledge.

San Antonio, TX20 days ago

Summary At Christus Hospice in San Antonio, TX, a part of LHC Group, we embrace a culture of caring, belonging, and trust and enjoy the meaningful connections that come from it: for the whole patient, their families, each other, and the communities we serve-it truly is all about helping people. Responsible to effectively communicating with members of the hospice IDG, clinical supervisor, and the patient's attending physician, if any, regarding changes in patient status and/or patient needs occurring during afterhours call.

San Antonio, TX13 days ago

The Radiology RN IV drives unit and hospital-wide practice improvements, leads or contributes to shared governance, quality, and safety initiatives, and supports the continuous development of nursing practice and positive patient outcomes across the organization. As a clinical expert and advanced leader, the RN IV serves as a mentor, educator, and resource to nursing staff, modeling excellence in communication, evidence-based practice, and patient advocacy.

San Antonio, TX13 days ago

$23–$25 Per Hour

This is your chance to build lasting relationships and grow your career in private duty nursing and long-term home health care, with a supportive team that truly has your back. Join Team Select Home Care, where you'll provide one-on-one care to pediatric and/or adult patients with complex medical needs in the comfort of their homes.

San Antonio, TX30+ days ago

Develops a personalized care plan / service plan for long-term care members, addresses issues, and educates members and their families/caregivers on services and benefit options available to receive appropriate high-quality care. Develops and continuously assesses ongoing long-term care plans / service plans and collaborates with care management team to identify providers, specialists, and/or community resources needed to address member's needs .

New!

San Antonio, TXToday

Introduce innovative nursing techniques, practices, and approaches in collaboration with health care providers to identify, assess, educate, plan, and coordinate care through programs designed to provide efficient, comprehensive, and cost-effective service for case managed patients. Qualifications: Degree/Education: Baccalaureate Degree of Nursing from a college or university accredited by Accreditation Commission for Education in Nursing (ACEN), the Commission on Collegiate Nursing Education (CCNE) or as otherwise outlined in this PWS.

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Utilization Management Nurse Jobs in San Antonio, TX

Manager Registered Nurse - Ambulatory Surgery Center CHRISTUS Health

Nurse Manager of Critical Care ICU Methodist Hospital Specialty and Transplant

Nurse Manager of Medical Surgical Methodist Hospital Stone Oak

Nurse Manager of Surgery OR Methodist Hospital Northeast

Nurse Manager of Medical Telemetry Methodist Hospital Metropolitan

Nurse Manager of Labor and Delivery Methodist Hospital Metropolitan

Registered Nurse Case Manager Methodist Hospital Northeast

Nurse Manager of Critical Care ICU Methodist Hospital Stone Oak

Nurse Manager of Recovery PACU Methodist Hospital Northeast

Registered Nurse (RN) - Hiring Now! Methodist Hospital Stone Oak

Registered Nurse (RN) - Hiring Now! Methodist Hospital Specialty and Transplant

Registered Nurse (RN) - Hiring Now! Methodist Hospital Northeast

Registered Nurse (RN) - Hiring Now! Methodist Hospital Metropolitan

Clinical Director - General Surgery CHRISTUS Health

Clinical Director - Mother Baby Unit CHRISTUS Health

Clinical Director - Emergency Department CHRISTUS Health

Administrative Director Nursing - Ambulatory Surgery Center CHRISTUS Health

Utilization Review Nurse - RN (WHWC) Methodist Healthcare Ministries of South Texas Inc

Medical Management Nurse Elevance Health Inc

Registered Nurse Case Manager (RN) - Case Management Baptist Medical Center

Registered Nurse Case Manager (RN) - Case Management Tenet Healthcare Corp

Nurse Case Manager PRN University Health

RN Case Manager United Surgical Partners International

Case Management Manager University Health

Medical Review Nurse -UM/Post Appeals (Michigan RN license req) Molina Healthcare Inc

Nurse Manager of Medical Telemetry Methodist Healthcare System

Nurse Manager of Surgery OR Methodist Healthcare System

Registered Nurse (RN) - Pediatric & Adult Home Health | Private Duty Nursing Team Select Home Care LLC

Nurse Manager of Recovery PACU HCA Healthcare

Case Manager RN PRN HCA Healthcare

Nurse Manager of Critical Care ICU HCA Healthcare

Nurse Manager of Labor and Delivery HCA Healthcare

Nurse Manager of Medical Telemetry HCA Healthcare

Case Manager RN HCA Healthcare

Nurse Manager of Medical Surgical HCA Healthcare

Nurse Manager of Surgery OR HCA Healthcare

Registered Nurse Case Manager HCA Healthcare

Registered Nurse UnitedHealth Group Inc

Care Manager II - Case Management CHRISTUS Health

Nurse Manager of Medical Surgical Methodist Healthcare System

Clinical Care Nurse (RN) Humana Inc

Registered Nurse Case Manager (RN) Resolute Health Hospital

Registered Nurse Case Manager (RN) Saint Luke's Hospital

Hospital - Oncology RN IV (Night Shift, Full Time) UT Health San Antonio School of Dentistry

Afterhours RN LHC Group Inc

Hospital - Radiology RN IV UT Health San Antonio School of Dentistry

Licensed Vocational Nurse (LVN) - Pediatric & Adult Home Health | Private Duty Nursing Team Select Home Care LLC

Senior LTSS Service Care Manager (RN) - J01077 IMCS Group Inc

Registered Nurse Case Manager Dawson

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