RN Utilization Review Manager

HealthCare Support; Houston (TX); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare organization is seeking an RN Utilization Review Manager in Houston, TX. This role involves conducting audits, coordinating clinical rounds, ensuring staff compliance, and actively contributing to departmental goals. Ideal candidates will possess a BSN and have substantial experience in utilization management, with a strong focus on leadership within a managed care environment. Opportunities for remote work are available for qualified applicants.

Benefits

Immediate enrollment in Health Insurance

Dental Insurance

Life Insurance

Employee Assistance Program (EAP)

Access to Investment Accounts

Career and educational tools

Qualifications

• Two years of utilization management experience in a Managed Care environment required.
• Two years supervisory or leadership experience.
• Moderate level of computer knowledge.

Responsibilities

• Conducts audits of UM nurses and UM Coordinators.
• Coordinates clinical rounds and coaches UM nurses.
• Responsible for daily operations and staff assignments.

Skills

Utilization Management

Leadership

Clinical Coaching

Communication

Analytical Skills

Education

BSN degree with active Texas RN license

MBA, MPH, MHA, MSN (preferred)

Tools

MS Word

MS Excel

Outlook

Powerpoint

Access databases

Job description

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HealthCare Support is actively seeking a RN Utilization Review Manager to fill an opening with a healthcare organization in Houston, TX.

Daily Responsibilities for RN Utilization Review Manager:

• Conducts monthly audits of UM nurses and UM Coordinators. Audits may be performed more frequently based on results or staff performance indicators.
• Coordinates clinical rounds and coaches UM nurses in preparing summaries and presenting cases.
• Works independently and takes initiative to improve UM processes. Participates in work groups and committees.
• Communicates key information to director and assist director as needed.
• Responsible for daily operations and ensuring staff assignments support workload.
• Ensures turnaround time compliance is met with all UM processes, communicates opportunities to director. Works with staff to mitigate and prevent non- compliance.
• Ensures that staff onboarding and orientation is completed for all UM staff. Makes recommendation to UM trainer.
• Manages the staffing needs by reviewing analytic reports for productivity, pended cases, average admissions per facility, and complexity if facility needs.
• Participates in Medical Affairs department programs, focus studies and all initiatives to improve the health and quality of clinical care and service delivery to the Community members and providers.
• Supports staff with clinical presentations to medical directors.
• Actively contributes to achievement of departmental goals, as identified in Department’s annual business plan, including specific departmental process improvement plans.
• Demonstrates company values, including trust, integrity, mutual respect, diversity, responsiveness, and caring service.
• Other duties as assigned
  
  
  

Can be fully Remote in but prefer candidates local to Houston.

Shift 8-5 Monday- Friday

Required Qualifications for RN Utilization Review Manager:

BSN degree with active Texas RN license required, MBA, MPH, MHA, and MSN preferred.

Two years of utilization management experience in a Managed Care environment required

Two Years Supervisory Or Leadership Experience Required

Highlight lines of business worked- Texas Medicaid, CHIP, marketplace

Highlight experience – was it inpatient or outpatient

Moderate level of Computer knowledge of MS Word, MS Excel, Outlook, Powerpoint and access data bases

Wants someone with MCO background

Wants someone with experience managing 10+ UM RNs

WIll need to use their OWN EQUIPMENT: 2 screens, will need a headset, high speed internet, (Chromebooks do not work well but MAC or any other seem to work fine)

Benefits for RN Utilization Review Manager:

• Immediate enrollment in Health Insurance
• Dental Insurance
• Life Insurance
• Employee Assistance Program (EAP)
• Access to Investment Accounts
• Career and educational tools within our Ingenovis ACT (Advocacy) Program
  
  
  

Pay Details: $50 – $56 / hour

Interested in being considered?

If you are interested in applying to this position, please click Apply Now for immediate consideration.

For additional consideration, please email a copy of your resume to [e-mail] with your phone number, the job title and location, and our recruiters will reach out.

Healthcare Support Staffing, LLC is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Staffing and Recruiting

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