RN Utilization Review Remote

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

Job summary

A prestigious healthcare company in Houston, TX is seeking a Utilization Review RN to manage and authorize care for patients. Responsibilities include reviewing clinical information, assisting with discharge planning, and maintaining eligibility verification. This role requires strong clinical experience and a current Texas RN license, with attractive benefits and flexible shifts available.

Benefits

Immediate health insurance enrollment

Dental, Life Insurance

Employee Assistance Program (EAP)

Access to Investment Accounts

Career and educational tools via Ingenovis ACT Program

Qualifications

• Three years clinical experience in an acute setting and 3 years in UR/UM.
• Experience with Texas Medicaid, CHIP, or marketplace insurance.
• Interqual experience preferred.

Responsibilities

• Review clinical information to authorize care and assist in discharge planning.
• Participate in Community Nursing Rounds and maintain knowledge of software systems.
• Meet performance metrics for case reviews and contribute to departmental goals.

Skills

Clinical experience

Utilization Review

Communication

Education

RN, current Texas License

Tools

Microsoft Office

Job description

Join to apply for the RN Utilization Review Remote role at HealthCare Support.

Utilization Review RN

HealthCare Support is actively seeking a Utilization Review RN to fill an opening with a Prestigious HealthCare Company in Remote Houston TX.

Daily Responsibilities for Utilization Review RN:

• Review telephonic and faxed clinical information to authorize medically necessary inpatient and outpatient care, utilizing nationally recognized evidenced-based clinical criteria or approved medical guidelines. Refer cases that do not meet criteria to Medical Director for review.
• Assist in discharge planning, especially Home Health Nursing requests and DME requests for members at discharge, as well as new requests for members who have not had recent hospitalization. Review extension requests and refer non-compliant cases to Medical Director.
• Participate in Community Nursing Rounds with Medical Director, prepare adequately, and assist colleagues with difficult cases through open discussion. Communicate concerns to the Manager and/or Medical Director.
• Maintain knowledge of referral and provider software systems. Verify member eligibility, benefit coverage, and facility contract status before processing authorization requests. Enter required information accurately into the managed care platform, following UM policies and procedures.
• Assist in coordinating care for hospitalized, medically complex, and members with special needs. Make referrals and follow-ups with other Community programs/departments.
• Meet performance metrics for case reviews within established turnaround times and adhere to quality standards.
• Contribute to departmental goals, including process improvement initiatives.
• Demonstrate Harris Health and Community Health Choice values, including trust, integrity, mutual respect, diversity, responsiveness, and caring service.

Shifts:

• Thurs-Sun, 10-hour days, 7 am to 5 pm
• Mon-Fri, 8 am to 5 pm

Required Qualifications:

• RN, current Texas License
• Three years clinical experience in an acute setting and 3 years in UR/UM
• Experience with Texas Medicaid, CHIP, or marketplace insurance
• Proficiency in Microsoft Office (Word, Outlook, Excel)

Preferred Qualifications:

• Interqual experience
• Caseloads of 20-25 cases per day

Benefits:

• Immediate health insurance enrollment
• Dental, Life Insurance
• Employee Assistance Program (EAP)
• Access to Investment Accounts
• Career and educational tools via Ingenovis ACT (Advocacy) Program

Pay: $38 – $42 per hour

If interested, please click "Apply Now" or email your resume to [e-mail] with your phone number, job title, and location for consideration.

Healthcare Support Staffing, LLC. is an equal employment opportunity employer.

Details:

• Senior level, Mid-Senior level
• Contract, Healthcare Provider role in Staffing and Recruiting industry