Utilization Management Nurse: Remote, Flexible Shifts & Impact

Harris Health System, Inc.; Bellaire (TX); Hybrid; USD 90,000 - 120,000; Full time

Job summary

Harris Health System, Inc. is seeking a Utilization Management Review Nurse to evaluate medical necessity, appropriateness, and efficiency of services, ensuring care aligns with evidence-based guidelines.

The role involves partnering with Care Management, Physician Advisors, Finance, and 3rd party payers to deliver high-quality, cost-effective outcomes while supporting the health of Harris County residents.

Qualifications

• Graduated from an accredited school of Nursing with a BSN.
• Licensed to practice nursing in the State of Texas.
• 2 years in Case Management, Quality Management, Utilization Management, or Coding.

Responsibilities

• Evaluate the necessity, appropriateness, and efficiency of medical services and facilities.
• Collaborate with Care Management, Physician Advisors, Finance, and payers to ensure appropriate care.
• Reconcile denials and reconsiderations with payers; assist with appeals as needed.
• Participate in quality improvement activities and promote professional standards.

Skills

Nursing

Case Management

Utilization review

Analytical thinking

Verbal communication

Education

Bachelor of Science in Nursing (BSN)

Tools

MS Word

MS Excel

MS PowerPoint

Job description

Harris Health System, Inc. is seeking a Utilization Management Review Nurse to evaluate medical necessity, appropriateness, and efficiency of services, ensuring care aligns with evidence-based guidelines.

The role involves partnering with Care Management, Physician Advisors, Finance, and 3rd party payers to deliver high-quality, cost-effective outcomes while supporting the health of Harris County residents.