Utilization Management RN — Precertification & Review Expert

Texas Children's Hospital; Bellaire (TX); On-site; USD 90,000 - 120,000; Full time

Job summary

Texas Children’s Hospital is seeking a Utilization Management Clinical Registered Nurse to support precertification of inpatient hospitalizations and outpatient procedures requiring authorization. You will perform telephonic and concurrent review of hospital stays and outpatient treatment.

You will analyze requests against clinical guidelines, communicate decisions to providers, and collaborate with the medical director to ensure care meets regulatory standards and patient needs.

Qualifications

• Diploma, associate or bachelor's in nursing; RN licensure as required.
• Bachelor's degree in nursing preferred.
• 3 years of nursing experience required.

Responsibilities

• Analyzes request situations against guidelines and regulatory requirements.
• Assesses clinical acuity and appropriateness of treatment proposed.
• Creates case summaries when medical necessity criteria are not met and discusses with medical director.

Skills

Nursing experience

Education

Diploma in nursing

Associates degree in nursing

Bachelor's degree in nursing

RN license (Texas BON or compact)

Job description

Texas Children’s Hospital is seeking a Utilization Management Clinical Registered Nurse to support precertification of inpatient hospitalizations and outpatient procedures requiring authorization. You will perform telephonic and concurrent review of hospital stays and outpatient treatment.

You will analyze requests against clinical guidelines, communicate decisions to providers, and collaborate with the medical director to ensure care meets regulatory standards and patient needs.