Utilization Review Nurse Home Health Registered Nurse

Doctor's Choice Home Care & Hospice; Houston (TX); On-site; USD 70,000 - 100,000; Full time

Job summary

Doctor's Choice Home Care & Hospice in Houston seeks an experienced Utilization Review Nurse (RN) to review clinical documentation, patient plans of care, and utilization patterns to ensure appropriate, effective, and compliant home health services. The role focuses on optimizing patient outcomes, managing care utilization, and supporting clinicians in providing the right care at the right time.

Collaboration with field clinicians, case managers, and leadership is essential to promote efficiency

Qualifications

• Active RN license in the state of practice required.
• Minimum 2 years in home health, quality assurance, or utilization management preferred.
• Knowledge of Medicare CoPs, OASIS documentation, and home health standards.
• Experience with EMR systems (WellSky or equivalent) preferred.
• Strong analytical, communication, and critical-thinking skills.
• Ability to work independently with interdisciplinary teams.
• Knowledge of clinical pathways and evidence-based care guidelines.
• Strong organizational and time-management abilities.
• Proficient in data analysis and documentation review.
• Support of agency values and goals with flexibility and initiative.

Responsibilities

• Review clinical documentation and patient plans of care.
• Assess utilization patterns to ensure appropriate, compliant home health services.
• Collaborate with field clinicians, case managers, and leadership.
• Support regulatory compliance across all episodes of care.

Skills

RN licensure Texas

Home health experience

CoPs & OASIS knowledge

EMR systems (WellSky)

Analytical skills

Communication skills

Independent work with teams

Education

2 Year Degree

ADN

Tools

WellSky EMR

CareInsights

Job description

Job Details

Job Location: Houston Branch - Houston, TX 77040

Position Type: Full Time

Education Level: 2 Year Degree

Travel Percentage: None

Job Shift: Day

Job Category: Nursing

Summary of Essential Functions for the Position:

Committed to Caring, the Utilization Review Nurse (RN) is responsible for reviewing clinical documentation, patient plans of care, and utilization patterns to ensure appropriate, effective, and compliant delivery of home health services. This position focuses on optimizing patient outcomes, managing care utilization, and supporting clinicians in providing the right care at the right time. The Utilization Review Nurse collaborates closely with field clinicians, case managers, and leadership to promote efficiency, quality, and regulatory compliance across all episodes of care.

Qualifications

Qualifications / Licensure / Certification / Knowledge / Skills / Abilities:

• Current and active RN license in the state of practice required.
• Minimum 2 years of experience in home health, quality assurance, or utilization management preferred.
• Knowledge of Medicare Conditions of Participation (CoPs), OASIS documentation, and home health regulatory standards.
• Experience with EMR systems (Wellsky and WellSky CareInsights or equivalent preferred).
• Excellent analytical, communication, and critical-thinking skills.
• Ability to work independently while collaborating effectively with interdisciplinary teams.
• Knowledge of clinical pathways and evidence-based care guidelines.
• Strong organizational and time-management abilities.
• Proficient in data analysis and documentation review.
• Acceptance and ability to demonstrate support of the core values and goals of Agency.
• Ability to demonstrate flexibility, initiative, and work with minimal supervision.
• Strong communication skills, both oral and in writing, with excellent interpersonal skills.

Educational Requirements

High School Diploma or GED. Graduate of an approved college or university with a at least a diploma or an associate’s degree in nursing (ADN) from an accredited nursing program.

Working Conditions & Physical Requirements

Work environment includes autonomy and can be stressful due to deadlines, multiple tasks and general compliance of law, rules, and regulations. The position requires visual acuity and dexterity, sitting, standing, some pushing, pulling, and lifting up to 25 pounds.