Utilization Review Nurse Specialist

3 weeks ago


Houston, Texas, United States Nexus Health Systems Ltd Full time
Job Title: Utilization Review Nurse

Job Summary:

Nexus Health Systems Ltd is seeking a skilled Utilization Review Nurse to join our team. As a Utilization Review Nurse, you will play a critical role in ensuring the delivery of cost-effective quality care within an appropriate length of stay.

Key Responsibilities:

  • Maintain patient confidentiality and adhere to all company and professional ethical, legal, and accreditation/regulatory standards.
  • Review medical necessity within two business days of admission and document using the appropriate UR form.
  • Participate in weekly UM meetings to review all outstanding cases for appropriateness of admission and discharge.
  • Provide clinical updates to third-party payors after admission to obtain continued stay authorization.
  • Identify and track variations that affect patient care, resource management, or length of stay.
  • Ensure the utilization of medical resources for patients efficiently and effectively.

Requirements:

  • Minimum Bachelor's degree in a healthcare field.
  • Two to three years of experience in hospital case management, utilization management, or discharge planning of complex medical/surgical cases.
  • Proficient in evaluating complex clinical documentation.
  • Strong analytical and organizational skills.
  • Working knowledge and ability to apply professional standards of practice in the work environment.

What We Offer:

Nexus Health Systems Ltd offers a dynamic and supportive work environment, opportunities for professional growth and development, and a competitive compensation package.



  • Houston, Texas, United States Nexus Health Systems Full time

    Job Title: Utilization Review NurseNexus Health Systems is seeking a skilled Utilization Review Nurse to join our team. As a key member of our healthcare team, you will play a critical role in ensuring the delivery of cost-effective quality care within an appropriate length of stay.Responsibilities:Maintain patient confidentiality and adhere to all company...


  • Houston, Texas, United States Steward Health Care Full time

    Job Title: Utilization Review RNAt St. Joseph Medical Center, we are seeking a skilled Utilization Review RN to join our team. As a Utilization Review RN, you will play a critical role in ensuring that patients receive the necessary care and services to achieve optimal health outcomes.Job Summary:The Utilization Review RN is responsible for conducting...


  • Houston, Texas, United States Care Full time

    Job Title: Utilization Review RNAt Care, we are seeking a skilled Utilization Review RN to join our team. As a Utilization Review RN, you will play a critical role in ensuring that patients receive the necessary care and services to achieve optimal health outcomes.Job Summary:The Utilization Review RN is responsible for conducting thorough reviews of patient...


  • Houston, Texas, United States Care Full time

    Job Title: Utilization Review RNJob Summary:The Utilization Review RN is responsible for ensuring the medical necessity of patient admissions and continued stays. This role involves reviewing patient medical records, evaluating the appropriateness of care, and communicating with payors and healthcare teams.Key Responsibilities:Conduct thorough reviews of...


  • Houston, Texas, United States Care Full time

    Job Title: Utilization Review RNJob Summary:We are seeking a skilled Utilization Review RN to join our team at St. Joseph Medical Center. As a Utilization Review RN, you will play a critical role in ensuring that patients receive the necessary care and services to achieve optimal health outcomes.Key Responsibilities:Conduct thorough reviews of patient...


  • Houston, Texas, United States Steward Health Care Full time

    Job Title: Utilization Review RNAt St. Joseph Medical Center, we are seeking a highly skilled and dedicated Utilization Review RN to join our team. As a Utilization Review RN, you will play a critical role in ensuring that our patients receive the highest quality care while minimizing unnecessary hospital stays.Job Summary:The Utilization Review RN is...


  • Houston, Texas, United States Nexus Health Systems Ltd Full time

    Job Title: Utilization Review NurseJob Summary:Nexus Health Systems Ltd is seeking a skilled Utilization Review Nurse to join our team. As a Utilization Review Nurse, you will play a critical role in ensuring the delivery of cost-effective quality care within an appropriate length of stay.Key Responsibilities:Maintain patient confidentiality and adhere to...


  • Houston, Texas, United States Care Full time

    Job Title: Utilization Review RNJob Summary:The Utilization Review RN is responsible for ensuring the medical necessity of patient admissions and continued stays. This role involves reviewing patient records, collaborating with healthcare teams, and communicating with payors to ensure compliance with approved treatment plans.Key Responsibilities:Conduct...


  • Houston, Texas, United States destinationone Consulting Full time

    Job Overviewdestinationone Consulting is a leading recruitment agency specializing in diverse sectors, including Healthcare, Health Tech, Government, Municipalities, Non-Profits, Legal, Public Accounting, and more. We are building a comprehensive database of opportunities in these fields. By applying, you ensure our recruiters can efficiently match you with...


  • Houston, Texas, United States Astrana Health Full time

    Job Title: Utilization Management Review NurseAbout the Role:Astrana Health is seeking an experienced Utilization Review Nurse to work remotely from Texas. This position requires a strong understanding of state and federal regulations and accreditation standards. The ideal candidate will have excellent interpersonal skills and the ability to collaborate with...


  • Houston, Texas, United States Denovo Review Full time

    Job Title: Bilingual Client Relations SpecialistDenovo Review is seeking a highly skilled Bilingual Client Relations Specialist to join our team in Houston, TX. As a key member of our client relations team, you will be responsible for creating exceptional customer experiences while executing administrative duties with precision and attention to detail.Key...


  • Houston, Texas, United States Elite Services Full time

    Job Title: Utilization Review NurseAt Elite Services, we are seeking a skilled Utilization Review Nurse to join our team. As a Utilization Review Nurse, you will play a critical role in ensuring the medical necessity of treatment requests submitted by providers, requestors, claimants, or carriers.Key Responsibilities:Perform thorough evaluations of medical...

  • Clinical Review Nurse

    3 weeks ago


    Houston, Texas, United States Elite Services Full time

    Job Title: Utilization Review NurseAt Elite Services, we are seeking a skilled Utilization Review Nurse to join our team. As a Utilization Review Nurse, you will play a critical role in ensuring the medical necessity of treatment for Workers' Compensation requests.Job Purpose:The primary purpose of this role is to review Workers Compensation requests...


  • Houston, Texas, United States ChaseSource, LP Full time

    Image Reviewer/Data Entry SpecialistChaseSource, LP is seeking a detail-oriented Image Reviewer/Data Entry Specialist to accurately identify license plate numbers, state codes, and plate types. The ideal candidate will possess strong attention to detail, typing skills, and the ability to work independently.Key Responsibilities:Identify and extract license...


  • Houston, Texas, United States BGE, Inc. Full time

    Job SummaryWe are seeking a highly skilled Utility Coordination Specialist to join our team at BGE, Inc. As a key member of our consulting firm, you will play a critical role in providing services in civil engineering, planning, landscape architecture, construction management, survey, and environmental services for public and private clients.Key...


  • Houston, Texas, United States City of Houston, TX Full time

    Job SummaryWe are seeking a highly skilled Utility Maintenance Specialist to join our team at the City of Houston, TX. As a key member of our Public Works department, you will be responsible for ensuring the effective maintenance and operation of our wastewater utility.Key ResponsibilitiesOperate and maintain sampling instruments and perform field analysis...


  • Houston, Texas, United States Eco-Life Employment Group Full time

    Job Title: Image Review Audit Validation SpecialistThe Image Review Audit Validation Specialist plays a crucial role in ensuring the accuracy and quality of the image review process. This position is responsible for verifying the accuracy of reviewed images from the Image Review and Image Review Audit teams.Key Responsibilities:Reviews images to ensure...


  • Houston, Texas, United States Eco-Life Employment Group Full time

    Job Title: Image Review Audit Validation SpecialistThe Image Review Audit Validation Specialist plays a crucial role in ensuring the accuracy and quality of the image review process. This position is responsible for verifying the accuracy of reviewed images from the Image Review and Image Review Audit teams.Key Responsibilities:Reviews images to ensure...


  • Houston, Texas, United States Solstice Consulting Group LLC Full time

    Job Title: Utilities EngineerSolstice Consulting Group LLC is seeking a skilled Utilities Engineer to join our team in Houston, Texas. This role involves overseeing the operational excellence of all plant-related utilities, ensuring optimal performance, and implementing enhancements.Key Responsibilities:Monitor and maintain utility systems, including fresh...


  • Houston, Texas, United States Molina Healthcare Full time

    Job SummaryMolina Healthcare Services (HCS) is seeking a skilled Registered Nurse to join our team as a Care Review Clinician, Inpatient Review. This role is responsible for assessing inpatient services for members to ensure optimum outcomes, cost-effectiveness, and compliance with state and federal regulations and guidelines.Key ResponsibilitiesAnalyze...