Top 28 Utilization review rn Jobs in Conroe Tx

Case Manager / RN (PRN)
Houston Methodist Willowbrook Hospital —Houston, TX
- PRN
- Nursing
- Microsoft Excel
- Microsoft Outlook
11d
Clinical Nurse, Outpatient - PACU - Woodlands
MD Anderson —The Woodlands, TX
- $32.69 - $68.50 an hour
- Overtime
- CPR Certification
- Nursing
- RN License
- Health savings account
- AD&D insurance
3d
RN Case Manager
Nexus Children's Hospital —Shenandoah, TX
- Full-time
- Nursing
- RN License
- Bachelor of Science
Quick Apply
Charge RN II OR Department Premium
Houston Methodist The Woodlands Hospital —The Woodlands, TX
- Full-time
- Acute care
- Nursing
- RN License
MDS Coordinator - LVN/RN
Paradigm Northwest —Houston, TX
- Full-time
- Skilled nursing facility
- Microsoft Outlook
- LVN
- Health insurance
- Dental insurance
Quick Apply
9d
Charge Registered Nurse II - Infusion Center
Houston Methodist Willowbrook Hospital —Houston, TX
- Full-time
- Nursing
- RN License
- BLS Certification
2h
Charge Registered Nurse II -Observation
Houston Methodist Willowbrook Hospital —Houston, TX
- Full-time
- Nursing
- RN License
- BLS Certification
11d
Charge Registered Nurse II - Extended Waiting
Houston Methodist Willowbrook Hospital —Houston, TX
- Full-time
- Nursing
- RN License
- BLS Certification
9d
Periop Nurse Coordinator - Neuro
Houston Methodist Willowbrook Hospital —Houston, TX
- 8 hour shift
- Acute care
- Nursing
- Surgery
2h
Nurse Manager RN Post Medical Surgical
HCA Houston Healthcare Conroe —Conroe, TX
- Full-time
- Medical-Surgical
- 1 year
- Senior level
- Employee stock purchase plan
- Disability insurance
Quick Apply
8d
Registered Nurse, Operating Room
Townsen Memorial Hospital —The Woodlands, TX
- Full-time
- Background check
- Nursing
- Surgery
- AD&D insurance
- Disability insurance
Quick Apply
Nurse Manager RN IMCU
HCA Houston Healthcare Conroe —Conroe, TX
- Full-time
- Mid-level
- 1 year
- Leadership
- Employee stock purchase plan
- Disability insurance
Quick Apply
8d
Nurse Manager RN Cardiovascular Progressive Care
HCA Houston Healthcare Conroe —Conroe, TX
- Full-time
- 1 year
- Senior level
- Leadership
- Employee stock purchase plan
- Disability insurance
Quick Apply
8d
Clinical Coordinator - Charge Registered Nurse - Dialysis
Fresenius Medical Care —Humble, TX
- Full-time
- Nursing
- RN License
- Administrative experience
- Tuition reimbursement
2h
Nurse Practitioner - N. Houston
Clay Consulting —Houston, TX
- $120,000 - $150,000 a year
- Extended hours
- Nursing
- Blood sampling
- Microsoft Excel
Quick Apply
11d
Complex Care Manager RN-Western MA (Hybrid)
WellSense Health Plan —United States
- $74,000 - $107,000 a year
- Full-time
- Hybrid work
- Background check
- School experience
- Nursing
- Health insurance
- Dental insurance
Remote Utilization Management Nurse (RN or LVN – CA Lic. Req.) | Preservice/Denials Dept.
Dragonfly Global —United States
- $100,000 - $105,000 a year
- Full-time
- Remote
- Spanish
- Nursing
- Microsoft Excel
- Travel reimbursement
- Health savings account
Quick Apply
1d

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Case Manager / RN (PRN)

Houston Methodist Willowbrook Hospital -
Houston, TX

Apply Now

Job Details

PRN
11 days ago

Qualifications

Customer communication
Microsoft Excel
Microsoft Outlook
Inpatient experience
Utilization review
RN License
Writing skills
In-person customer service
English
Medicaid health insurance
Managing patients as a nurse case manager
Evidence-based practice
Medicare regulations
Utilization management
Patient care
Resource utilization in healthcare
Medicaid
Healthcare reimbursement methods
Hospital experience

Full Job Description

Houston Methodist Willowbrook Hospital (PRN)

At Houston Methodist, the Case Manager PRN (CM) position is a licensed registered nurse (RN) who comprehensively plans for case management of a target patient population on a designated unit(s). This position works with the physicians and interprofessional health care team to facilitate and maintain compassionate, efficient quality care and achievement of desired treatment outcomes. The CM PRN holds joint accountability with social worker for discharge planning and continuity of care and assures that admission and continued stay are medically necessary and communicates clinical information to payors to ensure reimbursement. The CM PRN helps drive change by identifying areas where performance improvement is needed (e.g., day-to-day workflow, education, process improvements, patient satisfaction).

FLSA STATUS
Non-exempt

QUALIFICATIONS

EDUCATION

Graduate of education program approved by the credentialing body for the required credential(s) indicated below in the Certificates, Licenses and Registrations section.

EXPERIENCE

Three (3) years hospital clinical nursing experience which includes two (2) years in case management

LICENSES AND CERTIFICATIONS
Required

RN - Registered Nurse - Texas State Licensure - Texas Board of Nursing_PSV Compact Licensure – Must obtain permanent Texas license within 60 days (if establishing Texas residency)

SKILLS AND ABILITIES

Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations.
Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security.
Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles.
Strong assessment, organizational and problem-solving skill as evidenced by capacity to prioritize multiple tasks and role components
Knowledge of Medicare, Medicaid and Managed Care requirements
Comprehensive knowledge of community resources, health care financial and payer requirements/issues, and eligibility for state, local and federal programs
Comprehensive knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement.
Understanding of pre-acute and post-acute venues of care and post-acute community resources.
Ability to work independently
Strong assessment, organizational and problem-solving skill as evidenced by capacity to prioritize multiple tasks and role components
Demonstrates critical thinking and makes decisions using evidence-based analytical approach in interactions with physicians, payors, and patients and their families

ESSENTIAL FUNCTIONS

PEOPLE ESSENTIAL FUNCTIONS

Collaborates with the physician and all members of the interprofessional health care team to facilitate care for designated case load; monitors the patient’s progress, intervening as needed to ensure that the plan of care and services provided are patient-focused, high quality, efficient, and cost-effective; facilitates timely: • completion and reporting of diagnostic testing; • completion of treatment plan and discharge plan; • modification of plan of care, as necessary, to meet the ongoing needs of the patient; • assignment of appropriate levels of care; • completion of all required documentation in EPIC and MIDAS
Serves as a preceptor, as appropriate, and implements staff education specific to patient populations and unit processes; coaches and mentors other staff and students. Serves a resource for case management and social work resources and needs for the department and the hospital.

SERVICE ESSENTIAL FUNCTIONS

Performs review for medical necessity of admission, continued stay and resource use, appropriate level of care and program compliance. Identifies when services no longer meet InterQual/Millman l criteria, initiates discussion with attending physicians, coordinates with the external case manager to facilitate discharge planning, seeks assistance from the physician advisor, if needed, and informs management of the possible need for issuing Medicare Hospital Initiated Notice of Non-coverage.
Applies approved utilization criteria to monitor appropriateness of admissions, level of care, resource utilization, and continued stay. Reviews level of care denials to identify trends and collaborate with team to recommend opportunities for process improvement.

QUALITY/SAFETY ESSENTIAL FUNCTIONS

Documents assessment and interventions efficiently and effectively.
Plans for routine/difficult discharge and anticipates/prevents and manages emergent situations. Specific focus given to discharge plan and elimination of barriers.
Performs post-discharge review by analyzing the inpatient record to ensure that compliance with quality indicators are met. Intervenes and takes appropriate action to foster real-time compliance with CMS guidelines and other performance measures associated with certification programs and other regulatory, national, regional or locally- sponsored quality programs. Provides reports, as needed, to appropriate parties showing: • compliance with established governmental and/or institutional rules and regulations • analysis of problematic areas, and • actions taken to improve compliance
Conducts chart audits and performs peer-to-peer evaluations for continuous quality improvement.
Identifies opportunities to improve patient satisfaction with focus on discharge domain and collaborates with unit leadership to implement evidence-based patient engagement strategies.

FINANCE ESSENTIAL FUNCTIONS

Monitors Length of Stay (LOS) for case load on an ongoing basis. Identifies population and/or service-specific trends impacting LOS and addresses/resolves problems impeding treatment progress. Proactively takes action to achieve continuous improvement and expedite care/facilitate discharge. Contributes to meeting departmental financial target on scorecard
Manages all patients in Observation Status, daily, informing physicians of timely disposition options to assure maximum benefits for patients and reimbursement for the hospital.
Secures reimbursement for hospital services by communicating medical information required by all external review entities, managed care contracts, insurers, fiscal intermediaries, and state and federal agencies. Responds to requests for information, monitors covered days, and initiates review to assure that all days are covered and reimbursable.

GROWTH/INNOVATION ESSENTIAL FUNCTIONS

Provides education to unit-based physicians, nurses, and other healthcare providers on any case management topics.
Identifies opportunity for practice changes. Offers innovative solutions through evidence-based practice/performance improvement projects and shared governance activities.

SUPPLEMENTAL REQUIREMENTS

WORK ATTIRE

- Uniform: No
- Scrubs: No
- Business professional: Yes
- Other (department approved): No

ON-CALL*

- Note that employees may be required to be on-call during emergencies (ie. Disaster, Severe Weather Events, etc) regardless of selection below.
- On Call* Yes

TRAVEL**

**Travel specifications may vary by department**

- May require travel within the Houston Metropolitan area Yes
- May require travel outside Houston Metropolitan area No

QUALIFICATIONS

EDUCATION

Graduate of education program approved by the credentialing body for the required credential(s) indicated below in the Certificates, Licenses and Registrations section.

EXPERIENCE

Three (3) years hospital clinical nursing experience which includes two (2) years in case management

LICENSES AND CERTIFICATIONS
Required RN - Registered Nurse - Texas State Licensure - Texas Board of Nursing_PSV Compact Licensure – Must obtain permanent Texas license within 60 days (if establishing Texas residency)

Company Profile:

Houston Methodist Willowbrook Hospital is a Magnet-recognized, not-for-profit, faith-based hospital that serves the growing Northwest Houston community. We are committed to providing quality, cost-effective health care in a compassionate environment for a full range of services, including emergency care, cardiology, orthopedics and sports medicine, comprehensive women’s services, neurology and neurosurgery, oncology, and primary and general medicine.

Houston Methodist is an Equal Opportunity Employer.

Apply Now

Refine Your Search

utilization review rn jobs in conroe tx

Case Manager / RN (PRN)

Clinical Nurse, Outpatient - PACU - Woodlands

RN Case Manager

Charge RN II OR Department Premium

MDS Coordinator - LVN/RN

Charge Registered Nurse II - Infusion Center

Charge Registered Nurse II -Observation

Charge Registered Nurse II - Extended Waiting

Periop Nurse Coordinator - Neuro

Nurse Manager RN Post Medical Surgical

Registered Nurse, Operating Room

Nurse Manager RN IMCU

Nurse Manager RN Cardiovascular Progressive Care

Clinical Coordinator - Charge Registered Nurse - Dialysis

Nurse Practitioner - N. Houston

Complex Care Manager RN-Western MA (Hybrid)

Remote Utilization Management Nurse (RN or LVN – CA Lic. Req.) | Preservice/Denials Dept.

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