Top 117 Utilization review Jobs in Houston Tx

MOT Admissions Registered Nurse
Sun Behavioral Houston —Houston, TX
- From $40 an hour
- Full-time
- Nursing
- RN License
- Master's degree
- Wellness program
- Disability insurance
Quick Apply
Manager of Case Management (RN or LMSW)
TriSource —Houston, TX
- $110,000 - $130,000 a year
- Full-time
- Acute care
- Nursing
- RN License
- Health insurance
- Dental insurance
Quick Apply
Remote UTILIZATION REVIEW NURSE - RN
Nexus Health Systems Ltd —Houston, TX
- Full-time
- Remote
- Nursing
- RN License
- Bachelor of Science
- Paid holidays
- Health insurance
Quick Apply
Behavioral Health Care Advocate - UM - Remote
Optum —Houston, TX
- $60,200 - $107,400 a year
- Full-time
- Microsoft Outlook
- Pass drug screening
- Mid-level
Quick Apply
Utilization Specialist - Hybrid
Eduvention Mentoring & Consulting —Houston, TX
- Monday to Friday
- HIPAA
- Mid-level
- Master's degree
- Paid time off
Utilization Mgmt Clinical RN
Texas Children's Hospital —Bellaire, TX
- Full-time
- Nursing
- RN License
- Research
3d
STAR+PLUS Appeals Nurse RN
Harris Health —Houston, TX
- $80,000 - $100,000 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- Microsoft Outlook
- Health insurance
- Dental insurance
Care Coordinator Assistant
Texas Children's Hospital —Houston, TX
- Full-time
- Mid-level
- High school diploma or GED
- Home Health
Insurance Verification Representative-PT
West Oaks Hospital —Houston, TX
- Part-time
- Acute care
- Psychiatry
- Adults
- Paid time off
- 401(k) matching
Care Coordinator Assistant-Behavioral Health
Texas Children's Hospital —Houston, TX
- Full-time
- Mid-level
- High school diploma or GED
- Home Health
BH Utilization Manager RN
Harris Health —Houston, TX
- $67,200 - $85,000 a year
- Full-time
- Remote
- Microsoft Word
- Nursing
- Microsoft Outlook
- Health insurance
- Dental insurance
Regional Administrative Assistant
Health & Human Services Comm —Houston, TX
- $3,333.34 - $4,007.95 a month
- Online Application
- Hybrid work
- Microsoft Outlook
- 5 years
- Research
- Health insurance
- Opportunities for advancement
Quick Apply
7d
Utilization Management Specialist I
SUN Behavioral Houston —Houston, TX
- PRN
- CPR Certification
- Writing skills
- BLS Certification
- Employee assistance program
- 401(k) matching
Quick Apply
Care Coordinator Assistant PT- Behavioral Health
Texas Children's Hospital —Houston, TX
- Part-time
- Mid-level
- High school diploma or GED
- Home Health
Nurse, Concurrent Review
HealthHelp - A WNS Company —Houston, TX
- $75,000 a year
- Weekends as needed
- Remote
- Nursing
- Microsoft Excel
- RN License
- AD&D insurance
- Paid holidays
Quick Apply
Case Manager
Texas Children's Hospital —Houston, TX
- Full-time
- Nursing
- RN License
- Hospital
2d
Medical Care Coordinator
Brite Health Care —Katy, TX
- $17 - $23 an hour
- Full-time
- Background check
- HIPAA
- In-person
- Dental insurance
- Paid time off
Quick Apply
3d
Discharge Planner
SUN Behavioral Houston —Houston, TX
- Full-time
- CPR Certification
- LVN
- Writing skills
Quick Apply
21h
Director, Utilization Management, RN - ONSITE - Kelsey Seybold Clinics
Optum —Pearland, TX
- $112,700 - $193,200 a year
- Full-time
- Nursing
- RN License
- Pass drug screening
Quick Apply
3h
Clinical Team Lead - Utilization Management
The Harris Center for Mental Health and IDD —Houston, TX
- From $84,903 a year
- Full-time
- LMFT
- Word processing
- Writing skills
- Paid time off
- Gym membership

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MOT Admissions Registered Nurse

Sun Behavioral Houston -
Houston, TX

Quick Apply

Job Details

Full-time
From $40 an hour

Benefits

Wellness program
Disability insurance
Health insurance
Dental insurance
Paid time off
Employee assistance program
Vision insurance
401(k) matching
Employee discount
Life insurance

Qualifications

Behavioral health hospital experience
RN License
Mental health facility experience
Bachelor's degree

Full Job Description

Come join SUN Behavioral Houston, where our mission is to partner with communities to solve the unmet needs of those who suffer from mental illness and substance use disorders. We are a free-standing psychiatric hospital that operates 24/7 that provides a full continuum of specialized care, including inpatient and day hospital services, and offer specialized programs for children, adolescents and adults. As a member of SUN Behavorial's diverse team of professionals, you will be provided meaningful employment and a supportive culture. For more information, visit www.sunhouston.com.

Work Schedule: Variable, as needed

Location: 7601 Fannin St, Houston, Texas. 77054

Job Type: Full-Time (36hrs/wk)

FLSA: Non-Exempt

Supervisor: Director, Intake Services

What We Offer:

PTO
Shift Differential
Medical, Dental, Vision
Short-Term Disability Employer Paid
Basic Life Insurance Employer Paid
401(k) Plan with company match
Employee Assistance Program (EAP)
Employee Discount Savings Program
Employee Wellness program

Position Summary:

Receives inquiry calls and assists the caller with scheduling a face-to-face assessment or provide triage to the appropriate community referral based on patient need. Assesses or ensures necessary assessment by a licensed RN for patients who present for assessment. Upon assessment of the patient, coordinates with the physician to ensure appropriate treatment is provided either at the hospital or another appropriate provider in the community. Ensures appropriate screening of medical and behavioral emergency conditions. Completes all administrative processes of the admission for treatment including, as appropriate, the initial authorization of care with the insurance company/third-party payor. Able to work through and accept referrals through various platforms, Kno2, Carelink, Open Beds, Xferral, Bed Board

Position Requirements:

Required: Meeting state requirements, a Bachelors or Masters degree in Nursing, RN license.
Maintains education and development appropriate for position.
Required: minimum 1 year of experience in a behavioral health setting.
Preferred: Previous assessment and evaluation experience in a behavioral health setting.

Position Responsibilities:

Clinical / Technical Skills (40% of performance review)

· Demonstrates excellent phone skills including inquiry calls, explanation of assessment processes, scheduling appointments and successful closure of a call while avoiding phone therapy.

· States the procedure for managing a crisis call and identifies when to activate EMS services. Identifies safety and risk of each call.

· Documents all inquiry calls, completely, to include all applicable information on prospect form in Wellsky.

· Makes appropriate referrals to community resources if not scheduling an assessment

· States the process and reasoning for all follow up calls either to confirm an assessment, inquire about no-show status, or rescheduling an assessment to include documentation reflecting same.

· Enters all inquiry calls into HCS with all data needed to further action or follow up

· Shows competency and understanding of the review of the medical screen; as appropriate, notifies the RN for additional review and action.

· States the working definition and procedure for managing medically and psychiatric emergencies according to EMTALA guidelines as well as hospital policies.

· Identifies and triages emergent patients and prioritizes care based on same.

· Completes the clinical screening and assessment tool (intake assessment) with concise, clear documentation.

· As applicable, identifies the need for additional screening for substance use, nutrition needs, functional needs, and abuse for children/adolescents, school and development screening.

· Demonstrates understanding of admission criteria for inpatient, partial hospitalization, intensive outpatient hospitalization and outpatient levels of care.

· Documents any special needs related to spiritual or cultural needs.

· Demonstrates a working knowledge of community mental health and substance use programs/referral to be offered for all patients not at imminent risk nor requiring services at a higher level of care as provided at the hospital.

· By demonstrating competency and thorough clinical understanding, ensures that each patient is seen by a physician or has had a consult by a physician to obtain treatment recommendations and disposition.

· Upon admission to a treatment program within the hospital, notifies the unit staff of the patient’s level of acuity, chief compliant and history of illness leading to admission, medical concerns and attending physician.

· Evidences understanding of all hospital required forms for admission and completion of these admission forms for each department as applicable.

· Knowledge of state local laws, ordinances and practices governing involuntary hospitalization and ensure compliance with same.

· Ensure correct information on EMTALA log to include all timelines and no blanks in documentation.

· Demonstrates understanding of utilization review process to include treatment criteria and precertification payor to obtain initial authorization of care and document same with pass to the Utilization Management team for concurrent reviews.

· Demonstrates an ability to be flexible, organized and function well in stressful situations.

· Treats patients and their families with respect and dignity, ensures confidentiality of patients’ records.

· Interacts professionally with patient/family and provides explanations and verbal reassurance as necessary.

· Ensures that documentation meets current standards and policies.

· Answers the telephone in a polite manner and communicates information to the appropriate staff/family member.

· Individuals with a Registered Nurse license:

o Enter orders into HCS for admission and other orders as needed. This includes the follow up documentation required for PRN medication and first dose monitoring

o Knowledgeable of medications, including psychotropic drugs, and their correct administration based on the age of the patient and their clinical condition as demonstrated by observation of education completed with the patient/family members

o Conducts nurse to nurse report.

· Perform other duties as required

Pay: From $40.00 per hour

Education:

Bachelor's (Required)

Experience:

Behavioral health hospital: 1 year (Required)

License/Certification:

Registered Nurse (Required)

Work Location: In person

Quick Apply

Refine Your Search

utilization review jobs in houston tx

MOT Admissions Registered Nurse

Manager of Case Management (RN or LMSW)

Remote UTILIZATION REVIEW NURSE - RN

Behavioral Health Care Advocate - UM - Remote

Utilization Specialist - Hybrid

Utilization Mgmt Clinical RN

STAR+PLUS Appeals Nurse RN

Care Coordinator Assistant

Insurance Verification Representative-PT

Care Coordinator Assistant-Behavioral Health

BH Utilization Manager RN

Regional Administrative Assistant

Utilization Management Specialist I

Care Coordinator Assistant PT- Behavioral Health

Nurse, Concurrent Review

Case Manager

Medical Care Coordinator

Discharge Planner

Director, Utilization Management, RN - ONSITE - Kelsey Seybold Clinics

Clinical Team Lead - Utilization Management

I want to receive the latest job alert for utilization review in houston tx

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