Top 34 Utilization review nurse Jobs in Plano, Tx

TX, RN Certified Case Manager - Workers Compensation
The Reny Company —Dallas, TX
- $80,000 - $90,000 a year
- 8 hour shift
- Remote
- Nursing
- RN License
- Research
- Mileage reimbursement
- Disability insurance
Quick Apply
RN Navigator - Home Health Review
The CSI Companies —Irving, TX
- $40 - $55 an hour
- Contract
- Nursing
- RN License
- Mid-level
- Paid training
- Disability insurance
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5d
Utilization Review Nurse
Oscar Health —Dallas, TX
- $35.00 - $45.94 an hour
- Weekends as needed
- Remote
- Nursing
- RN License
- Mid-level
- Paid parental leave
- Paid holidays
Quick Apply
Utilization Review Nurse
Bracane Co —Plano, TX
- Full-time
- Remote
- RN License
- Mid-level
- 3 years
Quick Apply
Utilization Review Nurse Health Plans - HP Utilization Management
Christus Health —Irving, TX
- 8 hour shift
- Microsoft Word
- Nursing
- Microsoft Excel
13d
RN Utilization Review Coordinator, Full-time
Methodist Hospital for Surgery —Addison, TX
- Full-time
- CPR Certification
- Nursing
- RN License
Quick Apply
CLIN DOCUMENTATION SPEC I
Methodist Health System —Dallas, TX
- Full-time
- Nursing
- RN License
- Computer literacy
6h
Clinical Pre-Assessment Review Specialist
PAM Health, LLC —Plano, TX
- Customer service
- Word processing
- Writing skills
Quick Apply
4d
Staff Nurse Outpatient Clinic PHP/IOP CCF
Carrus Health —Frisco, TX
- RN License
- Computer literacy
- BLS Certification
Quick Apply
MDS Coordinator
The Healthcare Resort of Plano —Plano, TX
- Full-time
- Mid-level
- Teaching
Staff Nurse Outpatient Clinic PHP/IOP CCP
Carrus Health —Plano, TX
- RN License
- Computer literacy
- BLS Certification
Quick Apply
Staff Nurse Outpatient Clinic PHP/IOP CCG
Carrus Health —Garland, TX
- RN License
- Computer literacy
- BLS Certification
Quick Apply
Pre-Claim Review Coordinator - ProHealth Home Health and Hospice (Dallas, TX)
ProHealth Home Health and Hospice —Addison, TX
- Nursing
- English
- Mid-level
Quick Apply
Travel RN - Case Management/Utilization Review - Case Management
American Traveler —Dallas, TX
- $1,651.66 a week
- Contract
- RN License
- Hospital
- BLS Certification
Quick Apply
Registered Nurse Quality Assurance - RN QA
Muir Home Health —Dallas, TX
- $75,000 - $87,500 a year
- Full-time
- Nursing
- RN License
- Mid-level
- Disability insurance
- Health insurance
Quick Apply
11d
Staff Nurse Outpatient Clinic PHP/IOP CCFM
Carrus Health —Flower Mound, TX
- RN License
- Computer literacy
- BLS Certification
Quick Apply
Hospice Clinical Team Manager (RN Required)
VITAS Healthcare —Dallas, TX
- Full-time
- Nursing
- RN License
- Mid-level
- Disability insurance
- Health insurance
Quick Apply
Registered Nurse Case Manager
Health & Human Services Comm —Denton, TX
- $7,532.75 - $8,886.16 a month
- Extended hours
- 18 years or older
- CPR Certification
- Nursing
- Health insurance
- Opportunities for advancement
Quick Apply
Case Manager - FT
ClearSky Rehabilitation Hospital of Flower Mound, LLC —Flower Mound, TX
- Full-time
- Clean driving record
- Hospital
- Word processing
Quick Apply
Nurse Care Manager
Suvida Healthcare —Dallas, TX
- Full-time
- Spanish
- Nursing
- RN License
- Paid parental leave
- Paid holidays
Quick Apply
7d

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TX, RN Certified Case Manager - Workers Compensation

The Reny Company -
Dallas, TX

Quick Apply

Job Details

Full-time
$80,000 - $90,000 a year

Benefits

Mileage reimbursement
Disability insurance
Health insurance
Dental insurance
401(k)
Paid time off
Vision insurance
401(k) matching
Flexible schedule
Life insurance
Paid sick time

Qualifications

Utilization review
RN License
Research
Case management
Clinical documentation
Workers' compensation
Certified Case Manager

Full Job Description

Currently seeking TX, LA, OK RN for a full-time Pre Auth/ Certified Case Manager in the TX area (either Houston or DFW). The ideal candidate will be a RN with Pre Auth/Case Management experience in worker’s compensation and also certified in case management.

Responsibilities of the RN Pre-Auth/ Certified Case Manager - Workers Compensation

Conducts prospective review of authorization requests including selected specialties, medical treatments and services, elective hospital admissions, ancillary services, home care and out of network referrals. The nurse makes clinical decisions based on established criteria and regulatory requirements. Prepares documentation and manages the utilization of membership, conducts chart review for medical appropriateness of services, and ensures that quality care is delivered in a cost-effective, timely manner. The Pre-Authorization Nurse works in coordination with an interdisciplinary team to achieve the organization mission as well as department specific goals and objectives.
Research and recommend resources and creates flexible, cost-effective options for catastrophically or chronically ill or injured individuals on a case-by-case basis to facilitate quality individualized treatment goals, including timely return to work if appropriate.
Contact customer, medical provider and injured parties on claims involving medical treatment and /or disability to coordinate appropriate medical care and return to work.
Evaluate and update treatment and return to work plans within established protocols throughout the life of the claim.
Evaluate medical treatment requests to ensure that they are reasonable and necessary based upon jurisdictional guidelines.
Works closely with injured worker, claims adjusters, employers, and medical providers to ensure best possible medical care is received for the Worker Compensation injury.
Partner with claim professional to provide input on medical treatment and recovery time to assist in evaluating appropriate claim reserves.
Submit accurate billing documentation on all activities as outlined in established guidelines.
Perform other duties assigned.
Remote position- 85% telephonic & 15% field cases

Requirements of the RN Pre-Auth/Case Manager - Workers Compensation

Graduate of an accredited school of Nursing with a BSN preferred
Must be a Registered Nurse
3-5+ years nursing experience
Workers' compensation and UR experience strongly preferred
Strong technology, organizational and documentation skills a must
Able to work independently, be proactive, and assertive.
need to be a CCM

Benefits:

NO HANDS-ON NURSING REQUIRED!!!!
Remote position: DFW or Houston preferred location, will consider adjacent locations.
Top Salary and excellent benefits including Health Insurance and 401K

Job Type: Full-time

Pay: $80,000.00 - $90,000.00 per year

Benefits:

401(k)
401(k) matching
Dental insurance
Disability insurance
Flexible schedule
Health insurance
Life insurance
Mileage reimbursement
Paid sick time
Paid time off
Vision insurance

Schedule:

8 hour shift
Monday to Friday

Willingness to travel:

25% (Required)

Work Location: Remote

Quick Apply

Refine Your Search

utilization review nurse jobs in plano, tx

TX, RN Certified Case Manager - Workers Compensation

RN Navigator - Home Health Review

Utilization Review Nurse

Utilization Review Nurse

Utilization Review Nurse Health Plans - HP Utilization Management

RN Utilization Review Coordinator, Full-time

CLIN DOCUMENTATION SPEC I

Clinical Pre-Assessment Review Specialist

Staff Nurse Outpatient Clinic PHP/IOP CCF

MDS Coordinator

Staff Nurse Outpatient Clinic PHP/IOP CCP

Staff Nurse Outpatient Clinic PHP/IOP CCG

Pre-Claim Review Coordinator - ProHealth Home Health and Hospice (Dallas, TX)

Travel RN - Case Management/Utilization Review - Case Management

Registered Nurse Quality Assurance - RN QA

Staff Nurse Outpatient Clinic PHP/IOP CCFM

Hospice Clinical Team Manager (RN Required)

Registered Nurse Case Manager

Case Manager - FT

Nurse Care Manager

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