Top 54 Clinical documentation & utilization review nurses Jobs in Addison, Tx

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
CLIN DOCUMENTATION SPEC I
Methodist Health System —Dallas, TX
- Full-time
- Nursing
- RN License
- Computer literacy
2d
Utilization Review Nurse Health Plans - HP Utilization Management
Christus Health —Irving, TX
- 8 hour shift
- Microsoft Word
- Nursing
- Microsoft Excel
Utilization Review Nurse
Bracane Co —Plano, TX
- Full-time
- Remote
- RN License
- Mid-level
- 3 years
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RN Utilization Review Coordinator, Full-time
Methodist Hospital for Surgery —Addison, TX
- Full-time
- CPR Certification
- Nursing
- RN License
Quick Apply
DRG Reviewer
Machinify —Dallas, TX
- $90,000 - $115,000 a year
- Remote
- Nursing
- HIPAA
- Mid-level
- Health savings account
- Health insurance
Quick Apply
Senior Consultant - Clinical Documentation Specialist
Deloitte —Dallas, TX
- $110,700 - $218,300 a year
- Full-time
- Microsoft Word
- Nursing
- RN License
Clinical Review Specialist
The Specialty Alliance —Southlake, TX
- $65,000 - $90,000 a year
- Full-time
- Nursing
- LVN
- 5 years
Quick Apply
Clinical Pre-Assessment Review Specialist
PAM Health, LLC —Plano, TX
- Customer service
- Word processing
- Writing skills
Quick Apply
6d
CDI Specialist
Exceptional Healthcare Inc. —Dallas, TX
- Full-time
- Nursing
- RN License
- Inpatient
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
REGIONAL CLINICAL REIMBURSEMENT SPECIALIST - SOUTH CENTRAL TEXAS
INNOVATIVE NURSE CONSULTING LLC —Dallas, TX
- Nursing
- Management
- RN License
High Cost Therapy Liaison RN
Children's Health —Dallas, TX
- Full-time
- Nursing
- RN License
- Mid-level
- Paid parental leave
- Health insurance
5d
Home Health Quality Assurance LVN
UT Southwestern —Dallas, TX
- Full-time
- Nursing
- LVN
- Mid-level
- Paid parental leave
- Paid holidays
Appeal and Denial Specialist Carrollton TX
Continuum Rehab Group —Carrollton, TX
- Email
- Hybrid work
- LVN
- Mid-level
- Office
Quick Apply
MDS Coordinator
The Healthcare Resort of Plano —Plano, TX
- Full-time
- Mid-level
- Teaching
Team Lead, Clinical Documentation Improvement
Methodist Health System —Dallas, TX
- Full-time
- Nursing
- Management
- RN License
Quality Analyst, RN
Baylor Scott & White Medical Center - Sunnyvale —Sunnyvale, TX
- Full-time
- Acute care
- Nursing
- RN License
MDS Coordinator (PCC) LVN
CARRARA —Plano, TX
- Full-time
- Skilled nursing facility
- LVN
- RN License
- Continuing education credits
- Health insurance
Quick Apply
MDS Coordinator (PCC) LVN
SAN REMO —Richardson, TX
- Full-time
- Skilled nursing facility
- LVN
- RN License
- Continuing education credits
- Health insurance
Quick Apply

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Utilization Review Nurse

Oscar Health -
Dallas, TX

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Job Details

$35.00 - $45.94 an hour

Benefits

Paid parental leave
Paid holidays
Disability insurance
Health insurance
Dental insurance
Parental leave
Vision insurance
Paid sick time

Qualifications

Nursing
Utilization review
Managed care organization experience
Acute care facility experience
InterQual
Utilization management
Decision making
Resource utilization in healthcare
Nursing

Full Job Description

Hi, we're Oscar. We're hiring a Utilization Review Nurse to join our Utilization Review team.

About the role:

You will perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed. You will make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions.

You will report into the Supervisor, Utilization Review.

Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois; Iowa; Kansas; Michigan; Missouri; Nebraska; New Jersey; North Carolina; Ohio; Pennsylvania; South Carolina; Tennessee; Texas; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events.

Pay Transparency: The base pay for this role is: $35.00 - $45.94 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Responsibilities:

Complete medical necessity reviews and level of care reviews for requested services using clinical judgment and Oscar Clinical Guidelines, Milliman Care Guidelines
Obtain the information necessary (via telephone and fax) to assess a member's clinical condition, and apply the appropriate evidence-based guidelines
Meet required decision-making SLAs
Refer members for further care engagement when needed
Compliance with all applicable laws and regulations
Other duties as assigned

Requirements:

Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)
Associate Degree - Nursing or Graduate of Accredited School of Nursing Or Successful completion of Nursing Diploma Program in Accredited School of Nursing
Ability to obtain additional state licenses to meet business needs
1+ year of utilization review experience in a managed care setting
Strong experience utilizating MCG (Milliman Care Gudielines) or InterQual
1+ years of clinical experience (including at least 1+ year clinical practice in an acute care setting, i.e., ER or hospital)
Weekend availability is required; all applicants must be able to work at least one weekend day (Saturday or Sunday) each week.

Bonus points:

BSN
Previous experience conducting concurrent or inpatient reviews for a managed care plan

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care - an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team ([email protected]) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

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Refine Your Search

clinical documentation & utilization review nurses jobs in addison, tx

Utilization Review Nurse

CLIN DOCUMENTATION SPEC I

Utilization Review Nurse Health Plans - HP Utilization Management

Utilization Review Nurse

RN Utilization Review Coordinator, Full-time

DRG Reviewer

Senior Consultant - Clinical Documentation Specialist

Clinical Review Specialist

Clinical Pre-Assessment Review Specialist

CDI Specialist

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

REGIONAL CLINICAL REIMBURSEMENT SPECIALIST - SOUTH CENTRAL TEXAS

High Cost Therapy Liaison RN

Home Health Quality Assurance LVN

Appeal and Denial Specialist Carrollton TX

MDS Coordinator

Team Lead, Clinical Documentation Improvement

Quality Analyst, RN

MDS Coordinator (PCC) LVN

MDS Coordinator (PCC) LVN

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