Top 42 Utilization review nurse Jobs in Dallas, 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
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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 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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7d
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
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RN Utilization Review Coordinator, Full-time
Methodist Hospital for Surgery —Addison, TX
- Full-time
- CPR Certification
- Nursing
- RN License
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CLIN DOCUMENTATION SPEC I
Methodist Health System —Dallas, TX
- Full-time
- Nursing
- RN License
- Computer literacy
2d
Staff Nurse Outpatient Clinic PHP/IOP CCG
Carrus Health —Garland, TX
- RN License
- Computer literacy
- BLS Certification
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
Clinical Review Specialist
The Specialty Alliance —Southlake, TX
- $65,000 - $90,000 a year
- Full-time
- Nursing
- LVN
- 5 years
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Staff Nurse Outpatient Clinic PHP/IOP CCFM
Carrus Health —Flower Mound, TX
- RN License
- Computer literacy
- BLS Certification
Quick Apply
Staff Nurse Outpatient Clinic PHP/IOP CCP
Carrus Health —Plano, 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
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Staff Nurse Outpatient Clinic PHP/IOP CCSL
Carrus Health —Southlake, TX
- RN License
- Computer literacy
- BLS Certification
Quick Apply
Case Manager II PRN Days
Kindred Hospital Tarrant County - Arlington —Arlington, TX
- PRN
- Master of Social Work
- Nursing
- RN License
Registered Nurse/Social Worker Case Manager
Texas Health Hospital Mansfield —Mansfield, TX
- $24.47 - $62.59 an hour
- Full-time
- Nursing
- Microsoft Outlook
- Customer service
- Paid parental leave
- Disability insurance
Clinical Pre-Assessment Review Specialist
PAM Health, LLC —Plano, TX
- Customer service
- Word processing
- Writing skills
Quick Apply
6d
MDS Coordinator
The Healthcare Resort of Plano —Plano, TX
- Full-time
- Mid-level
- Teaching
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
13d
Case Manager ( RN / RT / SW / LPN )
Select Specialty Hospital - Dallas Downtown —DeSoto, TX
- Full-time
- RN License
- Inpatient
- Mid-level
- Dental insurance
- Paid time off
Quick Apply
13d

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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

utilization review nurse jobs in dallas, tx

Utilization Review Nurse

Utilization Review Nurse Health Plans - HP Utilization Management

Utilization Review Nurse

RN Navigator - Home Health Review

TX, RN Certified Case Manager - Workers Compensation

RN Utilization Review Coordinator, Full-time

CLIN DOCUMENTATION SPEC I

Staff Nurse Outpatient Clinic PHP/IOP CCG

Travel RN - Case Management/Utilization Review - Case Management

Clinical Review Specialist

Staff Nurse Outpatient Clinic PHP/IOP CCFM

Staff Nurse Outpatient Clinic PHP/IOP CCP

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

Staff Nurse Outpatient Clinic PHP/IOP CCSL

Case Manager II PRN Days

Registered Nurse/Social Worker Case Manager

Clinical Pre-Assessment Review Specialist

MDS Coordinator

Registered Nurse Quality Assurance - RN QA

Case Manager ( RN / RT / SW / LPN )

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