Top 12 Utilization review nurse Jobs in Edinburg Tx

Quality Assurance Nurse
Stepping Stones Home Care Services Ltd —McAllen, TX
- $25 - $30 an hour
- Full-time
- LVN
- RN License
- Data analysis skills
- Health insurance
- Dental insurance
Quick Apply
4d
LVN Case Manager- FT - Days - Res Mgmt
DHR Health —Edinburg, TX
- Full-time
- Nursing
- LVN
- Hospital
RN Transfer - PRN - Varies - Patient Intake Care
DHR Health —Edinburg, TX
- Call employer
- Spanish
- Nursing
- RN License
Case Manager RN
Mission Regional Medical Center —Mission, TX
- Day shift
- Nursing
- Hospital
- Computer literacy
- 401(k)
RN Case Manager
Mission Regional Medical Center —Mission, TX
- 8 hour shift
- Nursing
- RN License
- Hospital
- Health insurance
NPST Clinical Operations Manager
Nurse Practitioner Services of Texas —Weslaco, TX
- Weekends as needed
- Nursing
- RN License
- Computer literacy
Quick Apply
12d

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LVN Case Manager- FT - Days - Res Mgmt
DHR Health —Edinburg, TX
Current license/valid permit to practice in the State of Texas will be required of all certified individuals. Transition planning assessment and reassessment,.

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Clinical Review Nurse Supervisor (Medicaid Health Systems Administrator 1)
State of Ohio - Medicaid —Columbus, OH
Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence. Exp. in the delivery of a health services program or…
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Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…
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utilization review nurse jobs near edinburg tx

Quality Assurance Nurse

Stepping Stones Home Care Services Ltd -
McAllen, TX

Quick Apply

Job Details

Full-time
$25 - $30 an hour
4 days ago

Benefits

Health insurance
Dental insurance
Paid time off
Vision insurance
Life insurance

Qualifications

LVN
RN License
Home health
Home healthcare regulations
Home health agency experience
Quality assurance experience within healthcare

Full Job Description

Company Overview

Stepping Stones Home Care Services Ltd is committed to delivering excellence and integrity in health services. Our agency specializes in providing compassionate, high-quality care tailored to each individual's needs.

Job Summary

We are seeking a dedicated and detail-oriented Quality Assurance Nurse to oversee clinical documentation, compliance, and quality standards within our home care setting. The ideal candidate will possess extensive experience in Home Health documentation review, utilization management, and healthcare regulations, ensuring that our services meet all required standards of quality and safety. This role offers an opportunity to influence patient care quality through meticulous review and adherence to industry best practices.

Responsibilities

Conduct comprehensive reviews of Start of Cares, OASIS, Discharges, ensuring accuracy, completeness, and compliance with clinical documentation standards.
Monitor adherence to healthcare regulations including HIPAA, CMS guidelines, and state-specific policies.
Collaborate with clinical teams to improve documentation practices aligned with Medicare, Medicaid, and long-term care regulations.
Perform utilization management activities by reviewing patient cases for appropriate resource utilization and care planning.
Support clinical documentation improvement initiatives to enhance coding accuracy (CPT, ICD-9, ICD-10) and DRG assignments for billing purposes.
Utilize EMR such as AXXESS & HealthTrust and other electronic health record platforms for documentation review and data analysis.
Maintain up-to-date knowledge of health regulation policies including CMS updates to ensure ongoing compliance.

Experience

Proven of 3 years experience in the Home Health Setting as a QA Nurse
Strong background in managed care environments with familiarity in Medicare regulations and utilization review processes.
Experience working with EMR, AXXESS, HealthTrust or similar platforms.
Knowledge of ICD coding (ICD-10), CPT coding, DRG assignment.

If interested give us a call at 956-661-9400 ask for Ashlee or Juan

Pay: $25.00 - $30.00 per hour

Benefits:

Dental insurance
Health insurance
Life insurance
Paid time off
Vision insurance

Experience:

QA NURSE IN HOME HEALTH: 3 years (Required)
OASIS: 3 years (Required)

License/Certification:

RN License (Required)
LVN (Required)

Work Location: In person

Quick Apply

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utilization review nurse jobs in edinburg tx

Quality Assurance Nurse

LVN Case Manager- FT - Days - Res Mgmt

RN Transfer - PRN - Varies - Patient Intake Care

Case Manager RN

RN Case Manager

NPST Clinical Operations Manager

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