Top 593 utilization review Jobs in texas

Utilization Review Specialist
ADDICTION AND MENTAL HEALTH SERVICES, LLC —Dallas, TX
- Weekends as needed
- Nursing
- Addiction Medicine
- RN License
- Loan repayment program
- Health insurance
Quick Apply
RN Utilization Management - Nights onsite
CHRISTUS Health (IHE/Hosted) —Corpus Christi, TX
- $31.70 - $47.00 an hour
- Full-time
- Background check
- Master of Social Work
- Nursing
- Health savings account
- Relocation assistance
Quick Apply
Medical Director
Health & Human Services Comm —Terrell, TX
- $25,374.89 - $25,432.58 a year
- Extended hours
- 18 years or older
- Medicine
- Psychiatry
- Health insurance
- 401(k)
Quick Apply
Nurse Practitioner/ Physician Assistant (Must beBilingual)
Medical Care Center —Houston, TX
- $120,000 - $150,000 a year
- Full-time
- Working with individuals with developmental disabilities
- Spanish
- Nursing
- Health insurance
- Dental insurance
Quick Apply
Family Nurse Practitioner
Preventative care health services —Alpine, TX
- $110,000 - $120,000 a year
- Full-time
- Working with individuals with developmental disabilities
- Nursing
- Primary Care
- Relocation assistance
- Health insurance
Quick Apply
Director of Nursing (DON)
Bluebonnet Detention Center —Anson, TX
- $100,000 a year
- Full-time
- CPR Certification
- Nursing
- Clean driving record
- AD&D insurance
- Paid holidays
5d
MDS COORDINATOR - RN/LVN
Bastrop Lost Pines Nursing and Rehabilitation Center —Bastrop, TX
- Full-time
- Nursing
- Skilled nursing facility
- LVN
- Disability insurance
- Health insurance
Quick Apply
RN Weekend Supervisor (Sat & Sun)
Ridgecrest Retirement and Healthcare —Waco, TX
- Part-time
- Nursing
- Anatomy knowledge
- Patient monitoring
Quick Apply
11d
Retail Pharmacist
Mid Coast Pharmacy —El Campo, TX
- PRN
- Anatomy knowledge
- Internal Medicine
- HIPAA
Quick Apply
(CEM) - RN Case Manager
Loyal Source —El Paso, TX
- $35.89 an hour
- Weekends as needed
- Spanish
- Nursing
- Microsoft Excel
Quick Apply
9d
Retail Pharmacist
Mid Coast Pharmacy —El Campo, TX
- PRN
- Anatomy knowledge
- Internal Medicine
- HIPAA
Quick Apply
Case Management, RN
Community Health Choice —Houston, TX
- $37.24 - $44.85 an hour
- Full-time
- Hybrid work
- Microsoft Excel
- Microsoft Outlook
- Up to 50% travel
- Disability insurance
- Health insurance
Quick Apply
2d
Utilization Review Registered Nurse
Harmony Health Fort Worth —Fort Worth, TX
- From $65,000 a year
- Full-time
- Background check
- Nursing
- RN License
- Health insurance
- Dental insurance
Quick Apply
Utilization Review Registered Nurse
Paradigm Healthcare —Silsbee, TX
- $35 - $43 an hour
- Full-time
- Background check
- Skilled nursing facility
- Microsoft Outlook
- Health insurance
- Dental insurance
Quick Apply
MDS Nurse
Remington Transitional Care Center —Richardson, TX
- Full-time
- Nursing
- Skilled nursing facility
- LVN
Quick Apply
Case Manager / RN (PRN)
Houston Methodist Willowbrook Hospital —Houston, TX
- PRN
- Nursing
- Microsoft Excel
- Microsoft Outlook
14d
VP Patient Flow & Care Transitions
Harris Health —Bellaire, TX
- $233,480 - $303,472 a year
- Full-time
- Nursing
- Microsoft Excel
- RN License
RN Director of Care Management - Sign On Bonus & Relocation
Lake Granbury Medical Center —Granbury, TX
- Full-time
- Nursing
- RN License
- Hospital
- Health insurance
- Dental insurance
Quick Apply
Case Manager RN PRN
Methodist Hospital Texsan —San Antonio, TX
- PRN
- Bachelor of Science
- Mid-level
- 3 years
- Employee stock purchase plan
- Disability insurance
Quick Apply
MDS Coordinator - LVN/RN
Paradigm at the Prairies —El Campo, TX
- Full-time
- Skilled nursing facility
- Microsoft Outlook
- LVN
- Health insurance
- Dental insurance
Quick Apply
9d

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Utilization Review Specialist

ADDICTION AND MENTAL HEALTH SERVICES, LLC -
Dallas, TX

Quick Apply

Job Details

Benefits

Loan repayment program
Health insurance
Dental insurance
Paid time off
Employee assistance program
Vision insurance
Pet insurance

Qualifications

Confidential information handling
Bachelor's degree

Full Job Description

This is a PRN position

About Company:

We’re officially a Great Place To Work®! We’ve always believed that supporting our team is just as important as supporting our patients. Now, we’re proud to share that we’ve earned Great Place To Work® Certification - based entirely on feedback from our own employees.

Read more here: https://ow.ly/YQ1C50WuRH1

This certification reflects the culture we’ve worked hard to build - one rooted in trust, inclusion, and purpose-driven leadership.

At Bradford Health Services, we are committed to providing exceptional care to our patients while fostering a supportive and rewarding workplace for our employees. We believe that taking care of our team allows them to take better care of others, which is why we offer a comprehensive benefits package designed to support their well-being.

Our benefits include:

Medical Coverage – Three new BCBSAL medical plans with better rates, improved co-pays, and enhanced prescription benefits.
Expanded Coverage – Options for domestic partners and a wider network of in-network providers.
Mental Health Support – Improved access to services and a new Employee Assistance Program (EAP) featuring digital wellness tools like Cognitive Behavioral Therapy (CBT) modules and wellness coaching.
Voluntary Coverages – Pet insurance, home and auto insurance, family legal services, and more.
Student Loan Repayment – Available for nurses and therapists.
Retirement Benefits – 401(k) plan through Voya to help employees plan for the future.
Generous PTO – A robust paid time off policy to support work-life balance.
Voluntary Benefits for Part-Time Employees – Dental, vision, life, accident insurance, and telehealth options for those working 20 hours or more per week.

At Bradford Health Services, we don’t just invest in our patients—we invest in our people.

About the Role:

The Utilization Review Coordinator plays a critical role in ensuring that patients at our facility receive the appropriate level of care while managing treatment costs. This position involves coordinating, assessing, and authorizing treatment plans, collaborating with medical staff, and maintaining compliance with healthcare regulations. The Utilization Review Coordinator works closely with insurance companies, clinicians, and support staff to ensure that treatment plans are clinically appropriate and reimbursable, advocating for the best interests of the patients and the hospital.

Key Responsibilities:

Case Review and Assessment
- Conduct daily reviews of patient charts, treatment plans, and progress notes to determine if the level of care provided aligns with clinical guidelines and insurance requirements.
- Monitor patient progress, reassess treatment needs, and recommend adjustments in care levels as needed.
- Collaborate with clinical teams to understand patient needs, assess treatment efficacy, and make informed recommendations.
Insurance Coordination
- Act as the primary point of contact with insurance providers for treatment authorization, concurrent review, and appeal processes.
- Submit required documentation to insurance companies in a timely manner, including clinical updates, to secure and maintain treatment authorization.
- Resolve reimbursement issues, advocating for patient treatment needs and securing necessary approvals.
Documentation and Compliance
- Ensure all documentation is complete, accurate, and in line with state, federal, and hospital policies to facilitate compliance and quality audits.
- Maintain a working knowledge of current insurance guidelines, DSM-5 criteria, and ASAM (American Society of Addiction Medicine) criteria.
- Participate in internal and external audits, preparing records and reports as necessary.
Collaboration and Communication
- Work closely with medical and support staff to ensure continuity of care and that utilization review processes are aligned with patient needs.
- Provide guidance to clinical staff regarding documentation best practices and criteria required for continued care authorizations.
- Participate in multidisciplinary team meetings to discuss patient care plans, discharge planning, and treatment adjustments.
Quality Improvement
- Identify trends in denied claims or treatment authorizations, providing recommendations for process improvements.
- Assist in training hospital staff on utilization review processes, criteria for different levels of care, and effective documentation practices.
- Collaborate in developing policies to improve efficiency, patient care outcomes, and financial performance.

Qualifications:

Education: Bachelor’s degree in Nursing, Social Work, or a related field required. Master’s degree in a health-related field preferred.
Experience: Minimum of 2 years in utilization review, case management, or related field, preferably within a behavioral health or chemical dependency setting.
Licensure: Current RN, LCSW, or LPC license preferred.
Skills and Competencies:
- In-depth understanding of mental health, substance abuse treatment and ASAM criteria.
- Strong analytical and critical thinking skills with the ability to make clinical judgments based on patient data.
- Excellent communication and interpersonal skills to facilitate interactions with insurers, staff, and patients.
- Proficiency with electronic medical records (EMR) and utilization review software.
- Knowledge of state, federal, and industry regulations related to chemical dependency and mental health care.

Working Conditions:

Full-time, primarily daytime hours, with occasional on-call duties or weekends as needed.
Must be able to work in a high-paced environment and handle sensitive information with discretion.
Physical demands may include sitting for extended periods, light lifting, and using a computer for most of the workday.

Quick Apply

Refine Your Search

utilization review jobs in texas

Utilization Review Specialist

RN Utilization Management - Nights onsite

Medical Director

Nurse Practitioner/ Physician Assistant (Must beBilingual)

Family Nurse Practitioner

Director of Nursing (DON)

MDS COORDINATOR - RN/LVN

RN Weekend Supervisor (Sat & Sun)

Retail Pharmacist

(CEM) - RN Case Manager

Retail Pharmacist

Case Management, RN

Utilization Review Registered Nurse

Utilization Review Registered Nurse

MDS Nurse

Case Manager / RN (PRN)

VP Patient Flow & Care Transitions

RN Director of Care Management - Sign On Bonus & Relocation

Case Manager RN PRN

MDS Coordinator - LVN/RN

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