Utilization Management Nurse

  • Jobbing Staffing
  • November 14, 2022 4:47 pm
  • Houston, TX, USA

Utilization Management Nurse


South Loop West

8 am – 5 pm OT weekends are an option

Contract Possible Hire

A busy healthcare organization in Houston off the South Loop West is seeking a Utilization Management Nurse who will assist with case management or caseloads for managed care. In this role, you will compile and review authorizations, review discharge documentation, and coordinate medical plan with medical providers while verifying Medicare/Medicaid criteria sets and standards. Your goal is to balance the quality of patient care with cost efficiency, ultimately maximizing the continuity of care a patient receives.

As part of this role, you will have a strong understanding of the necessity of services before authorizing or preparing cases as well as denials and appeals, and work with patients to help them understand their benefits. Applicants must have an RN license and clinical nursing experience. This is an administrative role, not a bedside role.

Utilization Review Nurse Duties and Responsibilities:

  • Balance quality of care with cost efficiency
  • Obtaining authorization on the provider side
  • Coordinate discharge orders
  • Review the patient’s discharge information
  • Work directly with insurance providers within the Utilization Criteria
  • Compile and review medical information and insurance coverage
  • Authorize requested medical services and prepare cases for physician review
  • Inform patients about their benefits and coverage limits
  • Identify alternative, cost-effective resources

Utilization Review Nurse Requirements and Qualifications:

  • Bachelor’s or master’s degree in nursing
  • Registered Nurse (RN) license
  • Clinical nursing experience (2-4 years)
  • Experience in care or utilization management (2+ years), Case Management, and Home Health Case management is needed
  • BLS certification
  • Computer proficiency including
  • Organizational skills
  • InterQual, Epic, and/or MCG-Milliman is a huge plus

Benefits During This Contract:

  • Direct Deposit options
  • Weekly Pay Periods
  • Easy access to freeway
  • Located in the heart of shopping and restaurants
  • Located near Metro Transit
  • Gain excellent experience with a major healthcare organization
  • Opportunity to become permanent

If you feel you would be an asset by reviewing, authorizing, and handling patient loads, apply today for immediate consideration.

About Resource Staffing

Resource Staffing is an affiliate of The Reserves Network, a family-owned and veteran-founded company. Since 1989, we have been bringing employers and job seekers together in a variety of industries and positions throughout the great state of Texas. As an equal-opportunity employer, we value our employees and foster an environment of respect, integrity, and trust in every aspect of employment. However you identify and whatever your background, we encourage you to .


Apply Now:

Send an email reminder to: Email Address

Share This Job:

Apply Now

Apply Later

Send an email reminder to: Email Address

Share This Job:

Related Jobs:

There are currently no related jobs. Please .


Why people call The Reserves Network

This job has been so rewarding. I have found a passion for connecting talent to create opportunities. The Reserves Network has been very supportive in providing everything that is needed to make us successful. Jeannette Davila

The best thing about The Reserves Network is that you have a support system, from the executive team to the leadership to the training team. We re also big on community involvement and giving back. Michelle Lee

At TRN, I found a company that inspires me. A culture that I am sincerely proud to be part of. A career that challenges and empowers me. All of this coupled with an incredible team spirit. Michael Gilliam

I feel like I have been able to achieve my personal and economic goals in a very short amount of time. I have excellent colleagues, and TRN makes me feel like I m important. Rafael Santiago

I ve learned new skills and been able to share some of my knowledge with other members of the TRN family. I m working towards a new role, and have the best team to support me. I could not ask to be with a better company! Meredith Farmer

My job is really fun. TRN is a little bit different in the sense of the support you can receive we share, we re a team, we re a family. Leland Lyle

It s a great place to expand your career path and venture out and see what s a good fit for you. Within the company, there are so many departments and roles where you get to explore and find a fit. I ve been here for 16 years and am hoping for 16 more! Christi Bittner

The staff was very pleasant and very helpful. They helped me through the entire process and it took less time than I thought. I will definitely be coming here again and I would highly recommend this place. Nandi W.

The Reserves Network has always been very helpful since I have been with them for almost two years. The people are always professional and quick to help me resolve any issue I have had. they also, check in with me to see how I’m doing. Michael I.

Very good staff and they will have you working in no time. Anthony M.


About Us

TRN is a leading provider of Total Staffing Solutions including temporary, temp-to-hire and direct hire placements.

  • Category : Information Technology & Telecom
  • Salary : $52.00 per hour
  • Company Name : The Reserves Network


Houston, TX, USA

Leave a Reply