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Utilization review nurse jobs in Houston, TX

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  • Staff Nurse, Immediate Care

    Christus Health 4.6company rating

    Utilization review nurse job in Texas City, TX

    The competent Nurse, in the Critical Care and similar clinical setting , practices independently and demonstrates an awareness of all relevant aspects of a situation. Provides routine and complex care, in accordance with patient treatment plans. Continues to develop the ability to cope with and manage contingencies of clinical nursing. Makes appropriate assignments and delegates to other care providers as a means to help manage the clinical situation. Responsibilities: Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders. Meets expectations for flexibility of assignment within the ministry. Proactively provide assignment availability on a regular basis. Able to be assigned to more than one unit. Consistent with the ANA Scope and Standards of Practice, provides nursing care utilizing the nursing process, including assessment, diagnosis, planning, intervention and evaluation for assigned patients. Addresses increasingly complex psychological, emotional, cultural, and social needs of patient and families in accordance with their level of practice. Using the appropriate protocol, administers medications and treatments; monitors for side-effects and effectiveness of the treatment prescribed. Documents patient history, symptoms, medication, and care given. Assess learning needs and provides education to patients, family members and/or care givers; identify issues and resources. CORE COMPETENCIES Standard I: Utilizes the Nursing Process Uses critical thinking skills to assess the basic physical, psychosocial, social, cultural, spiritual, and development needs of patient and families. Communicates findings to appropriate healthcare team members. Develops and uses a specific plan of care and modifies it to meet individual patient needs using evidence-based practice. Implements patient care and therapeutic procedures; monitors and documents progression of treatment and teaching goals. Evaluates the care and treatment(s) provided to the patient and the patient response to the care and treatment(s). Performs timely reassessment and documentation. Must be able to perform unit-specific competencies based on the specific patient care need for the designated unit's patient population. Standard II. Patient Throughput & Patient Flow Process Anticipates and plans for admission/discharge/transfer needs to facilitate patient flow. Utilizes appropriate systems of communication and tools to facilitate the discharge process. Coaches on tools and techniques for checking, cross checking and validating orders to ensure accuracy. Standard III. Unit Operations Plans, directs, and evaluates the overall nursing care and functions in a particular nursing unit during an assigned shift. Demonstrates good stewardship in proper use and maintenance of equipment and Supplies. Assesses departmental staffing needs; actively participates in resourcing efforts. Educates and trains others on the operations, ethics, and regulations within the industry. Standard IV. Safe Practice/Quality Care/Regulations Incorporates patient safety practices/guidelines to promote a safe environment resulting in positive patient outcomes. Demonstrates accountability for nursing research and quality improvement activities. Provides evidence-based nursing care. Communicates patient information effectively across the continuum of care. Educates and trains others on the operations, ethics, and regulations within the industry. Knowledge of federal, state and local healthcare-related laws and regulations; ability to comply with these in healthcare practices and activities. TECHNICAL COMPETENCIES Clinical Policies and Standards Follows a specific set of standards and associated clinical procedures Analyzes policy and standards documentation and ensures organizational compliance.. Provides feedback for improvement of procedures. Assists in the development and implementation of specific procedures. Works with control and monitoring mechanisms, tools and techniques. Health Information Documentation Shares experiences with maintaining paper and electronic patient documentation. Walk through the steps and procedures for receiving, validating and updating patient records. Describes the flow of information between various stations or units. Discusses the functions, features and document flow of electronic documentation. Transcribes verbal orders; explains techniques for ensuring their accuracy. Explains health information documentation best practices and their rationale across health care practices. Medical Equipment Describes experience with basic medical equipment used in own unit or facility. Uses standard diagnostic tools and techniques to resolves common equipment problems. Educates patients about the appropriate use of home medical equipment. Ensures that all equipment and related supplies are in proper working order prior to use to ensure patient safety. Inspects, troubleshoots and evaluates incoming equipment. Medical Order Processing Shares experiences with processing medical orders for one or more groups of patients or conditions. Describes functions and features of the system used to enter, validate, update and forward medical orders. Discusses common errors, their sources and procedures for correcting. Explains considerations for entering and following standing orders. Differentiates between standing orders and preprinted orders and considerations for each. Patient Chart Reading and Interpretation Describes experiences in reading and interpreting patient charts for patients on unit and under own care. Reviews patients' charts for completion and accuracy; identifies and alerts to mistakes or omissions. Recognizes unexpected readings and alerts nursing or medical staff. Relates examples of mis-readings or misinterpretations and lessons learned. Reviews, discusses and validates own interpretation with others. Patient Safety Shares experiences with ensuring safety for one or more patient groups or settings. Explains key features of safety guidelines and procedures for those groups and settings. Listens and responds to safety inquiries from patients and family members. Recognizes and addresses physiological and psychological signs of problems. Describes considerations for patients who can cause to harm to self, versus harm to others. Utilizes appropriate systems to document misses and near misses, participates in immediate investigating, analysis and reporting in real-time. Job Requirements: Education/Skills ~ Bachelor of Science Degree in Nursing, preferred Experience ~ Minimum of 2 years of combined experience required in both the Critical Care setting and one other specialty (e.g. Medsurg, Telemetry, IMC or Emergency) ~5 years of experience preferred Licenses, Registrations, or Certifications BLS required ACLS required RN License in the state of employment or compact required PALS is required at CHRISTUS Children's Hospital NRP is required at CHRISTUS Children's Hospital Work Schedule: 7AM - 7PM Work Type: Part Time
    $59k-75k yearly est. 1d ago
  • Nurse Reviewer I

    Carebridge 3.8company rating

    Utilization review nurse job in Houston, TX

    Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Work Schedule: Monday through Friday, 9:30 AM - 6:00 PM CST or PST (Local Time) A proud member of the Elevance Health family of companies, Carelon Medical Benefits Management, formerly AIM Specialty Health, is a benefit-management leader in Illinois. Our platform delivers significant cost-of-care savings across an expanding set of clinical domains, including radiology, cardiology and oncology. The Nurse Reviewer I is responsible for conducting preauthorization, out of network and appropriateness of treatment reviews for diagnostic imaging services by utilizing appropriate policies, clinical and department guidelines. * Collaborates with healthcare providers, and members to promote the most appropriate, highest quality and effective use of diagnostic imaging to ensure quality member outcomes, and to optimize member benefits. * Works on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. * Partners with more senior colleagues to complete non-routine reviews. * Through work experience and mentoring learns to conduct medical necessity clinical screenings of preauthorization requests to assess the medical necessity of diagnostic imaging procedures, out of network services, and appropriateness of treatment. How you will make an impact: * Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review. * Conducts initial medical necessity review of exception preauthorization requests for services requested outside of the client health plan network. * Notifies ordering physician or rendering service provider office of the preauthorization determination decision. * Follows-up to obtain additional clinical information. * Ensure proper documentation, provider communication, and telephone service per department standards and performance metrics. Minimum Requirements: * Requires AS in nursing and minimum of 3 years of clinical nursing experience in an ambulatory or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management, and/or call center experience; or any combination of education and experience, which would provide an equivalent background. * A current unrestricted RN license in applicable state(s) required. Preferred Experience, Skills, and Capabilities: * Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PPO and POS plans strongly preferred. * BA/BS degree preferred. * Previous utilization and/or quality management and/or call center experience preferred. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $33.12 to $ 54.41. Locations: California; Illinois; Nevada In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
    $33.1-54.4 hourly Auto-Apply 60d+ ago
  • Formulary Strategy & Utilization Review Pharmacist

    Pharmacy Careers 4.3company rating

    Utilization review nurse job in Houston, TX

    Formulary Strategy & Utilization Review Pharmacist Shape the drug benefit landscape-analyze and optimize medication use. Key Responsibilities: Review prescribing trends and propose cost-saving alternatives. Maintain evidence-based formularies across multiple payers. Conduct retrospective DUR and prepare stakeholder reports. Qualifications: PharmD with managed care, DUR, or pharmacy benefit experience. Strong Excel/data analytics background preferred. Understanding of clinical guidelines and P&T processes. Why Join Us? Join a top-tier managed care team Hybrid flexibility Strategic and data-driven focus
    $62k-74k yearly est. 60d+ ago
  • Telephonic Nurse Case Manager II

    Elevance Health

    Utilization review nurse job in Houston, TX

    Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Hours: Monday - Friday 9:00am to 5:30pm EST and 1 late evening 11:30am to 8:00pm EST. * This position will service members in different states; therefore Multi-State Licensure will be required. The Telephonic Nurse Case Manager II is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically. How you will make an impact: * Ensures member access to services appropriate to their health needs. * Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. * Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. * Coordinates internal and external resources to meet identified needs. * Monitors and evaluates effectiveness of the care management plan and modifies as necessary. * Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. * Negotiates rates of reimbursement, as applicable. * Assists in problem solving with providers, claims or service issues. * Assists with development of utilization/care management policies and procedures. Minimum Requirements: * Requires BA/BS in a health related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. * Current, unrestricted RN license in applicable state(s) required. * Multi-state licensure is required if this individual is providing services in multiple states. Preferred Capabilities, Skills and Experiences: * Certification as a Case Manager. * Ability to talk and type at the same time. * Demonstrate critical thinking skills when interacting with members. * Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly. * Ability to manage, review and respond to emails/instant messages in a timely fashion. * Minimum 2 years' experience in acute care setting. * Minimum 2 years "telephonic" Case Management experience with a Managed Care Company. * Managed Care experience. For candidates working in person or virtually in the below locations, the salary* range for this specific position is $76,944 to $126,408. Locations: Colorado; New York; New Jersey In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Job Level: Non-Management Exempt Workshift: Job Family: MED > Licensed Nurse Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
    $76.9k-126.4k yearly 16d ago
  • Acute, Nurse Case Manager

    Chenmed

    Utilization review nurse job in Houston, TX

    We're unique. You should be, too. We're changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy? We're different than most primary care providers. We're rapidly expanding and we need great people to join our team. The Nurse Case Manager 1 (RN) is responsible for achieving positive patient outcomes and managing quality of care across the continuum of care. The incumbent in this role will first and foremost serve as an advocate for our patients. He/She works closely with other members of the care team to develop effective plans of care and high levels of care coordination. This care planning and coordination may follow the patient from our centers into acute and post-acute facilities, as well as, their home environments. The Nurse Case Manager 1 (RN) role also involves establishing relationships with patients' families and care givers, primary care physicians, specialists, other care providers, social workers, other case managers and nurses, acute and post-acute facilities, home health care companies, and health plans. He/She adheres to strict departmental goals/objectives, standards of performance, regulatory compliance, quality patient care compliance and policies and procedures. CORE JOB DUTIES/RESPONSIBILITIES: * Manages and plans for transitions of care, discharge and post discharge follow-up for patients admitted to key, high-volume/high-priority hospitals. * Establishes a trusting relationship with patients and their caregivers. * Collaborates with clinical staff in the development and execution of the plan of care and achievement of goals. Reports variations to PCP/Transitional Care Physicians (TCP) and implements actions as appropriate. * Builds relationships with preferred acute care providers (hospitalists, specialists, etc.). * Directs referrals to preferred providers. * Coordinates the integration of social services/case management functions in the pre-acute, ER, acute and post-acute setting. Coordinates the patient care, discharge and home planning processes with hospital case management departments, and other healthcare facilities. * In conjunction with the PCP, Hospitalist, Medical Director, insurance case manager and the hospital case manager, coordinates the patient transition to the appropriate/least constrictive level of care using a preferred provider. * Keeps the PCP aware of patient(s) condition via e-mail, DASH, HITS or other appropriate means of communication. * Introduces self to patient/family and explains Nurse Case Manager's role and processes to contact the Nurse Case Manager for questions, guidance and education. * Provides high intensity engagement with patient and family. * Facilitates patient/family conferences to review treatment goals and optimize resource utilization; provides family education and identifies post-hospital needs. * Serves as a patient advocate. Enhances a collaborative relationship to maximize the patient/family's ability to make informed decisions. * Addresses advanced care planning including treatment goals and advance directives. * Refers cases to social worker (Hospital and ChenMed/JenCare/Dedicated) for complex psychosocial and economic needs. * Refers cases where patient and/or family would benefit from counseling required to complete complex discharge plan to social worker. * Reports observed or suspected child or adult abuse pursuant to mandated requirements. * Obtains onsite and EMR access at priority facilities. * Maintains clinical and progress notes for each patient receiving care and provides progress report to PCP and others as appropriate. * Submits required documentation in a timely manner and in appropriate computer system. * Participates in surveys, studies and special projects as assigned. * Conducts concurrent medical record review using specific indicators and criteria as approved by medical staff. Acts as patient advocate: investigates and reports adverse occurrences, and performs staff education related to resource utilization, discharge planning and psychosocial aspects of healthcare delivery. * Promotes effective and efficient utilization of clinical resources and mobilizes resources to assist in achieving desired clinical outcomes within specific timeframe. * Conducts review for appropriate utilization of services from admission through discharge. Evaluates patient satisfaction and quality of care provided. * Communicates with physicians at regular intervals throughout hospitalization and develops an effective working relationship. Assists physicians to maintain appropriate cost, case and desired patient outcomes. * Coordinates the provision of social services to patients, families and significant others to enable them to deal with the impact of illness on individual family functioning and to achieve maximum benefits from healthcare services. * Completes expanded assessment of patients and family needs at time of admission. Completes psychosocial assessment. * Directs and participates in the development and implementation of patient care policies and protocols to provide advice and guidance in handling unusual cases or patient needs. * Attends meetings as assigned * Performs other duties as assigned and modified at manager's discretion. There are 4 Nurse Case Manager 1 Roles with additional Essential Job Functions: Acute Case Manager (primarily hospital based) Responsibilities include all the above "Core" duties/responsibilities plus the following: * Identify appropriateness of inpatient vs. observation status. * Identify and manage safety risk (complete a social assessment), identify functional status (ADLs and PT needs), discuss medications and self-management, identify and correct knowledge deficits. * Implement the ACM Coaching program with the appropriate patient population. * In markets as appropriate, when patient in SNF, in conjunction with the post-acute physician, coordinate the transition to a lower level of care as soon as appropriate using a preferred provider if further services are needed. * Facilitate discharge to appropriate level of care and preferred providers * Communicate discharge to all stakeholders including PCP, Center Manager and Community Case Manager. * Document the appropriate date that the patient is medically discharged and update as appropriate. * Contact the center manager to arrange for a follow-up PCP appointment prior to discharge and whenever possible, communicate this information to the patient/caregiver. * As appropriate, discuss patients' eligibility for CCM or DM programs and identify patient interest in participation. * Coordinate acute UR physician meetings. Community Case Manager (primarily clinic and community based) Responsibilities include all the above "Core" duties/responsibilities plus the following: * Provides telephonic or outpatient visits to patients at high-risk for readmissions (as identified by CM Plan) to the ER or hospital, to patients with active care planning requirements, to disease management patients per the Disease Management Plan and to others as referred via transitional care team, acute case managers and Transitional Care team. * Visits may include evening and weekend hours with the goal of preventing ER visits or hospital admissions. * Performs clinical functions including disease-oriented assessment and monitoring, medication monitoring, health education and self-care instructions in the outpatient setting. Coordinate the Plan of Care: * Conducts/coordinates initial case management assessment of patients to determine outpatient needs. * Ensures individual plan of care reflects patient needs and services available. * Makes recommendations to the team. * Completes individual plan of care with patients and team members. * Communicates instructions and methodologies as appropriate to ensure that the plan is implemented correctly. * Assesses the environment of care, e.g., safety and security. * Assesses the caregiver capacity and willingness to provide care. * Assesses patient and caregiver educational needs. * Coordinates, reports, documents and follows-up on Super Huddles and HPP/IDT meetings. * Helps patients navigate health care systems, connecting them with community resources; orchestrates multiple facets of health care delivery and assists with administrative and logistical tasks. * Coordinates the delivery of services to effectively address patient needs. * Facilitates and coaches patients in using natural supports and mainstream community resources to address supportive needs. * Maintains ongoing communication with families, community providers and others as needed to promote the health and well-being of patients. * Establishes a supportive and motivational relationship with patients that support patient self-management * Monitors the quality, frequency and appropriateness of HHA visits and other outpatient services. * Assists patient and family with access to community/financial resources and refer cases to social worker as appropriate. Community/Skilled Nursing Facility Case Manager (Community Case Manager Role with additional SNF duties as assigned) Responsibilities include all the above "Core" duties/responsibilities plus the following: * Community Case Manager role as above. * CM telephonic or onsite visits to SNFs, communication with physical therapists (PT), social workers, patient and families as appropriate. * Validates appropriate level of care/LOS. * Validates Discharge plan for safe transition home, utilization of preferred providers or timely transition to long term care. * Reminds patient of need for 4-day PCP post hospital/SNF discharge visit and future visits. * Collaborates with payor onsite SNF CMs. Transitional Case Manager (Blended Acute and Community Case Manager Roles) Responsibilities include all the above "Core" duties/responsibilities plus the following: * Acute and Community Case Manager roles as above. KNOWLEDGE, SKILLS AND ABILITIES: * Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community. * Critical thinking skills required. * Ability to work autonomously is required. * Ability to monitor, assess and record patients' progress and adjust and plan accordingly. * Ability to plan, implement and evaluate individual patient care plans. * Knowledge of nursing and case management theory and practice. * Knowledge of patient care charts and patient histories. * Knowledge of clinical and social services documentation procedures and standards. * Knowledge of community health services and social services support agencies and networks. * Organizing and coordinating skills. * Ability to communicate technical information to non-technical personnel. * Proficient in Microsoft Office Suite products including Excel, Word, PowerPoint and Outlook, plus a variety of other word-processing, spreadsheet, database, e-mail and presentation software. * Ability and willingness to travel locally, regionally and nationwide up to 10% of the time. * Spoken and written fluency in English. * Bilingual preferred. PAY RANGE: $35.8 - $51.17 Hourly EMPLOYEE BENEFITS ****************************************************** We're ChenMed and we're transforming healthcare for seniors and changing America's healthcare for the better. Family-owned and physician-led, our unique approach allows us to improve the health and well-being of the populations we serve. We're growing rapidly as we seek to rescue more and more seniors from inadequate health care. ChenMed is changing lives for the people we serve and the people we hire. With great compensation, comprehensive benefits, career development and advancement opportunities and so much more, our employees enjoy great work-life balance and opportunities to grow. Join our team who make a difference in people's lives every single day. Current Employee apply HERE Current Contingent Worker please see job aid HERE to apply #LI-Onsite
    $35.8-51.2 hourly 18d ago
  • Hiring Home Healthcare A Nurse ,Case manager and Direct care staff

    Wonderful Blessed Care Inc.

    Utilization review nurse job in Houston, TX

    Job DescriptionNurse must have experience in home Health care. Case manager must have experience in client case management. Direct care must have experience in cleaning, cooking , and administering meds. Each hire have to have a passion for this healthcare field.
    $52k-78k yearly est. 6d ago
  • Community Nurse Liaison Houston Region

    Sunshine Pediatric Day Center

    Utilization review nurse job in Houston, TX

    Job Description The Community Nurse Liaison Houston Region is a licensed nursing professional (LVN or RN) responsible for generating pediatric referrals and driving admissions into Sunshine Pediatric Day Centers Houston facility. This high-impact role merges clinical expertise with strategic relationship-building to grow the organization's presence across the Houston healthcare community. The Liaison develops partnerships with hospitals, pediatricians, discharge planners, and local agencies, while educating them on the benefits and eligibility requirements of our PPECC services. This individual will serve as both a clinical representative and a business development driver to ensure sustained growth and community engagement. Essential Job Responsibilities: Serve as the primary referral generator for the Houston region, building and maintaining relationships with healthcare providers, pediatricians, case managers, hospitals, and agencies. Promote the mission and services of Sunshine Pediatric Day Center through in-person outreach, educational presentations, and community engagement. Identify and secure new referral pipelines by cultivating strategic partnerships within the pediatric and healthcare ecosystem. Support the clinical intake team by facilitating smooth referral transitions, guiding families through the process, and coordinating with internal staff for onboarding. Lead local community events and participate in external events that enhance visibility and foster referral partnerships. Maintain accurate referral source data, document activities in CRM or tracking systems, and provide weekly and monthly reports on referral progress and admissions. Meet or exceed a minimum monthly target of 12 qualified referrals that align with PPECC admission criteria. Assist in clinical operations as designated by the Director of Clinical Operations. Ensure outreach and communication activities remain compliant with HIPAA and state regulatory standards. Minimum Qualifications: Required: Active LVN or RN license in the state of Texas. Preferred: Pediatric nursing experience or prior experience in a liaison, outreach, or case management role. Associate Degree in Nursing (minimum); Bachelor's degree in Nursing, Healthcare Administration, or related field preferred. At least 2 years of clinical or healthcare outreach experience. Familiarity with PPECC operations or pediatric extended care services is a plus. Key Competencies: Strong interpersonal and communication skills, with the ability to influence and educate clinical and non-clinical stakeholders. Demonstrated ability to meet referral and admissions targets within assigned territories. Exceptional organizational, follow-up, and reporting capabilities. Self-driven and results-oriented, with a commitment to Sunshine Pediatric Day Centers values and growth. Comfort with using EMRs, Microsoft Office, CRM tools, and data tracking software. Other Requirements: Reliable transportation and valid drivers license; frequent travel within the greater Houston area is required. Flexible schedule to accommodate provider meetings, family assessments, and community events. Knowledge of Texas Administrative Code related to pediatric extended care services is highly desirable.
    $52k-68k yearly est. 13d ago
  • Field Nurse Practitioner - Harris County, Texas

    Advantmed 3.6company rating

    Utilization review nurse job in Houston, TX

    Job Description Advantmed is a leading provider of risk adjustment, quality improvement and value-based solutions to health plans and providers. We drive market leading performance with integrated technology, service, and program solutions that optimize the risk and quality performance of our partners. Our solutions focus on identifying, managing, and documenting risk and quality performance, and the proactive clinical engagement of high acuity populations. The building B.L.O.C.K.S. of our team's success! Bring the fun Leverage together for better Outperform yourself Care at every touchpoint Keep your word. Keep it real Stay curious & listen well Primary Purpose: We are seeking a highly skilled and compassionate Nurse Practitioner to join our Advantmed provider network. In this role, you will be responsible for conducting in-home wellness risk adjustment assessments for Medicare and other populations. Your primary objective will be to assess the overall health and well-being of member beneficiaries to ensure accurate and comprehensive risk adjustment coding, leading to greater value-based care. NP Responsibilities: Perform annual wellness visits and health assessments on a population with chronic conditions Deliver patient health education opportunities Assist in closing quality care gaps (i.e. screenings and labs) An enthusiastic collaborator contributing to the enhancement of care delivery Providers are expected to commit a minimum of 30 hours per month Locations: Harris County, Texas Requirements NP Qualifications: Must have a valid unencumbered NP License for the state you will be working in Previous in-home Risk Assessment experience preferred 3 years patient care experience preferred (primary care/adult/geriatric, EMR) Bilingual is a plus Benefits Advantmed offers: Competitive wages (contractor per diem, per completed in-home assessment rate ~$100) Paid mileage Flexible work schedule Evening and weekend availability Dedicated coordinator support Advanced member scheduling coverage State of art technology
    $70k-105k yearly est. 9d ago
  • Transport Nurse Coordinator

    Texas Children's Medical Center 4.5company rating

    Utilization review nurse job in Houston, TX

    We are searching for a Transport Nurse Coordinator - someone who will coordinate emergency and critical care services for rotor, fixed wing, and ground transports. Provides continuity of care through intake of patient information relevant to the transport experience, coordination of transport resources based on nursing assessment of patient needs, and arrangement for timely and appropriate disposition of the patient at a receiving facility. Think you've got what it takes? Qualifications Bachelor's degree in nursing, associate's degree, or technical diploma in nursing with acceptance or current enrollment in a BSN program and signed agreement or an associate's degree in a related field accepted by the Texas Board of Nursing for the purposes of obtaining and maintaining an RN license required or must be currently enrolled in a nursing bridge program working toward an MSN with a verified BSN-equivalency or a signed agreement RN License by Texas Board of Nursing or Nurse Licensure Compac BLS certification from the American Heart Association required 3 years' or more of clinical experience in a pediatric critical care, neonatal intensive care, or a pediatric emergency department environment. Responsibilities Coordinating emergency and critical care services for rotor, fixed wing, and ground transport. Demonstrate commitment and dedication to patients, families, and transferring centers Demonstrate commitment to program development and quality initiatives. Responsible for maintaining professional development of self and others.
    $68k-77k yearly est. Auto-Apply 60d+ ago
  • Fertility Nurse Case Manager

    Center of Reproductive Medicine, LLP

    Utilization review nurse job in Spring, TX

    Enjoy what you do while contributing to a company that makes a difference in people's lives. Shady Grove Fertility, one of the premier fertility centers in the United States, continually seeks experienced, compassionate, and dynamic team players who are committed to delivering exceptional patient care to join our growing practice. The work we do, building families, offers stimulation, challenge, and personal reward. If you're a Registered Nurse looking for a new opportunity to work in a fast-paced, professional environment where your talent contributes to changing people's lives, then we want to talk to you. This position requires collaborating with physicians, other medical providers, and patients by providing nurse case management services for fertility treatments. We are seeking a full-time Fertility Nurse Case Manager to join our office in Spring Woodlands TX, Monday - Friday 7:30-4pm. Sat and Sun rotation every 4-5 weeks and rotating holidays at Clear Lake, TX office. How You'll Contribute: Assisting with the coordination, case management, and treatment of our fertility patients Providing patient/couple counseling Teaching about procedures and how to administer injections Scheduling treatment after initial and follow up visits Coordinating patient treatment plans in conjunction with established clinical protocols Establishing a compassionate environment by providing emotional and psychological support to patients and patients' families Required to work occasional weekends and holidays Skills & Qualifications: IVF/fertility experience and background in women's health a plus; training will be provided Valid RN license Experience working with electronic medical records a must High level of customer service essential and must be a self-starter A minimum of 1 year of experience in a clinical RN position More important than the best skills, however, is the right person. Employees who embrace our mission, vision, and core values are highly successful. What We Offer: We are proud to provide a comprehensive and competitive benefits package tailored to support the needs of our team members across all employment types: Full-Time Employees (30+ hours/week): Medical, dental, and vision insurance 401(k) with company match Tuition assistance Performance-based bonus opportunities Generous paid time off and paid holidays Part-Time Employees: 401(k) with company match Performance-based bonus opportunities Per Diem Employees: 401(k) with company match To learn more about our company and culture, visit here. How To Get Started: To have your resume reviewed by someone on our Talent Acquisition team, click on the “Apply” button. Or if you happen to know of someone who might be interested in this position, please feel free to share the job description by clicking on an option under “Share This Job” at the top of the screen.
    $52k-77k yearly est. 25d ago
  • Fertility Nurse Case Manager

    Us Fertility

    Utilization review nurse job in Spring, TX

    Enjoy what you do while contributing to a company that makes a difference in people's lives. Shady Grove Fertility, one of the premier fertility centers in the United States, continually seeks experienced, compassionate, and dynamic team players who are committed to delivering exceptional patient care to join our growing practice. The work we do, building families, offers stimulation, challenge, and personal reward. If you're a Registered Nurse looking for a new opportunity to work in a fast-paced, professional environment where your talent contributes to changing people's lives, then we want to talk to you. This position requires collaborating with physicians, other medical providers, and patients by providing nurse case management services for fertility treatments. We are seeking a full-time Fertility Nurse Case Manager to join our office in Spring Woodlands TX, Monday - Friday 7:30-4pm. Sat and Sun rotation every 4-5 weeks and rotating holidays at Clear Lake, TX office. How You'll Contribute: Assisting with the coordination, case management, and treatment of our fertility patients Providing patient/couple counseling Teaching about procedures and how to administer injections Scheduling treatment after initial and follow up visits Coordinating patient treatment plans in conjunction with established clinical protocols Establishing a compassionate environment by providing emotional and psychological support to patients and patients' families Required to work occasional weekends and holidays Skills & Qualifications: IVF/fertility experience and background in women's health a plus; training will be provided Valid RN license Experience working with electronic medical records a must High level of customer service essential and must be a self-starter A minimum of 1 year of experience in a clinical RN position More important than the best skills, however, is the right person. Employees who embrace our mission, vision, and core values are highly successful. What We Offer: We are proud to provide a comprehensive and competitive benefits package tailored to support the needs of our team members across all employment types: Full-Time Employees (30+ hours/week): Medical, dental, and vision insurance 401(k) with company match Tuition assistance Performance-based bonus opportunities Generous paid time off and paid holidays Part-Time Employees: 401(k) with company match Performance-based bonus opportunities Per Diem Employees: 401(k) with company match To learn more about our company and culture, visit here. How To Get Started: To have your resume reviewed by someone on our Talent Acquisition team, click on the “Apply” button. Or if you happen to know of someone who might be interested in this position, please feel free to share the job description by clicking on an option under “Share This Job” at the top of the screen.
    $52k-77k yearly est. 23d ago
  • IV Infusion Nurse

    Kalologie Texas 3.7company rating

    Utilization review nurse job in Houston, TX

    Job Description WHO WE ARE: Kalologie Medspa combines the latest in medical aesthetic and wellness treatments to help clients look and feel their best. Kalologie is a premier provider of medical aesthetic treatments such as IV Drip Hydration, Botox, Fillers, Coolsculpting, and Microneedling. With locations in California, Arizona, Nevada, and Texas - and upcoming 2024 launches in Virginia, Florida, New York, Connecticut, and Michigan - Kalologie is rapidly expanding and looking for best-in-class aesthetics providers to join our growing team. Kalologie Medspa is located in the Club Studio Kingwood location - please see more details about our partnership here: ********************************* WHO YOU ARE: A passionate, dedicated, and skillful nurse. You thrive working in a fast-paced environment and are always willing to learn more and strengthen your skills to deliver the best service and results. The ideal candidate would have specialized training in IV infusion therapy. (IV Infusion Therapy experience is a requirement of the role.) You also need to have excellent patient care and communication skills. WHAT YOU'LL DO: Administer IV Therapy Infusions and Vitamin Injections Create treatment plans and discuss benefits of IV and IM Create a calming environment and make sure the patient is comfortable during the treatment WHAT WE OFFER: Kalologie offers a competitive salary with flexible schedules, generous service discounts, and ongoing training opportunities on new techniques, equipment and products. We promote continued growth and development through our rapidly expanding medical aesthetic clinics.
    $47k-63k yearly est. 26d ago
  • Substitute Nurse

    River Oaks Baptist School 3.9company rating

    Utilization review nurse job in Houston, TX

    River Oaks Baptist School is actively searching for substitute nurses. A substitute nurse will be responsible for the administration of first aid, medication, specialized medical treatment, and care for ill or injured students and faculty/staff. A successful candidate will be a graduate of an accredited school of nursing, possess a license to practice professional nursing (R.N. preferred) in the State of Texas, and have nursing experience (school nursing preferred). Certification in CPR and experience with Type 1 (juvenile insulin dependent) diabetes is required. The candidate will demonstrate professional acumen, strong interpersonal skills, and respect for the confidentiality and dignity of students, faculty, and staff. This position is supported by a fellow school nurse and the Associate Head of School for Student Support, who is also a trained nurse. As with all faculty/staff openings, the School seeks candidates eager to support our mission of preparing students to meet life's challenges and lead tomorrow's world through a superior educational program undergirded by faith in Jesus Christ and Christian principles. To be considered for this position, qualified candidates will have: A vibrant Christian faith and a desire to work in a Christian environment Graduate of an accredited school of nursing A valid license to practice professional nursing (R.N.) in the State of Texas Professional experience in nursing. Experience in school nursing, emergenyc/ICU nursing, pediatric nursing or community health is preferable Experience with Type 1 (juvenile insulin dependent) diabetes Current CPR certification Basic computer literacy
    $46k-53k yearly est. 60d+ ago
  • Infusion Nurse (LVN or RN) - FT Days M-F

    Medical Clinic of Houston, L.L.P 4.4company rating

    Utilization review nurse job in Houston, TX

    INFUSION NURSE The Infusion Nurse is responsible for direct and telephone nursing care for oncology and infusion patients in the Clinic. The Infusion Nurse comprehensively assesses patients in suite and over the phone, develops nursing care plans, coordinates tests and/or therapeutic procedures, implements ordered treatment(s), and counsels and educates patients to promote health. Also, the Infusion Nurse manages medication refills, medication administration and reconciliation, as well as vaccine administration and scheduling. And, the Infusion Nurse directs, supports, and guides unlicensed support staff and evaluates the effectiveness of the care plan in relation to health goals. Lastly, the Infusion Nurse is responsible for managing inventory, compounding, and administering chemotherapy and biologicals with appropriate screening, monitoring, and follow up. Qualifications Graduate of an approved school of Professional Nursing (Bachelor's degree preferred). Unrestricted LVN or RN license/compact license to practice in the State of Texas. BLS certification. Two of more years previous experience in ambulatory care, hospital, or public health. ONS, Infusion certification a plus. Equal Employment Opportunity MCH is an Equal Opportunity Employer. Equal employment opportunity is a sound and just concept to which MCH is firmly bound. MCH will not engage in discrimination against or harassment of any person employed or seeking employment with MCH on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law.
    $42k-55k yearly est. 60d+ ago
  • Campus Nurse

    Responsive Education Solutions 3.5company rating

    Utilization review nurse job in Conroe, TX

    Provide health services to students. Implement comprehensive health program of health services for the campus. Promote health education and preventive health practices for students. Support the education process, by working to assure the health of the students. Qualifications: Education/Certification: Graduate of an accredited professional nursing education program Valid nursing license to practice professional nursing in Texas from the State Board of Nurse Examiners CPR and First Aid certifications Experience: Minimum of 3 years nursing experience, preferably in school nursing and/or community health nursing Required Knowledge, Skills, and Abilities (KSAs): Strong organizational, communication, and interpersonal skills Ability to implement policies and procedures Demonstrate a genuine interest in the student population and its health needs Ability to exercise professional judgement in making decisions Knowledge of state and local laws relating to health and school nursing Primary Duties: Provide direct care utilizing professional assessment skills, the nursing process, and established school health protocols Serve as a health advocate for the students Notify parents of accident or illness and secure medical care for students in emergency cases (if parents or emergency contact cannot be reached Properly administer medications to students at school according to district policy and procedures Educate faculty and staff as needed on health related topics Provide health counseling and instruction to individual students Serve as a health liaison between school, physicians, parents and the community Participate in developing and implementing individualized education plans (IEP) in regards to health services as needed Review, enter and update immunization records according to state requirements Compile, maintain, and file all physical and computerized reports, records, and other documents required, including clinic log sheets Requisition supplies and equipment needed to maintain clinic inventory Comply with policies established by federal and state laws, Texas Department of Health rule, State Board of Education rule, and board policy in health services area Report potential health and safety hazards to principal and Director of Health Services Comply with all district and campus routines and regulations Provides health education and anticipatory guidance Maintain certification in CPR and first aid Model behavior that is professional, ethical and responsible Travel as required Equipment Used: All equipment required to perform jobs, duties and tasks previously described Physical / Environmental Factors: The physical demands are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Responsive Education Solutions considers applicants for all positions without regards to race, color, national origin, age, religion, sex, marital status, veteran or military status, disability, or any other legally protected status. Being authorized to work in the U.S. is a precondition of employment. ResponsiveEd is an Equal Opportunity Employer.
    $48k-56k yearly est. 60d+ ago
  • 2025-2026 Substitute Nurse

    Magnolia Independent School District (Tx 3.9company rating

    Utilization review nurse job in Magnolia, TX

    Substitute/Substitute Date Available: 2025-26 School Year Additional Information: Show/Hide Job Title: Substitute - School Nurse Reports to: Director - Student Services / Principal Dept./School: Assigned Campus Primary Purpose: Implement comprehensive program of health services for campus. Provide health services to students. Promote health education and preventive health practices for students. Qualifications: Education/Certification: Graduate of an accredited professional nursing education program Valid registered nurse license to practice professional nursing in Texas from the State Board of Nurse Examiners Certified by Texas Department of Health to conduct vision and hearing screening CPR Certification Special Knowledge/Skills: Knowledge of health appraisal to identify student health defects Strong organizational, communication, and interpersonal skills Ability to implement policies and procedures Experience: Two years nursing experience, preferably in community health Major Responsibilities and Duties: Nursing Services * Provide direct care utilizing professional assessment skills, the nursing process, and established school health protocols. * Serve as health advocate for students. * Notify parents of accident or illness and secure medical care for students in emergency cases (if parents or emergency contact cannot be reached). * Coordinate management system to administer medications to students at school. Administer medications according to district policy and procedures. * Establish and implement effective procedures for mandatory screening programs. Make referrals as necessary. * Develop and coordinate continuing evaluation of campus health program and make changes based on findings. Instruction * Participate in development of campus health education curriculum and provide health education to individuals and groups. * Educate faculty and staff as needed on health related topics. * Provide health counseling and instruction to individual students. Consultation * Serve as health liaison between school, physicians, parents, and community. * Assess student problems and make appropriate referrals working with students, teachers, parents, and medical and health care professionals as needed. * Participate in Admission, Review, and Dismissal Committee, crisis team, and school committees and develops Individual Health Plan. * Collaborate with other professionals regarding implementation of health-related Individual Education Plan (IEP) items. * Participate in assessment and reporting of suspected child abuse. * Make home visits to help with student health problems as necessary with permission of principal. * Communicate regularly with principal, health services coordinator, school counselor, teachers, parents, food services, and other staff regarding health services issues. Administration * Review and evaluate immunization records. * Supervise and train nurse aide(s) and LVN(s) in clinic procedures and responsibilities according to district policy. * Compile, maintain, and file all physical and computerized reports, records, and other documents required, including clinic records and accurate, updated health records on all students. * Requisition supplies and equipment needed to maintain clinic inventory. * Comply with policies established by federal and state laws, Texas Department of Health rule, State Board of Education rule, and board policy in health services area. * Report potential health and safety hazards to principal. * Comply with all district and campus routines and regulations. Professional Development * Maintain certification in CPR, vision and hearing screening, and as a health screener. * Model behavior that is professional, ethical, and responsible. Supervisory Responsibilities: Direct the work of licensed vocational nurse (LVN) and assigned health clinic aide(s). Equipment Used: Thermometer, blood pressure cuff, audiometer, otoscope, sphygmomanometer, vision screening equipment, thermoscan, basic clinic equipment, computer, and copier. Working Conditions: Mental Demands/Physical Demands/Environmental Factors: Maintain emotional control under stress. Exposure to bacteria and communicable diseases. Ability to lift 30 pounds. Frequent standing, stooping, bending, pulling and pushing. * Adapted from School Health Staff Roles published by the Texas Department of Health School Health Advisory Committee, June 2002.
    $49k-59k yearly est. 60d+ ago
  • Community Nurse Liaison Houston Region

    Sunshine Pediatric Day Center

    Utilization review nurse job in Houston, TX

    The Community Nurse Liaison Houston Region is a licensed nursing professional (LVN or RN) responsible for generating pediatric referrals and driving admissions into Sunshine Pediatric Day Centers Houston facility. This high-impact role merges clinical expertise with strategic relationship-building to grow the organization's presence across the Houston healthcare community. The Liaison develops partnerships with hospitals, pediatricians, discharge planners, and local agencies, while educating them on the benefits and eligibility requirements of our PPECC services. This individual will serve as both a clinical representative and a business development driver to ensure sustained growth and community engagement. Essential Job Responsibilities: Serve as the primary referral generator for the Houston region, building and maintaining relationships with healthcare providers, pediatricians, case managers, hospitals, and agencies. Promote the mission and services of Sunshine Pediatric Day Center through in-person outreach, educational presentations, and community engagement. Identify and secure new referral pipelines by cultivating strategic partnerships within the pediatric and healthcare ecosystem. Support the clinical intake team by facilitating smooth referral transitions, guiding families through the process, and coordinating with internal staff for onboarding. Lead local community events and participate in external events that enhance visibility and foster referral partnerships. Maintain accurate referral source data, document activities in CRM or tracking systems, and provide weekly and monthly reports on referral progress and admissions. Meet or exceed a minimum monthly target of 12 qualified referrals that align with PPECC admission criteria. Assist in clinical operations as designated by the Director of Clinical Operations. Ensure outreach and communication activities remain compliant with HIPAA and state regulatory standards. Minimum Qualifications: Required: Active LVN or RN license in the state of Texas. Preferred: Pediatric nursing experience or prior experience in a liaison, outreach, or case management role. Associate Degree in Nursing (minimum); Bachelor's degree in Nursing, Healthcare Administration, or related field preferred. At least 2 years of clinical or healthcare outreach experience. Familiarity with PPECC operations or pediatric extended care services is a plus. Key Competencies: Strong interpersonal and communication skills, with the ability to influence and educate clinical and non-clinical stakeholders. Demonstrated ability to meet referral and admissions targets within assigned territories. Exceptional organizational, follow-up, and reporting capabilities. Self-driven and results-oriented, with a commitment to Sunshine Pediatric Day Centers values and growth. Comfort with using EMRs, Microsoft Office, CRM tools, and data tracking software. Other Requirements: Reliable transportation and valid drivers license; frequent travel within the greater Houston area is required. Flexible schedule to accommodate provider meetings, family assessments, and community events. Knowledge of Texas Administrative Code related to pediatric extended care services is highly desirable.
    $52k-68k yearly est. 60d+ ago
  • Flight Nurse - Fixed Wing/Ground

    Texas Children's Medical Center 4.5company rating

    Utilization review nurse job in Houston, TX

    We are searching for a Transport Flight Nurse - someone who's ready to grow with our company. In this position you will provide quality care, treatment and stabilization of critically ill neonatal, pediatric, maternal, and adult congenital heart patients during fixed wing and short- and long-range ground transport. The Transport Nurse will collaborate with healthcare team members and associated resource personnel to problem solve and implement interventions to maximize patient outcomes.. The Transport Nurse is committed to safe operations, premier customer service and excellent clinical practice. Think you've got what it takes? QUALIFICATIONS: Required Bachelor's Degree in nursing or associate degree in nursing with acceptance or current enrollment in a BSN program and signed agreement (see comments below) or an associate degree in a related field accepted by the Texas Board of Nursing for the purposes of obtaining and maintaining an RN license or Technical diploma in nursing with acceptance or current enrollment in a BSN program and signed agreement (see comments below) or must be currently enrolled in a nursing bridge program working toward an MSN. Verified BSN-equivalency or a signed agreement is required. Required Licenses/Certifications (ALL) RN - Lic-Registered Nurses by the Texas Board of Nursing or Nurse Licensure Compact BLS - Cert-Basic Life Support by the American Heart Association PASSPORT - US Passport/Int'l Doc by the US Department of State or other appropriate documentation allowing international travel (Required within 4 months of hire) PALS - Cert-PALS by the American Heart Association (Required within 4 months of hire) NRP - Cert-Neonatal Resusci Prog American Academy of Pediatrics and the American Heart Association. (Required within 4 months of hire) ACLS - Cert-Adv Cardiac LS ACLS by the American Heart Association (Required within 6 months of hire) CNPT - Neonatal Pediatric Transport by the National Certification Corporation (Required within 18 months of hire) CCRN - Critical Care Registered Nurse by the American Association of Critical Care Nurses (Required within 18 months of hire) Required 3 years Critical care experience in a pediatric or neonatal intensive care setting OR 3 years Pediatric Emergency Center experience in a Level 1 trauma center with CPEN certification. RESPONSIBILITIES: Assessing, planning, implementing and evaluating care to critically ill patients including neonates, pediatric and adult patients. Ability to demonstrate critical thinking skills, to autonomously evaluate critically ill patients, and to provide therapeutic intervention, emergency interventions and preparation for transport. Assess for and detect changes in the status of the patient and demonstrate a proactive approach. Provides care and treatment with other health care team members for life support and/or stabilization of critically ill patients. Collaborates with other health care team members to problem solve, implement treatment modalities and interventions to maximize patient outcomes. Provides care within the policies, protocols, guidelines and scope of practice as defined by the State of Texas. Performs advanced skills and procedures as indicated. Maintains complete and accurate records. Demonstrates commitment and dedication to patients and families. Keeps the family informed of a patient's condition and plan of care. Serves as a patient/family advocate while caring for the patient and family. Maintains confidentiality concerning patient/family issues. Demonstrates commitment to program development and quality initiatives. Communicates effectively and maintains positive interpersonal relationships in working with colleagues, patients, families, outside institutions/agencies and the public. Demonstrates the ability to problem solve and adapt to ongoing change and handle conflict management with a professional supportive attitude. Communicates with medical on-line control regarding patient condition and treatment plan. Represents Texas Children's as a customer service ambassador. Acts as liaison and participates in outreach marketing and education activities. Participates in quality initiative programs, perform data collection and participates in research activities. Ensure smooth safe program operations. Ensures team shift responsibilities are completed: equipment checks, supply and medication inventory. Plans, organizes and positions equipment and supplies for use in emergency conditions. Completes missions initiated within the timeframe of assigned shift with the understanding that completion of these missions may require additional work beyond normal work hours. Ensures 10 hours of rest time prior to reporting for the scheduled shift. Demonstrates knowledge of and adherence to safety procedures/standards to ensure safety of self, patient, medical personnel and equipment. Participates in all debriefings, transport/code and rapid response events. Responsible for maintaining professional development of self and others. Maintains clinical competence across all aspects of the Transport Services - KC scope of service including ventilator management/nitric implementation/ECMO/Trauma and skills such as IO. Maintains competence in use of systems: Epic/Teletracking/Computer-Aided Dispatch/EMS charts and other systems as indicated. Consistently participates in education sessions and Quality Council. Assists patients, families, and caregivers in the understanding and participation of the plan of care. Acts as a resource to members of the healthcare team to ensure delivery of quality patient care.
    $48k-65k yearly est. Auto-Apply 60d+ ago
  • Infusion Nurse (LVN or RN) - FT Days M-F

    Medical Clinic of Houston 4.4company rating

    Utilization review nurse job in Houston, TX

    INFUSION NURSE The Infusion Nurse is responsible for direct and telephone nursing care for oncology and infusion patients in the Clinic. The Infusion Nurse comprehensively assesses patients in suite and over the phone, develops nursing care plans, coordinates tests and/or therapeutic procedures, implements ordered treatment(s), and counsels and educates patients to promote health. Also, the Infusion Nurse manages medication refills, medication administration and reconciliation, as well as vaccine administration and scheduling. And, the Infusion Nurse directs, supports, and guides unlicensed support staff and evaluates the effectiveness of the care plan in relation to health goals. Lastly, the Infusion Nurse is responsible for managing inventory, compounding, and administering chemotherapy and biologicals with appropriate screening, monitoring, and follow up. Qualifications * Graduate of an approved school of Professional Nursing (Bachelor's degree preferred). * Unrestricted LVN or RN license/compact license to practice in the State of Texas. * BLS certification. * Two of more years previous experience in ambulatory care, hospital, or public health. * ONS, Infusion certification a plus. Equal Employment Opportunity MCH is an Equal Opportunity Employer. Equal employment opportunity is a sound and just concept to which MCH is firmly bound. MCH will not engage in discrimination against or harassment of any person employed or seeking employment with MCH on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law.
    $42k-55k yearly est. 6d ago
  • Substitute Nurse

    Responsive Education Solutions 3.5company rating

    Utilization review nurse job in Conroe, TX

    Provides preventative health services to facilitate the student's optimal physical, mental, emotional and social growth and development. Identifies problems and disabilities and provides such services as case finding, health education, referring and care in order to help prevent serious health problems which would later be more difficult and costly to address. Supports the education process by working to assure the health of the students. Qualifications: Education/Certification: Qualified to practice as a licensed or registered nurse in the State of Texas and holds an unrestricted license. Certified in CPR or BLS (or obtain in the first 6 months) Experience: Minimum of one (1) year experience in public health nursing, community health nursing, school health nursing or pediatric nursing Required Knowledge, Skills, and Abilities (KSAs): Knowledge of principles and practices underlying the special field of school health. Knowledge of current trends in nursing and of literature in the fields of school health. Knowledge of organization and administration of other cooperating agencies. Knowledge of state and local laws relating to health and social issues. Ability to participate cooperatively in a program of school health nursing. Ability to exercise professional judgment in making decisions. Ability to communicate appropriately and effectively with students, parents, administrators, other school personnel, etc… Demonstrate a genuine interest in the student population and its health needs Responsibilities and Duties: Promotes and protects the optimal health status of school-age children Provides health assessments Obtains a health history Screens and evaluates findings of the deficit in vision, hearing, scoliosis, growth, etc. Observes the child for development and health patterns in making nursing assessments. Identifies abnormal health findings. Develops and implements a student health plan Interprets the health status of students to parents and school personnel. Initiates referral to parents, school personnel or community health resources for intervention, remediation and follow through. Utilizes existing health resources to provide appropriate care of students. Provides ongoing health counseling with students, parents, school personnel or health agencies. Maintains, evaluates and interprets cumulative health data to accommodate individual needs of students Plans and implements school health management protocols Participates in home visits to assess the family needs as related to the child's health. Develops procedures and provides for emergency nursing management for injuries/illnesses Promotes and assists in the control of communicable diseases. Provides health education and anticipatory guidance Provides direct health education, and health counseling to assist students and families in making decisions on health and lifestyles that affect health. Participates in health education directly and indirectly for the improvement of health by teaching persons to become more assertive health consumers and to assume greater responsibility for their own health. Counsels with students concerning problems such as pregnancy, sexually transmitted diseases and substance abuse in order to facilitate responsible decision-making practices. Serves as a resource person to the school staff members in health instruction. Coordinates school and community health activities and serves as a liaison health professional between the home, school and community. Acts as a resource person in promoting health careers. Engages in research and evaluation of school health services to act as a change agent for school health programs and school nursing practices. Provides consultation in the formation of health policies, goals and objectives for the school district. Where applicable, participates in the IEP plan development. Travel as required. Equipment Used: All equipment required to perform jobs duties and task previously described Physical / Environmental Factors: The physical demands are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Responsive Education Solutions considers applicants for all positions without regards to race, color, national origin, age, religion, sex, marital status, veteran or military status, disability, or any other legally protected status. ResponsiveEd is an Equal Opportunity Employer. Salary: $100.00 per day
    $100 daily 60d+ ago

Learn more about utilization review nurse jobs

How much does a utilization review nurse earn in Houston, TX?

The average utilization review nurse in Houston, TX earns between $50,000 and $90,000 annually. This compares to the national average utilization review nurse range of $47,000 to $89,000.

Average utilization review nurse salary in Houston, TX

$67,000

What are the biggest employers of Utilization Review Nurses in Houston, TX?

The biggest employers of Utilization Review Nurses in Houston, TX are:
  1. Houston Methodist
  2. Carebridge
  3. Pharmacy
  4. Molina Healthcare
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