Utilization Review Nurse

Adecco Healthcare & Life Sciences is excited to collaborate with a healthcare organization in Houston, TX 77081 to recruit an (Onsite) Utilization Review RN for a full-time, direct hire opportunity in Houston, TX 77081.

*This is NOT a remote position*

What You'll Do:

Thoroughly evaluate patient medical records to assess the necessity and appropriateness of treatments and services.

Regularly audit medical records and healthcare practices to ensure compliance with federal, state, and local regulations.

Collaborate with physicians, nurses, and other healthcare professionals to gather essential information and recommend optimal care pathways.

Work with facilities to facilitate approvals and organize necessary peer reviews.

Communicate with insurance companies to effectively confirm coverage for recommended treatments and manage appeals or disputes.

Educate patients and their families on treatment options, explaining benefits and risks to empower informed decision-making.

Keep accurate, detailed records of evaluations, recommendations, and all communications regarding patient care and compliance.

What You’ll Need:

A Bachelor of Science in Nursing (BSN) is strongly preferred; candidates with an Associate Degree in Nursing (ADN) will also be considered.

Must hold an active and unrestricted Registered Nurse (RN) license.

A minimum of 2–3 years of hands-on clinical nursing experience or case management, ideally within an acute care setting.

At least 2–3 years of experience in medical coding is required.

Compensation:

$85,000-$110,000/annually