Utilization Review Nurse

Adecco Healthcare & Life Sciences is assisting a client hire a Utilization Review Nurse in Houston, TX! This role is in person / on site. Please read below and apply with an updated resume for consideration:

Type: Full time - direct hire with client!

Schedule: Monday through Friday, 8am to 5pm

Pay: $85,00 to $110,000 yearly

Responsibilities of the Utilization Review Nurse:

• Review Medical Records: Thoroughly evaluate patient medical records to assess the necessity and appropriateness of treatments and services.

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

• Coordinate with Healthcare Providers: 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.

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

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

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

• Collaboration: Partner with clinical and administrative teams to promote compliance with healthcare standards and practices.

• Training and Education: Provide healthcare staff with education and training on compliance protocols and best practices in utilization review.

• Audit Documentation: Maintain comprehensive records of audits, investigations, and compliance activities to support transparency and accountability.

• Stay Informed: Keep abreast of changes in healthcare policies, clinical practices, and regulations to provide informed recommendations and maintain best practices.

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Qualifications for the Utilization Review Nurse:

• Bachelors' degree in nursing preferred

• Current, unrestricted RN License in Texas

• 2 to 3 years of clinical nurse/case management experience

• 2 to 3 years of coding experience

• Strong analytical, communication, and problem-solving abilities. Proficiency in electronic health records (EHR) systems is essential.

• Preferred certifications include Certified Case Manager (CCM) or Certified Utilization Review Nurse (CURN).

Pay Details: $85,000.00 to $110,000.00 per year

Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable.

Equal Opportunity Employer/Veterans/Disabled

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The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable:

The California Fair Chance Act

Los Angeles City Fair Chance Ordinance

Los Angeles County Fair Chance Ordinance for Employers

San Francisco Fair Chance Ordinance