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Obtains relevant clinical data from sending facilities, working effectively with accepting physicians and nurses to ensure clear communication among caregivers and assist in correct clinical placement of patients to consistently achieve desired outcomes for patient care. This position ensures a compassionate, integrated, multi-disciplinary case approach which supports health caregivers to provide the highest quality, most clinically appropriate admission placement of patients, while promoting the most cost-effective utilization of the hospital's resources for those patients admitted to the hospital.

Houston Methodist Hospital

Point of Entry Nurse

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WNS, part of Capgemini, is an Agentic AI-powered leader in intelligent operations and transformation, serving more than 700 clients across 10 industries, including Banking and Financial Services, Healthcare, Insurance, Shipping and Logistics, and Travel and Hospitality. The Clinical Review Nurse makes prospective medical necessity determinations on prior authorization requests for HealthHelp's specialty programs, including Diagnostic Imaging, Cardiology, Musculoskeletal, Physical Medicine, Sleep, Oncology, and Genetic Testing.

YEAR

WNS (Holdings) Ltd

Nurse - Clinical Review

Minimum of three (3) years of prospective utilization management experience making medical necessity determinations (prior authorization, pre-service review or precertification) at a health plan, utilization management organization, or specialty or radiology benefit manager. Monitors case inventory, queues and turnaround times throughout the day, and adjusts the nurse assignment tool based on staffing, proficiency, request type and volume so client service levels and regulatory turnaround times are met.

Nurse Team Lead - Clin Rev

The role focuses on review of member appeals and fair hearing requests - clinical review, chart review, audits, letter review, working with clinical and non-clinical staff with varied backgrounds to review authorization, UR determinations, in preparation for a Fair Hearing with the State of Texas. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is a health care and well-being company that’s dedicated to improving the health outcomes of millions worldwide. We are comprised of two distinct and complementary businesses, UnitedHealthcare and Optum, working to build a better health system for all. Here, your contributions matter as they will help transform health care for years to come. Make an impact with a diverse team that shares your passion for helping others.

What we do

Gain insights on how we work to help people live healthier lives and help make the health system work better for everyone by watching this video.

<a href="https://www.youtube.com/watch?v=5PbNyi2IDkY">https://www.youtube.com/watch?v=5PbNyi2IDkY</a> 

Caring. Connecting. Growing together. 

Being a part of UnitedHealth Group means working to improve health outcomes for everyone, including yourself. Here is how:

• Caring. Your total health and well-being are important to us. Whatever matters most to you — we have resources to help you be your best at work and at home. The benefits range from free Peloton courses to financial counseling. <a href="https://careers.unitedhealthgroup.com/culture/what-we-offer/">Learn more about what we offer.</a> 

• Connecting. We recognize our collective power to make an impact across our communities because we believe the health of any society is measured by the overall health of its people. <a href="https://careers.unitedhealthgroup.com/culture/">Learn more about our culture.</a> 

• Growing together. UnitedHealth Group is full of inspiring career stories, and we offer a lifetime of opportunities. <a href="https://careers.unitedhealthgroup.com/career-areas/">Discover all the ways you can learn, grow and develop.</a>

UnitedHealth Group Inc

Senior Clinical Administrative RN - Remote in Texas

Ensures a competent workforce by participating in the design, development and oversight of the implementation of systems that evaluate and contribute to the quality of resident care by participating in Quality Assessment and Quality Improvement (QAQI) initiatives that address important aspects of nursing care. Additional Information: Applicants must pass a fingerprint criminal background check, pre-employment drug screen, and registry checks including the Client Abuse/Neglect Reporting System (CANRS), Nurse Aide, Medication Aide and Employee Misconduct and HHS List of Excluded Individuals/Entities (LEIE).

Texas Health and Human Services Commission

RN IV Nurse Manager

Lead utilisation management and case management operations, including concurrent review, retrospective review, discharge planning, and care coordination. Coordinate with clinical teams, payers, and post-acute providers to facilitate appropriate care transitions and discharge planning.

HOUR

Mercor

Case Management Leader - AI Trainer

Manatal

Case Management Expert - AI Trainer

The facility offers both inpatient and outpatient services, including hemodialysis or peritoneal dialysis, infectious disease management, intensive care, pain management, postsurgical complication management, pulmonary care management, trauma and neurological injury management, and outpatient rehabilitation therapies. Work Shift : 3 - Night (United States of America)
Job Category : Clinical
Houston Methodist Continuing Care Hospital is a long-term acute care hospital that proudly serves the Greater Houston area, focused on the needs of patients requiring extended hospitalization.

Houston Methodist is a diverse, inclusive and growing health care system offering a lifetime of meaningful careers within our many facilities. We're comprised of a nationally recognized academic medical center and four community hospitals with a history of health care innovation. We're currently ranked in U.S News & World Report's America's Best Hospitals list. For the eighth straight year we have been named to FORTUNE's list of "100 Best Companies to Work For" and have been ranked the #1 health care organization in Texas. Make your first day exceptional… at Houston Methodist.

Houston Methodist

RN II Ltac

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The facility offers both inpatient and outpatient services, including hemodialysis or peritoneal dialysis, infectious disease management, intensive care, pain management, postsurgical complication management, pulmonary care management, trauma and neurological injury management, and outpatient rehabilitation therapies. Work Shift : 1 - Day (United States of America)
Job Category : Clinical
Houston Methodist Continuing Care Hospital is a long-term acute care hospital that proudly serves the Greater Houston area, focused on the needs of patients requiring extended hospitalization.

RN II Ltac Med/Surg

The Nurse Manager provides clinical leadership and support to nursing staff, oversees daily operations, promotes professional development, and participates in quality and performance improvement initiatives. The Nurse Manager – NICU provides leadership and clinical oversight for the Neonatal Intensive Care Unit, ensuring the delivery of safe, high-quality, patient-centered care.

Royal Professional Services, Career Services

NICU Nurse Manager

Responsibilities for this position may include but are not limited to leading unit and shared governance activities, assessing unit needs related to practice and improvement opportunities, serving as a clinical resource for both unit and hospital staff and coordinating unit and hospital-wide education in partnership with management. Implements department strategies to achieve financial target on unit-based scorecard and mentors others to do the same through timely documentation of care, decreasing length of stay, optimizing efficiency, minimizing incidental overtime, and other areas according to departmental specifications.

Charge RN II Med/Surg/Transplant

Houston Methodist Sugar Land offers access to the most innovative care available, including comprehensive cancer care; neuroscience and spine care; orthopedics and sports medicine; heart and vascular care; women's services; childbirth center with level III NICU; bariatric and digestive care; and advanced imaging - all backed by our focus on healing people today and offering hope for tomorrow. Responsibilities for this position may include but are not limited to leading unit and shared governance activities, assessing unit needs related to practice and improvement opportunities, serving as a clinical resource for both unit and hospital staff and coordinating unit and hospital-wide education in partnership with management.

Charge Registered Nurse II - Medical/Surgical

Also, on the beautiful hospital campus, located at the intersection of Interstate 45 and Texas State Highway 242, are two medical office buildings, which include a Breast Care Center; Cancer Center; infusion center; heart and vascular services; neurology; orthopedics and sports medicine; rehabilitation services; wellness services; an outpatient laboratory; and several other multispecialty physician practices. In January 2022, Houston Methodist The Woodlands opened Healing Tower - a $250 million expansion project that added 106 beds, focused on medical-surgical and women's services, and provided nine operating rooms.

Nurse Scientist

Referral services for child, elder and pet care, home and auto repair, event planning and more Consumer discounts through Abenity and Consumer Discounts Retirement readiness, rollover assistance services and preferred banking partnerships Education assistance (tuition, student loan, certification support, dependent scholarships) Colleague recognition program Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. What you will need for this role: Associate Degree in Nursing, required Bachelor's Degree in Nursing, preferred Case Management certification, preferred Current Texas licensure with State Board of Nurse Examiners as an RN 1+ years experience in healthcare As a full-service, 420+ bed acute care hospital, HCA Houston Healthcare Kingwood has provided the northeast Houston community with high-quality, cost-effective healthcare for over 25 years.

At its founding in 1968, Nashville-based HCA was one of the nation's first hospital companies. Today, we are the nation's leading provider of healthcare services, a company comprised of locally managed facilities that includes about 165 hospitals and 115 freestanding surgery centers in 20 states and England and employing approximately 204,000 people. Approximately four to five percent of all inpatient care delivered in the country today is provided by HCA facilities. Richard M. Bracken serves as Chairman of HCA and R. Milton Johnson is the company's President and Chief Executive Officer. HCA is committed to the care and improvement of human life and strives to deliver high quality, cost effective healthcare in the communities we serve. Building on the foundation provided by our Mission & Values, HCA puts patients first and works to constantly improve the care we give them by implementing measures that support our caregivers, help ensure patient safety and provide the highest possible quality. Investing in our communities is important to us. HCA typically invests about $1.5 billion annually to keep our facilities modern and up-to-date technologically and to expand and add services where needed. Focusing primarily on communities where the company is a leading healthcare provider, HCA selectively adds new facilities in order to better serve our communities. And because two HCA founders were physicians, we value highly the strong relationships we've created with local physicians. We endeavor to provide them with a wide array of services and modern facilities in order to help them deliver the best possible care.

HCA Healthcare Inc

Registered Nurse Case Manager PRN

Develops and continuously assesses ongoing long-term care plans / service plans and collaborates with care management team to identify providers, specialists, and/or community resources needed to address member's needs. Develops a personalized care plan / service plan for long-term care members, addresses issues, and educates members and their families/caregivers on services and benefit options available to receive appropriate high-quality care.

Centene Management Company

Senior LTSS Service Care Manager RN

Demonstrates support for the Tenet Corporate Compliance Program by being knowledgeable of compliance responsibilities as expressed in the Code of Conduct; adhering to federal and state laws, rules, regulations, and corporate policies and procedures policies that affect his/her specific job functions/responsibilities; and reporting compliance issues/concerns in a timely and appropriate manner. Experience: Certifications: Required: Must be currently licensed, certified or registered to practice profession as required by law, regulation in state of practice or policy.

Tenet Healthcare Corporation is a diversified healthcare services company with 115,000 employees united around a common mission: to help people live happier, healthier lives. Through its subsidiaries, partnerships and joint ventures, including United Surgical Partners International, the Company operates general acute care and specialty hospitals, ambulatory surgery centers, urgent care centers and other outpatient facilities. Tenet's Conifer Health Solutions subsidiary provides technology-enabled performance improvement and health management solutions to hospitals, health systems, integrated delivery networks, physician groups, self-insured organizations and health plans. Since 2003, Tenet's Commitment to Quality has improved the quality of medical care and patient safety at its hospitals and other businesses by evaluating processes and promoting best practices. As the world in which Tenet operates continues to change, Tenet's Commitment to Quality will remain focused on quality, the growing quality gap relative to top performers in the industry, and the fact that payers and employees use quality as a distinguishing factor. Visit the Quality Care page for more information. Tenet has taken the lead in addressing the needs of the uninsured through its Compact With Uninsured Patients. Established in 2003, the Compact focuses on treating patients without insurance fairly and with respect during and after their treatment, regardless of their ability to pay. Tenet also is committed to working with its patients through financial counseling and alternative payment options.

Tenet Healthcare Corp

Pain Medicine Nurse Practitioner- Part Time- North Houston, TX

Maintains and submits accurate data for hospital-based statistics and regulatory agencies, if applicable, such as OPTN/UNOS/CMS/NMDP/CIBMTR/FACT, and Medicaid to ensure compliance with all government reporting requirements, and proper quality outcomes monitoring. Uses therapeutic communication in an active, positive, and effective manner with all transplant team members, patients, referring physicians, and other health care providers, reporting pertinent patient care and family data in a comprehensive and unbiased manner.

Pre-Transplant Coordinator (RN) | BMT

Pre-Transplant Coordinator (RN) | VAD/Pre Heart Coodinator

FULL_TIME

WNS, part of Capgemini, is an Agentic AI-powered leader in intelligent operations and transformation, serving more than 700 clients across 10 industries, including Banking and Financial Services, Healthcare, Insurance, Shipping and Logistics, and Travel and Hospitality. The Clinical Review Nurse makes prospective medical necessity determinations on prior authorization requests for HealthHelp’s specialty programs, including Diagnostic Imaging, Cardiology, Musculoskeletal, Physical Medicine, Sleep, Oncology, and Genetic Testing.

HealthHelp - A WNS Company

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Minimum of three (3) years of prospective utilization management experience making medical necessity determinations (prior authorization, pre-service review or precertification) at a health plan, utilization management organization, or specialty or radiology benefit manager . Monitors case inventory, queues and turnaround times throughout the day, and adjusts the nurse assignment tool based on staffing, proficiency, request type and volume so client service levels and regulatory turnaround times are met.

Utilization Management Nurse Jobs in Houston, TX

Point of Entry Nurse Houston Methodist Hospital

Nurse - Clinical Review WNS (Holdings) Ltd

Nurse Team Lead - Clin Rev WNS (Holdings) Ltd

Senior Clinical Administrative RN - Remote in Texas UnitedHealth Group Inc

RN IV Nurse Manager Texas Health and Human Services Commission

Case Management Leader - AI Trainer Mercor

Case Management Expert - AI Trainer Mercor

RN II Ltac Houston Methodist

RN II Ltac Med/Surg Houston Methodist

NICU Nurse Manager Royal Professional Services, Career Services

Charge RN II Med/Surg/Transplant Houston Methodist Hospital

Charge Registered Nurse II - Medical/Surgical Houston Methodist Hospital

Nurse Scientist Houston Methodist Hospital

Registered Nurse Case Manager PRN HCA Healthcare Inc

Senior LTSS Service Care Manager RN Centene Management Company

Pain Medicine Nurse Practitioner- Part Time- North Houston, TX Tenet Healthcare Corp

Pre-Transplant Coordinator (RN) | BMT Houston Methodist Hospital

Pre-Transplant Coordinator (RN) | VAD/Pre Heart Coodinator Houston Methodist Hospital

Nurse - Clinical Review HealthHelp - A WNS Company

Nurse Team Lead - Clin Rev HealthHelp - A WNS Company

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