RN Case Manager – Utilization Review

Role Overview

• Responsible for performing prospective, concurrent, and post-discharge utilization reviews.
• Supports accurate admission status determinations and active denial management.
• Assists with discharge planning activities and contributes to performance improvement initiatives.
• Conducts comprehensive medical record reviews and ensures compliance with hospital policy and regulations.
• Facilitates appropriate admission status determinations based on clinical documentation and payer requirements.

Requirements

• Bachelor of Science in Nursing preferred.
• Active RN license in Texas; current CPR certification.
• Case Management Certification(s) preferred.
• At least five years of experience with Case Management, Discharge Planning, and Utilization Review.

Benefits

• Health insurance
• Paid time off
• Professional development opportunities
• 401(k) retirement plan