Utilization Review Nurse Home Health Registered Nurse

Doctor's Choice Home Care & Hospice Texas • Houston, TX

6d • Onsite

About The Position

Committed to Caring, the Utilization Review Nurse (RN) is responsible for reviewing clinical documentation, patient plans of care, and utilization patterns to ensure appropriate, effective, and compliant delivery of home health services. This position focuses on optimizing patient outcomes, managing care utilization, and supporting clinicians in providing the right care at the right time. The Utilization Review Nurse collaborates closely with field clinicians, case managers, and leadership to promote efficiency, quality, and regulatory compliance across all episodes of care.

Requirements

• Current and active RN license in the state of practice required.
• Knowledge of Medicare Conditions of Participation (CoPs), OASIS documentation, and home health regulatory standards.
• Experience with EMR systems (Wellsky and WellSky CareInsights or equivalent preferred).
• Excellent analytical, communication, and critical-thinking skills.
• Ability to work independently while collaborating effectively with interdisciplinary teams.
• Knowledge of clinical pathways and evidence-based care guidelines.
• Strong organizational and time-management abilities.
• Proficient in data analysis and documentation review.
• Acceptance and ability to demonstrate support of the core values and goals of Agency.
• Ability to demonstrate flexibility, initiative, and work with minimal supervision.
• Strong communication skills, both oral and in writing, with excellent interpersonal skills.

Nice To Haves

• Minimum 2 years of experience in home health, quality assurance, or utilization management preferred.

Responsibilities

• Reviewing clinical documentation, patient plans of care, and utilization patterns to ensure appropriate, effective, and compliant delivery of home health services.
• Optimizing patient outcomes, managing care utilization, and supporting clinicians in providing the right care at the right time.
• Collaborating closely with field clinicians, case managers, and leadership to promote efficiency, quality, and regulatory compliance across all episodes of care.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree