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Utilization review nurse Jobs in Grand Prairie, TX

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Utilization review nurse • grand prairie tx

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Registered Nurse Navigator Home Health Review-Health Admin

Christus Health5101 North O Connor Boulevard, Irving, TX  75039
Full-time

The RN Navigator Home Health Review monitors home health patients to ensure patients continue to meet the CMS criteria for services.They are a member of the patient’s care team and act as a patient... Show more

Senior Risk Asset Review Examination Specialist | Risk Asset Review

Wells FargoIrving, TX, United States
Full-time

Senior Risk Asset Review Specialist.Wells Fargo is seeking a Senior Risk Asset Review Specialist within Credit Risk as part of Corporate Risk.Learn more about the career areas and lines of business... Show more

Travel Nurse - Registered Nurse - ER - Emergency Room

Medical SolutionsArlington, TX, US
Full-time

Medical Solutions is seeking an experienced Emergency Room Registered Nurse for an exciting Travel Nursing job in Arlington, TX.Shift: 3x12 hr nights Start Date: ASAP Duration: 13 weeks.A facility ... Show more

 • Promoted

Travel Nurse - Registered Nurse - Hospice - $2226 / Week

Fusion Medical StaffingIrving, TX, US
Full-time

Fusion Medical Staffing is seeking an experienced Hospice Registered Nurse for an exciting Travel Nursing job in Irving, TX.Shift: Inquire Start Date: 07/27/2026 Duration: 13 weeks Pay: $2226 / Wee... Show more

 • Promoted

Travel Nurse - Registered Nurse - PP - Postpartum - $1305 / Week

Host HealthcareArlington, TX, US
Full-time

Host Healthcare is seeking an experienced Postpartum Registered Nurse for an exciting Travel Nursing job in Arlington, TX.Shift: 12 hr nights Start Date: 07/28/2026 Duration: 13 weeks Pay: $1305 / ... Show more

 • Promoted

Travel Nurse - Registered Nurse - ICU - Intensive Care Unit

Axis Medical StaffingIrving, TX, US
Full-time

Axis Medical Staffing is seeking an experienced Intensive Care Unit Registered Nurse for an exciting Travel Nursing job in Irving, TX.Shift: 3x12 hr nights Start Date: 07/27/2026 Duration: 13 weeks... Show more

 • Promoted

Contract Review Specialist

Murray ResourcesIrving, TX
$25.00 hourly
Full-time

A leading electrical engineering services company is seeking a.The ideal candidate is a highly detail-oriented and organized professional with experience in contract review or legal support and the... Show more

Travel Nurse - Registered Nurse - MS - Medical Surgical - $1473 / Week

MedPro Healthcare StaffingArlington, TX, US
Full-time

MedPro Healthcare Staffing is seeking an experienced Medical Surgical Registered Nurse for an exciting Travel Nursing job in Arlington, TX.Shift: 3x12 hr days Start Date: 08/18/2026 Duration: 13 we... Show more

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Travel Nurse - Registered Nurse - Cath Lab - $2378.03 / Week

FlexCareIrving, TX, US
Full-time

FlexCare is seeking an experienced Cath Lab Registered Nurse for an exciting Travel Nursing job in Irving, TX.Shift: 5x8 hr days Start Date: 08/17/2026 Duration: 13 weeks Pay: $2378.Why Clinicians ... Show more

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Travel Nurse - Registered Nurse - Mother Baby - $1462.68 / Week

TRS HealthcareIrving, TX, US
Full-time

TRS Healthcare is seeking an experienced Mother Baby Registered Nurse for an exciting Travel Nursing job in Irving, TX.Shift: 3x12 hr nights Start Date: 08/10/2026 Duration: 13 weeks Pay: $1462.TRS... Show more

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Senior Commercial Real Estate Review Appraiser

U.S. BancorpIrving, TX, United States
Full-time

Commercial Real Estate Appraisal Review Coordinator.Coordinate the commercial real estate appraisal review process for assigned national portfolios and warehouse line engagements, serving as the ce... Show more

Travel Nurse - Registered Nurse - Cath Lab - $2369 / Week

Cynet HealthArlington, TX, US
Full-time

Cynet Health is seeking an experienced Cath Lab Registered Nurse for an exciting Travel Nursing job in Arlington, TX.Shift: 4x10 hr days Start Date: ASAP Duration: 13 weeks Pay: $2369 / Week.Ranked... Show more

 • Promoted

Travel Nurse - Registered Nurse - OR - Operating Room - $1882 / Week

Stability HealthcareArlington, TX, US
Full-time

Stability Healthcare is seeking an experienced Operating Room Registered Nurse for an exciting Travel Nursing job in Arlington, TX.Shift: 3x12 hr days Start Date: ASAP Duration: 13 weeks Pay: $1882... Show more

 • Promoted

Registered Nurse Navigator Home Health Review - Population Health

Christus Health5101 North O Connor Boulevard, Irving, TX  75039
Full-time

The RN Navigator Home Health Review plays a crucial role in monitoring post-acute patients to ensure they continue to meet the CMS criteria for services.As a key member of the patient’s care team, ... Show more

Registered Nurse Navigator Home Health Review-Health Admin

CHRISTUS HealthIrving, TX, US
Full-time

Description Summary: The RN Navigator Home Health Review monitors home health patients to ensure patients continue to meet the CMS criteria for services.They are a member of the patient’s care team... Show more

Credit Review Senior Officer I - C14

CitigroupIrving, TX, United States
Full-time

Credit Review Senior Officer I - C14.Credit Review Senior Officer I for its Irving, Texas location.Manage the execution of Business Monitoring and Reviews and ensure the monitoring of and evaluatio... Show more

Remote US Corporate Tax Review Specialist (Federal Corporate Tax) - AI Trainer ($120-$140 per hour)

MercorGrand Prairie, Texas, US
Remote
Full-time

We are seeking experienced **US Corporate Tax Specialists** to review and improve AI-generated tax research materials.You will evaluate existing corporate tax research questions, verify the legal a... Show more

Case Manager II PRN Days

Kindred Hospital Tarrant County - ArlingtonArlington, TX
Full-time

LTAC) hospital specializing in the treatment of patients recovering from post-intensive care and medically complex conditions.Our hospital provides both intensive care and telemetry-level services,... Show more

Utilization Review Nurse Health Plans - HP Utilization Management

Christus Health5101 North O Connor Boulevard, Irving, TX  75039
Full-time

The Utilization Review Nurse is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services.This nurse is res... Show more

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Registered Nurse Navigator Home Health Review-Health Admin

Registered Nurse Navigator Home Health Review-Health Admin

Christus Health5101 North O Connor Boulevard, Irving, TX 75039
30+ days ago
Job type
  • Full-time
Job description

Summary:

The RN Navigator Home Health Review monitors home health patients to ensure patients continue to meet the CMS criteria for services. They are a member of the patient’s care team and act as a patient advocate, providing proactive outreach to CHRISTUS Health value-based payer patients. The RN Navigator makes recommendations to primary care providers regarding ongoing services. The RN Navigator facilitates communication and coordinates care with physicians, the providers’ clinic, hospital facilities, family, caregivers, and other community healthcare providers. The Associate will support transitions of care as needed.

Responsibilities:

  • Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
  • Stays abreast of current CMS and other payer guidelines for Home Health services.
  • Receives and evaluates Home Health 485 form (Plan of Care) based on Medical Necessity guidelines and Homebound Status requirements.
  • Facilitates Case Conferences with Home Health Agencies for evaluation of patient progress toward goals and discharge plan.
  • Ensures Home Health agency is addressing the problem list and providing appropriate follow up for patient needs.
  • Based on CMS or other payer guidelines, patient assessment, and case conferences, makes recommendation to PCP regarding Home Health recertification or discharge from service.
  • Utilizes MCG Guidelines for Home Care to optimize the type, frequency, and duration of care.
  • Creates positive relationships with Home Health agencies as well as Primary Care Clinicians and Office Staff.
  • Ensures smooth transition of care along the continuum.
  • Facilitates communication between Home Health agencies and PCP practices as necessary to ensure patient's needs are addressed.
  • Demonstrates expertise in navigating electronic medical record and other care management applications.
  • Monitors key measures of program success and provides feedback regarding opportunities to improve.
  • Collaborates with team members in the discharge process, performing outreach/documentation according to CMS guidelines and the Population Health workflow.
  • Outreach to TOC patients should focus on medication reconciliation/adherence, self-management, use of personal health records, follow-up with PCPs/Specialists, and review of indicators that a patient’s condition is worsening and how to respond.
  • Promotes a positive work environment by displaying a caring, sensitive approach to others, as evidenced by listening, understanding, and responding to the needs of patients, colleagues, and supervisors.
  • Performs other duties as assigned.

Job Requirements:

Education/Skills

  • Bachelor’s Degree in Nursing preferred.

Experience

  • 3-5 years of clinical experience required.
  • 2 years of Home health experience preferred.
  • 2-3 years of managed care and/or care management experience preferred.

Licenses, Registrations, or Certifications

  • RN license in the state of employment or compact is required.

Work Schedule:

5 Days - 8 Hours

Work Type:

Full Time