Utilization Review Nurse, Registered Nurse (RN) at Doctor's Choice Home Care & Hospice Texas

Summary of Essential Functions for 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.

Qualifications / Licensure / Certification / Knowledge / Skills / Abilities:

• Active Registered Nurse (RN) license in the state(s) of practice required.
• Minimum 2 years of experience in home health, quality assurance, or utilization management preferred.
• 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.

Educational Requirements:

• High School Diploma or GED required.
• Graduate of an approved college or university with a at least a diploma or an associate’s degree in nursing (ADN) from an accredited nursing program required.

Working Conditions & Physical Requirements:

Work environment includes autonomy and can be stressful due to deadlines, multiple tasks and general compliance of law, rules, and regulations. The position requires visual acuity and dexterity, sitting, standing, some pushing, pulling, and lifting up to 25 pounds.