Lpn utilization review jobs in Houston, TexasCreate job alerts

Job DescriptionCompany Description HealthHelp - A WNS Company (), is the leader in the field of healthcare utilization and care management. We have gained this position by actively working to change out-of-date practices with a collaborative, non-denial based approach. Our methodology helps payors achieve a higher return on investment, gives providers education programs that better inform physicians, and ensures quality and safety for the patients needing treatment. HealthHelp’s innovative approach and strong IT capability in specialty benefits management means that staff will move healthcare forward when provided with evidence-based solutions and second opinions. HealthHelp's staff is comprised of healthcare professionals who make a difference every day. HealthHelp has a desire to fill their company with talented and innovative people who want a career path filled with success and personal growth. Our specialty benefits management services are broad and include, Cardiology, Oncology, Radiology, Radiation Therapy, Sleep Care, and Musculoskeletal Care. HealthHelp is headquartered in Houston, Texas. HealthHelp provides equal opportunities to all employees and applicants without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, marital status, amnesty or status as a covered veteran in accordance with applicable federal, state, and local laws. If you need assistance in completing this application due to a disability, please contact a member of the Talent Acquisition Group to request an accommodation or an alternative application process by emailing Job Description • Performs utilization review of cases to determine if the request meets medical necessity criteria in accordance with medical policies agreed upon with the Client and any applicable governing body., • Facilitates resolution of escalated cases that may require special handling., • Performs clinical reviews according to the policies and procedures of HealthHelp within the identified State and Federal or Client agreed upon timeframes., • Collaborates with client personnel to resolve customer concerns., • Appropriately identifies and refers quality issues to UM Leadership., • Assists Physician Reviewers and Medical Directors, as necessary, to ensure compliance with review timeframes., • Maintains written documentation according to HealthHelp’s documentation policy., • Ensures consistency in implementation of policy, procedure, and regulatory requirements in collaboration with Nursing Management., • Keeps current with regulation changes as provided by Compliance Department and Nursing Management., • Adheres to all HIPAA, state, and federal regulations pertaining to the clinical programs., • Provides quality customer service through interaction with providers, administrative staff, and others., • Creates, encourages, and supports an environment that fosters teamwork, respect, diversity, and cooperation with others., • Engages in phone conversations with ordering providers, members, internal staff, primary care physicians (PCPs), and rendering providers as necessary to facilitate the clinical review process and ensure appropriate care decisions., • Effectively utilizes various computer systems and software to manage cases and document reviews., • Promotes business focus which demonstrates an understanding of the company’s vision, mission, and strategy., • Participates in the HealthHelp Quality Management Program, as required., • Adheres to both URAC & NCQA standards pertinent to their job description., • Ability to prioritize projects, work independently under pressure, and meet critical deadlines., • Capable of communicating clinical concepts to providers and staff based on guidelines., • RN, LPN/LVN graduate from an accredited school of nursing, • Current, active unrestricted RN, LPN/LVN license in the state or territory of the U.S., • Minimum of two (2) years experience in utilization review, case management, or clinical quality improvement, • Proficient technical skills in Microsoft Office (Word, Excel, and PowerPoint) and ability to adapt to new healthcare specific software and systems, required, • Experience working with state and federal regulatory and compliance standards, preferred, • Working knowledge of National Coverage Determination (NCD) and Local Coverage Determination (LCD), • Knowledge of insurance terminology, • Good organizational and time management skills, • Excellent written and verbal communication skills, • Ability to utilize critical thinking skills, • Highly motivated, self-starter who can work efficiently and independently, or as a team member Additional Information Start Date: May 4th, 2026 Training Schedule (First 6 Weeks): Monday to Friday, 8:00 AM – 4:30 PM (CST) Regular Schedule After Training: 10:30amCST - 7:00pm CST Location: Remote Compensation Disclosure The base salary range for this position is $65,000 [LVN/LPN], $75,000 [RN] annually. This represents the base pay range that we reasonably expect to offer for this position. Final compensation will be determined based on a variety of factors, including but not limited to the candidate’s experience, education, skillset, and location. • Geographic location, • Overall professional experience, • Directly relevant experience, • Education and certifications, • Industry knowledge and expertise, • Skills and competencies In addition to base pay, this role may be eligible for performance-based bonuses, incentive pay, or commissions, which are not included in the listed base salary range. WNS complies with all applicable federal, state, and local pay transparency laws, including those in California, Colorado, New York, Washington, and Illinois. Note: For complete compensation information, please refer to the job posting on our official careers page. Benefits Overview Our benefits package includes (but is not limited to): • Medical, dental, and vision insurance, • Paid time off (PTO), holidays, and sick leave, • 401(k) with company match or other retirement plan, • Life and AD&D Insurance, • Employee Assistance Program Equal Opportunity Employer Statement WNS is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, genetic information, veteran status, or any other status protected under federal, state, or local law. We also provide reasonable accommodations to individuals with disabilities and for sincerely held religious beliefs in all aspects of employment, including the application process. How to Apply Please submit your application, including a resume and optional cover letter, through our careers page or email to .

Oversees and coordinates day-to-day activities of nursing personnel in patient care units, provides direction to Clinical Staff, implements work of assigned units and coordinates activities with other patient care units and related departments.Meets expectations of the applicable OneCHRISTUS Compete

Registered Nurse (RN) – Pediatric Home Health.Eligible candidates may qualify for a sign-on bonus* as part of their total compensation package.Bonus eligibility and payout structure will be discussed early in the interview process.A Nursing Role Built for Focused, One-on-One Care.At Care Options

Registered Nurse (RN) – Pediatric Home Health.Eligible candidates may qualify for a sign-on bonus* as part of their total compensation package.Bonus eligibility and payout structure will be discussed early in the interview process.A Nursing Role Built for Focused, One-on-One Care.At Care Options

We are looking for someone who works well in a fast-paced setting.In this position you'll provide quality nursing care to patients by assessing, planning, educating, implementing, and evaluating age-appropriate care in a manner that incorporates family-centered principles and cost-effective care.We

Registered Nurse (RN) – Pediatric Home Health.Eligible candidates may qualify for a sign-on bonus* as part of their total compensation package.Bonus eligibility and payout structure will be discussed early in the interview process.A Nursing Role Built for Focused, One-on-One Care.At Care Options

We are looking for someone who works well in a fast-paced setting.In this position you'll provide quality nursing care to patients by assessing, planning, educating, implementing, and evaluating age-appropriate care in a manner that incorporates family-centered principles and cost-effective care.We

Registered Nurse (RN) – Pediatric Home Health.Eligible candidates may qualify for a sign-on bonus* as part of their total compensation package.Bonus eligibility and payout structure will be discussed early in the interview process.A Nursing Role Built for Focused, One-on-One Care.At Care Options

Registered Nurse (RN) - GI Procedure Suite.We are looking for someone who works well in a fast-paced setting.In this position you'll provide quality nursing care to patients by assessing, planning, educating, implementing, and evaluating age-appropriate care in a manner that incorporates family-cent

We are searching for an Inpatient Staff Nurse -- someone who works well in a fast-paced setting.In this position, you will provide nursing care to patients by assessing, planning, educating, implementing, and evaluating age-appropriate care in a manner that incorporates family-centered principles an

Oversees and coordinates day-to-day activities of nursing personnel in patient care units, provides direction to Clinical Staff, implements work of assigned units and coordinates activities with other patient care units and related departments.Meets expectations of the applicable OneCHRISTUS Compete

Registered Nurse (RN) Pedi Radiology.This applicant will help bring together world-class expertise, leading-edge technology working alongside a renowned team to provide comprehensive, accurate and safe pediatric imaging.Think you've got what it takes?.Pediatric Radiology experience.Bachelor's degree

Adult Congenital Heart - Acute Care Nurse –.In this position, you will provide nursing care to adult and pediatric patients with acute care needs.Working in a Cross Coverage Care Model will afford you with the unique opportunity to provide continuity care to patients with complex congenital heart

We are searching for a Inpatient Staff Nurse- Infusion Center/Hemoc- someone who works well in a fast-paced setting.In this position, you will provide nursing care to patients by assessing, planning, educating, implementing, and evaluating age-appropriate care in a manner that incorporates family-ce

Description Summary: Oversees and coordinates day-to-day activities of nursing personnel in patient care units, provides direction to Clinical Staff, implements work of assigned units and coordinates activities with other patient care units and related departments.Responsibilities: Meets expectation

We are searching for an Pediatric Float Pool Registered Nurse (RN) - someone who works well in a fast-paced hospital setting.In this position you'll provide quality nursing care to patients by assessing, planning, educating, implementing, and evaluating age appropriate care in a manner that incorpor

Registered Nurse (RN) – Pediatric Home Health.Eligible candidates may qualify for a sign-on bonus* as part of their total compensation package.Bonus eligibility and payout structure will be discussed early in the interview process.A Nursing Role Built for Focused, One-on-One Care.At Care Options f

We are searching for an Inpatient Staff Nurse -- someone who works well in a fast-paced setting.In this position, you will provide nursing care to patients by assessing, planning, educating, implementing, and evaluating age-appropriate care in a manner that incorporates family-centered principles an

Description Summary: The competent Nurse, in the same or similar clinical setting, practices independently and demonstrates an awareness of all relevant aspects of a situation.Provides routine and complex care, with the ability to on long-range goals or plans.Continues to develop the ability to cope

Critical Care Registered Nurse.In this position, you will provide nursing care to adult and pediatric patients with ICU care needs.Working in a Cross Coverage Care Model will afford you the unique opportunity to provide continuity care to patients with complex congenital heart disease at various sta

Knowledge of health care and insurance industries and health care delivery systems, including current standards of medical practice; insurance benefit structures and related legal/medical issues; and utilization review and quality assurance procedures.

We are searching for a Registered Nurse for our General Med/Surg unit (20WT)– someone who works well in a fast-paced setting.WT is a 34 bed med/surg unit that sees kidney, liver transplant, renal and GI patients.Think you've got what it takes?.Bachelor's degree in nursing or an associate's degree,

Description Summary: The competent Nurse, in the same or similar clinical setting, practices independently and demonstrates an awareness of all relevant aspects of a situation.Provides routine and complex care, with the ability to on long-range goals or plans.Continues to develop the ability to cope

Administrative Director Of Emergency Services.Annual Compensation: $116,251 $174,366 (DOE) Annual Performance Bonus: ~17.Relocation: Case-by-case Sign-On Bonus: Case-by-case.A large, high-volume hospital system in Houston is seeking an experienced Administrative Director of Emergency Services to le

Applies approved utilization criteria to monitor appropriateness of admissions, level of care, resource utilization, and continued stay. Progressive knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement. Performs review for m

Registered Nurse/ RN, Home Health.RN / Registered Nurse, Home Health.Position: RN Case Manager, Home Health.Coverage Area: 77041, 77043, 77055, 77079, 77080, 77084, 77094, 77095.Find Your Passion and Purpose as an Registered Nurse, Home Health Case Manager.Schedule: Monday-Friday 8am-5pm.This posi

Fallbrook Dr, Houston, Texas, 77064-3318, United States of America.RN Case Manager - Position Highlights.Northwest Houston, TX - Hybrid - Remote.This is a hybrid, field based role requiring a dedicated home office and the ability to travel 3-4 days/week within an assigned territory.Coverage includes

The Buckingham is the premier not for profit, Life Care retirement community in the greater Houston region.Our mission is to enrich each resident’s life through exceptional experiences provided within an environment of comfort, elegance, exceptional hospitality and compassionate care.We offer a co

Applies approved utilization criteria to monitor appropriateness of admissions, level of care, resource utilization, and continued stay. Progressive knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement. Performs review for m

We are currently seeking qualified candidates for a part time PRN Per Visit Registered Nurse (RN) Case Manager position in the Houston area.This is an out-patient position that requires an independent and experienced RN-Case Manager.Primary functions are to coordinate patient care with the interdisc

N Loop WestSte 800, Houston, Texas, 77092-8838, United States of America.RN Case Manager - Position Highlights.Northwest Houston, TX - Hybrid - Remote.This is a hybrid, field based role requiring a dedicated home office and the ability to travel 3-4 days/week within an assigned territory.Coverage in

We are currently seeking qualified candidates for a full time Long Term Care Registered Nurse (RN) position in the Houston area.The hospice LTC RN is an integral part of the interdisciplinary care team.Responsible for all duties as outlined by the job description as well as the following responsibil

Do you enjoy interacting with people and making a difference in their lives?.If you are currently a licensed RN or LVN in the State of Texas we have a unique and rewarding opportunity available!.Assist with planning, organizing and developing the overall emotional and social needs of the residents a

Reviews case management documentation for accuracy, timeliness, and compliance with facility, CARF, and payer standards. Reviews patient pre-admission documentation in a timely manner. Writes and reviews weekly contact notes and ensures proper documentation.

You can Make A Difference in the lives of others!.At Heart to Heart Hospice, we provide "Compassionate Care from Our Hearts to Yours.Our employees enhance the lives of patients with life-limiting illnesses and their loved ones,during a time when compassionate care is needed most.We are dedicated to

Knowledge of health care and insurance industries and health care delivery systems, including current standards of medical practice; insurance benefit structures and related legal/medical issues; and utilization review and quality assurance procedures.

Applies approved utilization criteria to monitor appropriateness of admissions, level of care, resource utilization, and continued stay. Progressive knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement. Performs review for m

The Buckingham is the premier not for profit, Life Care retirement community in the greater Houston region.Our mission is to enrich each resident’s life through exceptional experiences provided within an environment of comfort, elegance, exceptional hospitality and compassionate care.We offer a co

Evaluate LPN at a minimum of one time per month.

The Utilization Management Review Nurse (UMRN) performs technical and administrative work required to evaluate the necessity, appropriateness, and efficiency of the utilization of medical services procedures and facilities. Other: Utilization review tools: MCG and or Change healthcare (Interqual). T

Are you a caring LPN looking to make strong connections and an impact on patients?. Possess an Active LPN license in the state of residence.

Explore opportunities with Kelsey-Seybold Clinic,.Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston.Be part of a team that is nationally recognized for delivering coordinated and accountable care.As a multi-specialty

We currently have an opportunity for a Full Time Case Manager (Utilization Management). Ensures delivery of information to Business Office, Admissions Office, Managed Care Organizations, and the Director of Utilization Management, while monitoring quality of documentation to facilitate collections.

Fallbrook Dr, Houston, Texas, 77064-3318, United States of America.RN Case Manager - Position Highlights.Northwest Houston, TX - Hybrid - Remote.This is a hybrid, field based role requiring a dedicated home office and the ability to travel 3-4 days/week within an assigned territory.Coverage includes