ZipRecruiter

Log In

1

Chart Utilization Review Jobs in Texas (NOW HIRING)

Shannon Health

Case Manager

San Angelo, TX

$19.50 - $25.25/hr

Performs Utilization Review accurately and refers cases appropriately for secondary review ... the chart and documents. * Provides adequate communication of relevant issues to the ...

Shannon Health

Case Manager

San Angelo, TX · On-site

$19.50 - $25.25/hr

Performs Utilization Review accurately and refers cases appropriately for secondary review ... the chart and documents. * Provides adequate communication of relevant issues to the ...

next page

Showing results 1-20

All JobsChart Utilization Review JobsChart Utilization Review Jobs in Texas

Chart Utilization Review information

What is chart utilization review?

Chart Utilization Review is a process commonly used in healthcare settings to assess the necessity, appropriateness, and efficiency of medical services provided to patients. It involves reviewing patient charts and medical records to ensure that treatments and procedures are justified according to established guidelines and policies. This process helps in improving patient care, managing costs, and ensuring compliance with regulatory requirements. Utilization review professionals work closely with medical staff, insurance companies, and regulatory agencies to support quality and cost-effective care.

What are some common challenges faced by professionals in chart utilization review, and how can they be addressed?

Professionals in Chart Utilization Review often encounter challenges such as navigating incomplete or inconsistent medical documentation, staying current with ever-evolving healthcare regulations, and balancing productivity with accuracy. To address these challenges, it is important to maintain open communication with clinical staff, participate in ongoing training, and utilize robust electronic health record systems. Additionally, collaborating closely with interdisciplinary teams can help clarify documentation and ensure compliance with regulatory standards.

What are the key skills and qualifications needed to thrive as a chart utilization review specialist, and why are they important?

To thrive as a Chart Utilization Review specialist, you need a background in healthcare, strong knowledge of medical terminology, and experience with patient care documentation, often supported by an RN or LPN license. Familiarity with utilization management software, electronic health records (EHR), and relevant certifications such as Certified Professional in Utilization Review (CPUR) are typically required. Attention to detail, analytical thinking, and effective communication are crucial soft skills for accurately reviewing charts and collaborating with healthcare providers. These abilities ensure compliance, optimize patient care, and support cost-effective healthcare delivery.

What is the difference between Chart Utilization Review vs Chart Review Specialist?

AspectChart Utilization ReviewChart Review Specialist
CredentialsTypically requires healthcare or insurance-related certificationsOften requires medical or coding certifications
Work EnvironmentHealthcare facilities, insurance companies, utilization management teamsMedical offices, insurance companies, coding firms
Employer & IndustryHospitals, insurance providers, healthcare organizationsMedical billing companies, insurance firms, healthcare providers
Primary FocusAssessing medical necessity and appropriateness of servicesReviewing medical records for coding accuracy and completeness

While both roles involve reviewing medical information, Chart Utilization Review focuses on evaluating the necessity of healthcare services, whereas Chart Review Specialists primarily verify medical documentation for coding and billing accuracy. Understanding these distinctions helps professionals choose the right career path or job search focus.

What are popular job titles related to Chart Utilization Review jobs in Texas?

For Chart Utilization Review jobs in Texas, the most frequently searched job titles are:

What job categories do people searching Chart Utilization Review jobs in Texas look for?

The top searched job categories for Chart Utilization Review jobs in Texas are:

What cities in Texas are hiring for Chart Utilization Review jobs?

Cities in Texas with the most Chart Utilization Review job openings:

Chart Utilization Review jobs near you
Infographic showing various Chart Utilization Review job openings in Texas as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 15% Part Time, 1% Temporary, and 3% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution.

UR LVN Utilization/Clinical Claim Review NurseSeybold Clinic

UnitedHealthcare

Pearland, TX • On-site

$20 - $36/hr

Other

Medical, Retirement

This job post has expired today. Applications are no longer accepted.

UnitedHealthcare rating

7.8

Company rating: 7.8 out of 10

Based on 705 frontline employees who took The Breakroom Quiz

134th of 898 rated healthcare providers

Job description

Utilization Review Lvn Nurse

Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. 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 clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together.

The Utilization Review LVN nurse will perform documentation review for medical necessity and benefit correlation of requested medical and surgical procedures, services and admissions for HMO, PPO and POS products. The UR LVN nurse will serve as facilitator of communication with clinic, payor and other customers.

Primary Responsibilities:

  • Data entry of all UR requests into the Kelsey-Seybold data system
  • Verifies eligibility
  • Obtains benefit interpretation from insurance company
  • Reviews request and chart to determine medical necessity by using internal criteria
  • Approves request or defers to insurance review and assists with MD review
  • Communicates with respective payor to obtain pre-certification authorization
  • Serves as resource to physicians, staff and patients regarding review process
  • Clarifies UR request discrepancies with office submitting or insurance company
  • Other duties as assigned

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • Licensed Vocational Nurse
  • CEU requirement
  • TX LVN license
  • 2+ years of utilization review experience at heath plan, ACO, IPA, or provider group OR 3+ years of diverse clinical experience, including acute care or similar care
  • Good organization and communication skills
  • HMO, PPO and POS insurance knowledge
  • Valid Driver's license

Preferred Qualifications:

  • Computer and Coding experience

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The hourly pay for this role will range from $20.00 to $36.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

What UnitedHealthcare employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply