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Chart Utilization Review Jobs in Texas (NOW HIRING)

Performs substantive chart reviews to assure there is evidence that quality care is being delivered. * Participates in the Outcomes Management and annual program review. * Performs utilization review ...

Performs substantive chart reviews to assure there is evidence that quality care is being delivered. * Participates in the Outcomes Management and annual program review. * Performs utilization review ...

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Chart Utilization Review information

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 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 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 cities in Texas are hiring for Chart Utilization Review jobs? Cities in Texas with the most Chart Utilization Review job openings:
Infographic showing various Chart Utilization Review job openings in Texas as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution.

Physician Family Practice-Without OB - Competitive Salary

YesCare

Waxahachie, TX • On-site

Other

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 5 days ago


YesCare rating

6.7

Company rating: 6.7 out of 10

Based on 20 frontline employees who took The Breakroom Quiz


Job description

Join YesCare: A Career with Purpose in Correctional Healthcare

Correctional healthcare is more than just a job—it’s a calling. At YesCare, you have the unique opportunity to make a meaningful difference in the health, well-being, and future of an underserved population.

As a pioneer in correctional healthcare services, YesCare is committed to innovation, clinical expertise, and compassionate care. By choosing a career with YesCare, you are opting for professional growth, impactful work, and the chance to be part of a legacy of excellence. You’ll have access to the resources, training, and support needed to enhance your skills and reach your full career potential. Your role at YesCare allows you to contribute directly to the care and well-being of patients who need it most. Join a team that’s known for its innovative approaches and dedication to improving correctional healthcare.

Make a difference where it matters most. Start your journey with YesCare today and be part of a team that is transforming lives through care and expertise.

Key Responsibilities

  • Administrative Duties:
  • Chair the Medical Audit Committee, ensuring quality standards are upheld.
  • Consult with community medical providers to address and resolve patient care issues.
  • Supervise clinical services provided by professional and paraprofessional staff.
  • Provide and ensure on-call services to support patient care needs.
  • Review and approve clinical protocols, policies, procedures, and the medical disaster plan annually.
  • Lead quality improvement initiatives, including patient complaints, infection control, peer review, and chart audits.
  • Oversee referrals to external healthcare facilities, ensuring appropriateness, quality, and continuity of care.
  • Serve as a resource and leader for all clinical staff, fostering collaboration and excellence.
  • Participate in screening, interviewing, credential evaluation, and hiring of healthcare providers.
  • Represent the healthcare program in discussions with civic groups or officials as needed.
  • Maintain timely, legible, and signed documentation of patient encounters in medical records.
  • Clinical Duties:
  • Deliver evidence-based care, including sick call, chronic care, history and physicals, and emergency care.
  • Conduct daily infirmary visits and document encounters as assigned.
  • Provide on-call services as needed, ensuring continuity of care.
  • Adhere to the approved formulary and document requests for non-formulary medications as necessary.
  • Utilize in-house resources to address patient issues before off-site referrals.
  • Demonstrate proficiency in cardiopulmonary resuscitation (CPR) and Automated External Defibrillator (AED) use, maintaining required certifications.
  • Lead medical staff meetings and provide monthly in-service education for staff.
  • Participate in quality improvement initiatives, including sentinel event reviews and chart audits.
  • Engage actively in the Utilization Review process, ensuring appropriate use of healthcare resources.

Key Qualifications

  • Medical Education: Graduate of an accredited medical school.
  • Licensure: Fully licensed to practice medicine in the state of employment.
  • DEA Registration: Active and current registration.
  • Board Certification:
  • Preferred: Board-certified or board-eligible in primary care specialties, including Family Practice, Internal Medicine, Emergency Medicine, Public Health, or Occupational Medicine.
  • Administrative Experience:
  • Experience in corrections and/or managed healthcare delivery is highly desirable.
  • Additional Requirements:
  • Must successfully pass a background check, security clearance, and drug screening.

YesCare Benefits (For Full-Time Positions)

  • Health, Dental, and Vision Insurance
  • Life and Disability Insurance
  • Generous PTO Plan
  • 401k with Matching Funds
  • Employee Discount and Rewards Program
  • Tuition Assistance
  • Continuing Education Reimbursement

Why Join YesCare?

YesCare provides a supportive and structured environment where you can thrive in a leadership role while delivering meaningful healthcare in a correctional setting. Your expertise and leadership will directly impact the quality of care and operations within our facilities.

Equal Opportunity Employer Statement

YesCare is an Equal Opportunity/Affirmative Action Employer . We comply with all federal and state employment opportunity laws and consider qualified applicants without regard to race, gender, national origin, religion, age, sexual orientation, disability, or veteran status.

Category: Physician


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