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Chart Utilization Review Jobs in Houston, TX (NOW HIRING)

Lifepoint Health

Office Coordinator

Richmond, TX · On-site

$10/hr

Communicates with treatment team to ensure chart compliance * Interfaces with others to ensure ... Work with the business office and the utilization review department to ensure payment for services

Houston Methodist

Case Manager - PRN

The Woodlands, TX · On-site

... resource utilization, and continued stay. Reviews level of care denials to identify trends and ... Conducts chart audits and performs peer-to-peer evaluations for continuous quality improvement.

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Showing results 21-40

All JobsChart Utilization Review JobsChart Utilization Review Jobs in Houston, TX

Chart Utilization Review information

See Houston, TX salary details

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How much do chart utilization review jobs pay per hour?

As of Sep 6, 2026, the average hourly pay for chart utilization review in Houston, TX is $40.38, according to ZipRecruiter salary data. Most workers in this role earn between $31.92 and $46.39 per hour, depending on experience, location, and employer.

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 Houston, TX?

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

What job categories do people searching Chart Utilization Review jobs in Houston, TX look for?

The top searched job categories for Chart Utilization Review jobs in Houston, TX are:

What cities near Houston, TX are hiring for Chart Utilization Review jobs?

Cities near Houston, TX with the most Chart Utilization Review job openings:

Chart Utilization Review jobs near you
Infographic showing various Chart Utilization Review job openings in Houston, TX as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 13% Part Time, 3% Contract, and 1% Nights. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $83,986 per year, or $40.4 per hour.

Medical Compliance Auditor

Texas Childrens Hospital

Bellaire, TX

Full-time

Re-posted 17 days ago

Texas Children's Hospital rating

8.3

Company rating: 8.3 out of 10

Based on 177 frontline employees who took The Breakroom Quiz

85th of 1,065 rated hospitals

Job description

We are searching for a Medical Compliance Auditor - someone who works well in a fast-paced setting. In this position, you will review and approve or deny medical claim appeals and perform clinical audits of medical records submitted in support of services billed by providers. This process includes clinical judgment, utilization review, application of product benefits, understanding of regulatory requirements for Medicaid managed care and fraud and abuse, and verification of medical necessity utilizing nationally recognized criteria.
Think you've got what it takes?
Job Duties & Responsibilities
• Assess the treatment plan, clinical information, and medical necessity of all requested services
• Utilizes established criteria to appropriately review billed services within established timeframe required.
• Consults with medical directors and clinical staff regarding patient's history and current care needs and whether services billed were appropriate.
• Refers case failing medical necessity criteria to the Special Investigations Unit (SIU) Director and SIU Workgroup for review and a recommendation for action.
• Telephonic follow-up with the provider's office to request additional information as needed.
• Completes timely entry of information into electronic file including a chart with detailed findings of the review and a report summarizing the results of the audit.
• Evaluate benefit coverage and regulatory guidelines pertinent to decision making for each investigation.
• Perform Clinical and Coding Review on Medical Claim Appeals.
• Assess and process all education and recoupment letters after Special Investigative Committee review decision.
• Facilitates provider communication and education.
• Liaisons with internal staff members.
• Perform Clinical Review and make recommendation on Audit Pass/Fail.
• Ongoing assessment for quality indicators and concerns.
Skills & Requirements
• Required Associate's Degree in Nursing or
• Technical Diploma in Vocation Nursing
• Preferred Bachelor's Degree in Nursing
• Required LVN - Lic- Licensed Vocational Nurses Texas Board of Nursing or Nursing Licensure Compact or
• RN-Lic-Registered Nurses Texas Board of Nursing or Nursing Licensure Compact
• Preferred CPC-Cert-Cert Professional Coder Americal Academy of Professional Coders
• Required 3 years Clinical experience in the applicable field according to the license (LVN or RN)
• 4 years of Medical Auditing experience.
ABOUT US
Founded in 1996, Texas Children's Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.
To join our community of 15,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities.
Texas Children's is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

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