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Contract Rn Case Review Jobs in Texas (NOW HIRING)

Prime Healthcare

Case Manager RN

Mission, TX

We are seeking an RN Case Manager , also referred to as a Registered Nurse Case Manager or RN ... Utilization Review: monitor the use of hospital resources and services to ensure appropriate care ...

Nexus Children's Hospital

RN Case Manager

Conroe, TX · On-site

RN Case Manager Nexus Children's Hospital - Shenandoah Full-Time | Monday-Friday | Day Shift About ... Practices "minimum information necessary" when performing utilization review, case management, and ...

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Contract Rn Case Review information

How does a Contract RN Case Review professional typically collaborate with other healthcare team members?

As a Contract RN Case Review professional, you'll frequently coordinate with physicians, social workers, and other nursing staff to ensure comprehensive patient care. Collaboration often involves reviewing patient charts, discussing care plans, and providing recommendations for discharge planning or ongoing management. Effective communication is key, as you'll need to relay findings and updates to both internal teams and external case managers. This role often requires balancing independent, detailed review work with regular interdisciplinary meetings to drive optimal outcomes for patients.

What are the key skills and qualifications needed to thrive as a Contract RN Case Review, and why are they important?

To thrive as a Contract RN Case Review, you need a valid RN license, strong clinical judgment, and experience in case management or utilization review. Familiarity with medical coding systems (such as ICD-10, CPT), case management software, and knowledge of regulatory guidelines like Medicare and Medicaid are typically required. Excellent analytical thinking, attention to detail, and effective communication skills are crucial soft skills for this role. These competencies ensure accurate case assessments, compliance with healthcare regulations, and effective collaboration with providers and payers.

What is the difference between Contract Rn Case Review vs Contract Rn Case Management?

AspectContract Rn Case ReviewContract Rn Case Management
CertificationsRN license, case review certificationsRN license, case management certifications (e.g., CCM)
Work EnvironmentReviewing medical records, assessing casesCoordinating patient care, managing cases
Employer & IndustryInsurance companies, healthcare agenciesHealthcare providers, insurance companies
Search & Comparison IntentUnderstanding case review roles, job differencesExploring case management careers, job duties

Contract Rn Case Review focuses on evaluating medical records and determining coverage or compliance, while Contract Rn Case Management involves coordinating patient care and managing cases throughout treatment. Both roles require RN licensure, but they differ in daily tasks and responsibilities within the healthcare and insurance industries.

What is a Contract RN Case Review nurse?

A Contract RN Case Review nurse is a registered nurse who is hired on a contractual basis to evaluate patient cases, often for insurance companies, hospitals, or healthcare organizations. Their main duties include reviewing medical records, ensuring compliance with clinical guidelines, and providing recommendations for patient care or coverage decisions. These nurses typically work remotely or in office settings and may be responsible for communicating findings to healthcare providers or insurance adjusters. This role requires strong clinical knowledge, attention to detail, and excellent communication skills.
What are the most commonly searched types of Rn Case Review jobs in Texas? The most popular types of Rn Case Review jobs in Texas are:
What cities in Texas are hiring for Contract Rn Case Review jobs? Cities in Texas with the most Contract Rn Case Review job openings:
Contract Rn Case Review jobs near you
Case Manager RN

Case Manager RN

Prime Healthcare

Mission, TX

Per diem

Medical, Retirement

Posted 8 days ago

Prime Healthcare rating

6.4

Company rating: 6.4 out of 10

Based on 277 frontline employees who took The Breakroom Quiz

636th of 877 rated healthcare providers

Job description

We are seeking an RN Case Manager, also referred to as a Registered Nurse Case Manager or RN Clinical Case Manager. An RN Case Manager will oversee and coordinate patient care from admission through discharge to ensure quality, cost-effective outcomes. They assess patients’ needs, develop care plans, and collaborate with physicians, nurses, social workers, and other providers to manage care transitions. RN Case Managers also conduct discharge planning, utilization review, and helping patients navigate insurance and healthcare systems. This position is on a per diem basis, meaning PD/PRN as needed. 

Shift’s Available:  Days 

Employment Type: Per-Diem (PRN / PD) 

Location: Mission Regional Medical Center, Mission TX

Here are some of the benefits of working at Prime Healthcare: 

  • Competitive compensation  
  • Medical insurance benefit plan 
  • 401K   

Mission Regional Medical Center is a 297-bed, non-profit hospital that provides inpatient and outpatient hospital services to the people of the Rio Grande Valley. Rated one of the top hospitals in the country for clinical excellence in many services including maternity and orthopedic care, Mission Regional Medical Center has been offering quality healthcare, close to home, for over 60 years. For more information visit www.missionrmc.org.


Essential Duties and Responsibilities (includes, but not limited to): 

  • Patient Assessment: evaluate patients’ medical, psychosocial, and discharge needs upon admission and throughout their stay 
  • Care Coordination: develop and implement individualized care plans in collaboration with the healthcare team to ensure effective treatment and timely interventions 
  • Discharge Planning: coordinate safe and appropriate discharge plans, including referrals to rehab, home health, or long-term care facilities 
  • Utilization Review: monitor the use of hospital resources and services to ensure appropriate care and avoid unnecessary treatments or extended stays 
  • Patient and Family Education: help patients and families understand care plans, post-discharge instructions, and available resources 
  • Advocacy: advocate for patient needs and preferences, ensuring care is aligned with their goals and values 

EDUCATION, EXPERIENCE, TRAINING

Required qualifications:

1. BSW or other bachelor's degree in a related field.  At least one year experience in case management, discharge planning or nursing management; or
2. Experience and knowledge in basic to intermediate computer skills.
 

Preferred qualifications:

1. Minimum 5 years of acute care experience preferred.
2. CCM or obtained within 1year
3. Current BCLS certificate preferred.
4. Knowledge of Milliman Criteria and InterQual Criteria preferred.

#LI-AG1


Per Diem
Days

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

 

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