The Utilization Review Nurse is responsible for determining the clinical appropriateness of care ... Associate's (ADN) or Bachelor's (BSN) in Nursing preferred Experience * 3 - 5 years of nursing ...
The Utilization Review Nurse is responsible for determining the clinical appropriateness of care ... Associate's (ADN) or Bachelor's (BSN) in Nursing preferred Experience * 3 - 5 years of nursing ...
The Utilization Review Nurse is responsible for determining the clinical appropriateness of care ... Associate's (ADN) or Bachelor's (BSN) in Nursing preferred Experience * 3 - 5 years of nursing ...
The Utilization Review Nurse is responsible for determining the clinical appropriateness of care ... Associate's (ADN) or Bachelor's (BSN) in Nursing preferred Experience * 3 - 5 years of nursing ...
Itemization Review Supervisor
Fort Worth, TX · Remote
$70K - $116K/yr
The Itemization Review Supervisor will maintain a positive team building approach with emphasis on ... Associate Degree in Nursing or higher * Minimum of 3 years' experience in LIBR preferred
Itemization Review Supervisor
Fort Worth, TX · Remote
$70K - $116K/yr
The Itemization Review Supervisor will maintain a positive team building approach with emphasis on ... Associate Degree in Nursing or higher * Minimum of 3 years' experience in LIBR preferred
Clinical Review Nurse Lead Virtual ... This role enables associates to work virtually full-time, with the exception of required in-person ...
Clinical Review Nurse Lead Virtual ... This role enables associates to work virtually full-time, with the exception of required in-person ...
Itemization Review Supervisor
Fort Worth, TX · Remote
$70K - $116K/yr
The Itemization Review Supervisor will maintain a positive team building approach with emphasis on ... Associate Degree in Nursing or higher * Minimum of 3 years' experience in LIBR preferred
Itemization Review Supervisor
Fort Worth, TX · Remote
$70K - $116K/yr
The Itemization Review Supervisor will maintain a positive team building approach with emphasis on ... Associate Degree in Nursing or higher * Minimum of 3 years' experience in LIBR preferred
Clinical Review Nurse Lead Virtual ... This role enables associates to work virtually full-time, with the exception of required in-person ...
Clinical Review Nurse Lead Virtual ... This role enables associates to work virtually full-time, with the exception of required in-person ...
Remote Care Review Processor
Houston, TX · On-site
Remote Care Review Processor Houston, Texas, United States Or refer someone About the Job Remote ... Associate degree Preferred Experience 3+ years experience in an administrative support role in ...
Remote Care Review Processor
Houston, TX · On-site
Remote Care Review Processor Houston, Texas, United States Or refer someone About the Job Remote ... Associate degree Preferred Experience 3+ years experience in an administrative support role in ...
RN Quality Review
Mexia, TX · On-site
RN - Quality Review Join Parkview Regional Hospital in Mexia, TX, a 49-bed, acute-care facility ... Associate Degree in Nursing (ADN) required * Bachelor's Degree in Nursing (BSN) preferred Licenses ...
RN Quality Review
Mexia, TX · On-site
RN - Quality Review Join Parkview Regional Hospital in Mexia, TX, a 49-bed, acute-care facility ... Associate Degree in Nursing (ADN) required * Bachelor's Degree in Nursing (BSN) preferred Licenses ...
RN Quality Review
Mexia, TX · On-site
Job Summary The RN - Quality Review is responsible for supporting the organization's quality and ... Associate Degree in Nursing (ADN) required * Bachelor's Degree in Nursing (BSN) preferred Licenses ...
RN Quality Review
Mexia, TX · On-site
Job Summary The RN - Quality Review is responsible for supporting the organization's quality and ... Associate Degree in Nursing (ADN) required * Bachelor's Degree in Nursing (BSN) preferred Licenses ...
Itemization Review Nurse I
Fort Worth, TX · Remote
$52K - $85K/yr
The Itemization Review Nurse provides a summary and analysis of items by reviewing all charges on a ... R. as an R.N. * Associate Degree in Nursing or higher * Experience in medical bill auditing ...
Itemization Review Nurse I
Fort Worth, TX · Remote
$52K - $85K/yr
The Itemization Review Nurse provides a summary and analysis of items by reviewing all charges on a ... R. as an R.N. * Associate Degree in Nursing or higher * Experience in medical bill auditing ...
Itemization Review Nurse II
Fort Worth, TX · On-site
$61K - $98K/yr
The Itemization Review Nurse provides a summary and analysis of items by reviewing all charges on a ... R. as an R.N. * Associate Degree in Nursing or higher * Experience in medical bill auditing ...
Itemization Review Nurse II
Fort Worth, TX · On-site
$61K - $98K/yr
The Itemization Review Nurse provides a summary and analysis of items by reviewing all charges on a ... R. as an R.N. * Associate Degree in Nursing or higher * Experience in medical bill auditing ...
Itemization Review Nurse II
Fort Worth, TX · On-site
$61K - $98K/yr
The Itemization Review Nurse provides a summary and analysis of items by reviewing all charges on a ... R. as an R.N. * Associate Degree in Nursing or higher * Experience in medical bill auditing ...
Itemization Review Nurse II
Fort Worth, TX · On-site
$61K - $98K/yr
The Itemization Review Nurse provides a summary and analysis of items by reviewing all charges on a ... R. as an R.N. * Associate Degree in Nursing or higher * Experience in medical bill auditing ...
Itemization Review Nurse II
Fort Worth, TX · On-site
$61K - $98K/yr
The Itemization Review Nurse provides a summary and analysis of items by reviewing all charges on a ... R. as an R.N. * Associate Degree in Nursing or higher * Experience in medical bill auditing ...
Itemization Review Nurse II
Fort Worth, TX · On-site
$61K - $98K/yr
The Itemization Review Nurse provides a summary and analysis of items by reviewing all charges on a ... R. as an R.N. * Associate Degree in Nursing or higher * Experience in medical bill auditing ...
Itemization Review Nurse II
Fort Worth, TX · On-site
$61K - $98K/yr
The Itemization Review Nurse provides a summary and analysis of items by reviewing all charges on a ... R. as an R.N. * Associate Degree in Nursing or higher * Experience in medical bill auditing ...
Itemization Review Nurse II
Fort Worth, TX · On-site
$61K - $98K/yr
The Itemization Review Nurse provides a summary and analysis of items by reviewing all charges on a ... R. as an R.N. * Associate Degree in Nursing or higher * Experience in medical bill auditing ...
Itemization Review Nurse II
Fort Worth, TX · On-site
$61K - $98K/yr
The Itemization Review Nurse provides a summary and analysis of items by reviewing all charges on a ... R. as an R.N. * Associate Degree in Nursing or higher * Experience in medical bill auditing ...
Itemization Review Nurse II
Fort Worth, TX · On-site
$61K - $98K/yr
The Itemization Review Nurse provides a summary and analysis of items by reviewing all charges on a ... R. as an R.N. * Associate Degree in Nursing or higher * Experience in medical bill auditing ...
Itemization Review Nurse II
Fort Worth, TX · On-site
$61K - $98K/yr
The Itemization Review Nurse provides a summary and analysis of items by reviewing all charges on a ... R. as an R.N. * Associate Degree in Nursing or higher * Experience in medical bill auditing ...
Itemization Review Nurse II
Fort Worth, TX · On-site
$61K - $98K/yr
The Itemization Review Nurse provides a summary and analysis of items by reviewing all charges on a ... R. as an R.N. * Associate Degree in Nursing or higher * Experience in medical bill auditing ...
Itemization Review Nurse II
Fort Worth, TX · Remote
$61K - $98K/yr
The Itemization Review Nurse provides a summary and analysis of items by reviewing all charges on a ... R. as an R.N. * Associate Degree in Nursing or higher * Experience in medical bill auditing ...
Itemization Review Nurse II
Fort Worth, TX · Remote
$61K - $98K/yr
The Itemization Review Nurse provides a summary and analysis of items by reviewing all charges on a ... R. as an R.N. * Associate Degree in Nursing or higher * Experience in medical bill auditing ...
Itemization Review Nurse I
Fort Worth, TX · Remote
$52K - $85K/yr
The Itemization Review Nurse provides a summary and analysis of items by reviewing all charges on a ... R. as an R.N. * Associate Degree in Nursing or higher * Experience in medical bill auditing ...
Itemization Review Nurse I
Fort Worth, TX · Remote
$52K - $85K/yr
The Itemization Review Nurse provides a summary and analysis of items by reviewing all charges on a ... R. as an R.N. * Associate Degree in Nursing or higher * Experience in medical bill auditing ...
Itemization Review Nurse II
Fort Worth, TX · Remote
$61K - $98K/yr
The Itemization Review Nurse provides a summary and analysis of items by reviewing all charges on a ... R. as an R.N. * Associate Degree in Nursing or higher * Experience in medical bill auditing ...
Itemization Review Nurse II
Fort Worth, TX · Remote
$61K - $98K/yr
The Itemization Review Nurse provides a summary and analysis of items by reviewing all charges on a ... R. as an R.N. * Associate Degree in Nursing or higher * Experience in medical bill auditing ...
Itemization Review Nurse I
Fort Worth, TX · Remote
$52K - $85K/yr
The Itemization Review Nurse provides a summary and analysis of items by reviewing all charges on a ... R. as an R.N. * Associate Degree in Nursing or higher * Experience in medical bill auditing ...
Quick apply
Itemization Review Nurse I
Fort Worth, TX · Remote
$52K - $85K/yr
The Itemization Review Nurse provides a summary and analysis of items by reviewing all charges on a ... R. as an R.N. * Associate Degree in Nursing or higher * Experience in medical bill auditing ...
Review Associate information
What is a review associate?
Review Associates are professionals responsible for evaluating and assessing documents, applications, or data to ensure accuracy, compliance, and completeness. They often work in industries such as finance, healthcare, law, or publishing, where thorough review processes are critical. Their duties typically include identifying errors, verifying information, and preparing reports or feedback for further action. Review Associates play a key role in maintaining quality standards and supporting decision-making within their organizations.
What are the key skills and qualifications needed to thrive as a review associate, and why are they important?
To thrive as a Review Associate, you need strong analytical abilities, attention to detail, and a relevant bachelor's degree, often in fields like business, finance, or the sciences. Familiarity with data management tools, workflow tracking systems, and industry-specific software such as Microsoft Excel or review platforms is typically required. Excellent communication, critical thinking, and time management skills help you excel in evaluating materials and collaborating with team members. These competencies ensure thorough, accurate reviews and contribute to maintaining quality standards and efficient operations.
What are some common challenges faced by review associates, and how can they be successfully managed?
Review Associates often work with large volumes of data or documents under strict deadlines, which can be challenging when maintaining accuracy and attention to detail. Managing these challenges typically involves developing strong organizational skills, mastering review tools and software, and collaborating closely with team members to balance workloads. Regular communication with supervisors and peers can help clarify expectations and prioritize tasks, while proactively seeking feedback supports continuous improvement. Embracing these strategies can lead to greater efficiency and success in the role.
How do I become a review associate?
To become a review associate, candidates typically need a high school diploma or equivalent and strong attention to detail. Relevant skills include good communication, analytical thinking, and familiarity with review or content moderation tools; some positions may require prior experience in customer service or quality assurance. Job requirements vary by employer but generally involve evaluating content or products according to company guidelines.
What are the most commonly searched types of Review jobs in Texas?
The most popular types of Review jobs in Texas are:
What cities in Texas are hiring for Review Associate jobs?
Cities in Texas with the most Review Associate job openings:
Utilization Review Nurse Health Plans - HP Utilization Management
Irving, TX • On-site
Full-time
Re-posted 15 days ago
CHRISTUS Health rating
6.7
Based on 531 frontline employees who took The Breakroom Quiz
531st of 888 rated healthcare providers
Job description
Summary:
The Utilization Review Nurse is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services. This nurse is responsible for performing a variety of pre-admission, concurrent, and retrospective UM related reviews and functions. They must competently and accurately utilize approved screening criteria (InterQual/MCG/Centers for Medicare and Medicaid Services "CMS" Inpatient List). They effectively and efficiently manage a diverse workload in a fast-paced, rapidly changing regulatory environment and are responsible for maintaining current and accurate knowledge regarding commercial and government payors and guidelines related to UM. This nurse effectively communicates with internal and external clinical professionals, efficiently organizes the financial insurance care of the patients, and relays clinical data to insurance providers and vendors to obtain approved certification for services. The Utilization Review Nurse collaborates as necessary with other members of the health care team to ensure the above according to the mission of CHRISTUS.
Responsibilities:
Job Requirements:
Education/Skills
Experience
Licenses, Registrations, or Certifications
Work Schedule:
5 Days - 8 Hours
Work Type:
Full Time
The Utilization Review Nurse is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services. This nurse is responsible for performing a variety of pre-admission, concurrent, and retrospective UM related reviews and functions. They must competently and accurately utilize approved screening criteria (InterQual/MCG/Centers for Medicare and Medicaid Services "CMS" Inpatient List). They effectively and efficiently manage a diverse workload in a fast-paced, rapidly changing regulatory environment and are responsible for maintaining current and accurate knowledge regarding commercial and government payors and guidelines related to UM. This nurse effectively communicates with internal and external clinical professionals, efficiently organizes the financial insurance care of the patients, and relays clinical data to insurance providers and vendors to obtain approved certification for services. The Utilization Review Nurse collaborates as necessary with other members of the health care team to ensure the above according to the mission of CHRISTUS.
Responsibilities:
- Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
- The prior authorization role completes an assessment of a proposed service to determine if the beneficiary has eligible coverage for the service and if it is medically necessary.
- Promote quality, cost-effective outcomes through prior authorization and concurrent review of requested services for medical necessity based upon evidence-based clinical guidelines.
- Identify and present cases of possible quality of care deviations, questionable admissions, and prolonged lengths of stay to the Medical Director for further determination.
- Appropriately refer beneficiaries who have complex or chronic conditions, a need for transition of care, disease management support, or other identifiable needs for coordination of the beneficiary's member's health care for behavioral health care management.
- Follow CHRISTUS Health Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent, or detect unauthorized disclosure of Protected Health Information (PHI).
- Protect the confidentiality of data and intellectual property; assures compliance with national health information guidelines.
- Analyze clinical information submitted by medical providers to evaluate the medical necessity, appropriateness, and efficiency of the use of medical services, procedures, and facilities.
- Perform provider outreach to address post-hospital discharge services, redirection to in-network providers for appropriate steerage, durable equipment usage, and utilization of other medical services and/or procedures and other necessary telephonic follow-up.
- Utilize the nursing process and critical thinking skills to provide oversight of services and evaluation of service options.
- Ability to work in a variety of settings with culturally diverse communities with the ability to be culturally sensitive and appropriate.
- Must have excellent communication skills (written and verbal), clinical judgment, initiative, critical thinking, and problem-solving abilities.
- Must be able to take after hour calls to meet business requirements as needed.
Job Requirements:
Education/Skills
- Graduate of an accredited school of vocational nursing or equivalent required
- Associate's (ADN) or Bachelor's (BSN) in Nursing preferred
Experience
- 3 - 5 years of nursing experience preferred
- Experience in Microsoft software (e.g., Outlook, Teams, Word, and Excel) required
- General computer knowledge and capability to use computers required
Licenses, Registrations, or Certifications
- LVN license in the state of employment or compact required
- RN license in state of employment or compact preferred
Work Schedule:
5 Days - 8 Hours
Work Type:
Full Time
What CHRISTUS Health employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About CHRISTUS Health
Sourced by ZipRecruiter
CHRISTUS Health is a prominent name in the healthcare industry, with its headquarters situated in Irving, TX, USA. Established in 1999, the company has since been devoted to providing comprehensive care and extending the healing ministry of Jesus Christ. This not-for-profit health system primarily operates more than 600 healthcare services and programs, including long-term care facilities, health insurance products, community clinics, and outreach services, serving both urban and rural populations.
Industry
Outpatient health care
Company size
1,001 - 5,000 Employees
Headquarters location
Irving, TX, US
Year founded
1999