Utilization Mgmt Clinical RN

Texas Children's Medical Center · Bellaire, TX Full Time

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Job Description

Description We’re searching for a Utilization Management Clinical Registered Nurse, someone who works well in a fast-paced setting. In this position, you’ll be responsible for providing precertification of inpatient hospitalizations and all outpatient procedures and services requiring authorization, and performing telephonic and/or concurrent review of inpatient hospitalizations and extended courses of outpatient treatment. Think you’ve got what it takes? Job Duties & Responsibilities Analyzes unique situation of request, identifying appropriate guideline and regulatory requirements for each request Applies clinical decision making to assessment of clinical acuity and appropriateness of suggested treatment/services Creates a case summary evaluation for requests failing medical necessity criteria, and has collaborative discussion with the medical director or designee for review and disposition Researches clinical guidelines for potential investigative service requests, researches weekly changes to Medicaid manual to assure coverage determinations, and maintains currency of clinical guideline elements Ensures the timeliness of all denial letters within the regulations mandated Creates communication pieces to providers, which meet accrediting and regulatory guidelines for clinical content and readability levels describing decision making rationale for service requests and notifies providers through written correspondence Collaborates with all disciplines within the health plan to meet goals and objectives meeting with contracting and provider relations on routine basis Screens, identifies, and refers potential members to case management and evaluation for programs or coverage Identifies potential quality of care issues, and/or fraud and abuse, and refers to appropriate department As part of our commitment to maintaining a safe and healthy workplace, all successful candidates will be required to undergo respiratory fit testing in compliance with occupational health and safety standards. Skills & Requirements Diploma in nursing required or Associates degree in nursing or an associate’s degree in a related field accepted by the Texas Board of Nursing for the purposes of obtaining and maintaining an RN license required or Bachelor's degree in nursing preferred RN - Lic-Registered Nurses by Texas Board of Nursing or Nursing Licensure Compact required 3 years of nursing experience required

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What Most Job Listings Don’t Tell You

General overview for this role type — specific duties and requirements vary by employer.

Nursing roles in senior living are fundamentally different from hospital nursing. Most positions involve building long-term relationships with the same residents over months or years rather than cycling through new patients every shift. Facilities in the Houston area typically require an active Texas RN or LVN license, current CPR/BLS certification, and many prefer at least one year of geriatric or long-term care experience.

Shift patterns vary widely — some facilities run traditional 8-hour shifts (day, evening, night), while others use 12-hour rotations. Weekend and holiday coverage is almost always part of the schedule. The nurse-to-resident ratio in assisted living is generally more favorable than in hospitals, but you will likely be the highest-level clinical staff on the floor during your shift, which means more autonomy and more responsibility for clinical judgment calls.

What to Expect in This Role Day-to-Day

Based on typical senior living facilities in the Houston area.

A typical shift starts with medication pass and resident assessments. You will review overnight notes from the previous shift, check vitals for residents on your watch list, and coordinate with CNAs on any changes in condition. Mid-shift usually involves documentation, family communication, and working with physicians on care plan updates — often by phone or telehealth rather than in-person rounds.

Depending on the facility, you may also handle admissions paperwork, manage wound care, supervise medication techs, and respond to emergencies. The documentation load in senior living is significant — state surveys and compliance requirements mean thorough charting is non-negotiable. Many nurses in this setting say the most rewarding part is knowing their residents personally and being able to notice subtle changes that a rotating hospital nurse might miss.

Houston Area Salary Data

According to the Bureau of Labor Statistics, Registered Nurse positions in the Houston metro area earn a median wage of $48.00/hr ($99,840/yr). The typical range is $39.37 – $55.77/hr (25th–75th percentile).

Entry Level (10th) $74,859/yr

Houston Median $99,840/yr

Experienced (90th) $130,437/yr

vs. National Median +2.3%

Source: Bureau of Labor Statistics, Occupational Employment & Wage Statistics (Houston-Pasadena-The Woodlands, TX Metro Area). Salary data provided by Houston Senior Living Guide.