Utilization Review RN

commonspirit· Care Management
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OTHER

About this role

Where You’ll Work

Baylor St. Luke’s Medical Center is an 881-bed quaternary care academic medical center that is a joint venture between Baylor College of Medicine and CHI St. Luke’s Health. Located in the Texas Medical Center, the hospital is the home of the Texas Heart® Institute, a cardiovascular research and education institution founded in 1962 by Denton A. Cooley, MD. The hospital was the first facility in Texas and the Southwest designated a Magnet® hospital for Nursing Excellence by the American Nurses Credentialing Center, receiving the award five consecutive times. Baylor St. Luke’s also has three community emergency centers offering adult and pediatric care for the Greater Houston area.

Job Summary and Responsibilities

As our Utilization Management Professional, you will be a critical guardian of healthcare efficiency and quality, ensuring integrity in clinical decision-making, regulatory compliance, and responsible resource utilization.Every day, you will meticulously review medical records, authorize services, and prepare cases for physician review in partnership with UM teams. You'll monitor patient care for appropriateness, quality, and cost-effectiveness, aligning decisions with established criteria.To be successful in this role, you will possess a strong clinical background, deep UM/regulatory knowledge, and exceptional analytical/organizational skills. Your ability to manage charts, apply criteria precisely, and communicate effectively with enthusiasm, efficiency, and empathy is paramount for optimal patient care and operational flow.
  • Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted based on established criteria and critical thinking.
  • Reviews include admission, concurrent and post discharge for appropriate status determination.
  • Ensures compliance with principles of utilization review, hospital policies and external regulatory agencies, Peer Review Organization (PRO), Joint Commission, and payer defined criteria for eligibility.
  • Reviews the records for the presence of accurate patient status orders and addresses deficiencies with providers.
  • Ensures timely communication and follow up with physicians, payers, Care Coordinators and other stakeholders regarding review outcomes.
  • Collaborates with facility RN Care Coordinators to ensure progression of care.

Job Requirements

Required
  • Diploma Of Nursing Graduate of an accredited school of nursing, upon hire and
  • Minimum two (2) years of acute hospital clinical experience , upon hire or
  • Registered Nurse: TX, upon hire and
Preferred
  • Bachelors Of Nursing Bachelor's Degree in Nursing (BSN) or related healthcare field. , upon hire
  • At least five (5) years of nursing experience., upon hire
  • Certified Case Manager, upon hire or
  • Accredited Case Manager, upon hire or

Frequently Asked Questions

Is the salary disclosed for the Utilization Review RN position at commonspirit?
The salary for this Utilization Review RN role at commonspirit is not publicly listed. Click "Apply Now" to learn more about the compensation package on their official careers page.
Is the Utilization Review RN role at commonspirit full-time or part-time?
This is listed as a OTHER position. It is posted as a Utilization Review RN role in the Care Management department at commonspirit.
Which team or department does the Utilization Review RN at commonspirit belong to?
This Utilization Review RN position is part of the Care Management department at commonspirit. See the full job description for more information about the team structure and responsibilities.
How do I apply for the Utilization Review RN position at commonspirit?
Click the "Apply Now" button on this page. You will be redirected to commonspirit's official application portal hosted on icims where you can submit your application directly.
When was the Utilization Review RN job at commonspirit posted?
This Utilization Review RN position at commonspirit was posted on Jul 27, 2026. Apply as soon as possible — early applications are often reviewed first.
Utilization Review RN
commonspirit
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