Healthcare

Clinical Reviewer, Utilization Management (SEGUIN)

Explore this opportunity from the hiring employer

University Health 531 W Court St, Seguin, TX 78155
Job typeOther PostedAug 28, 2026 Apply bySep 27, 2026

Applications open

You will first verify your request and provide contact information to RightJobsNow. You will then be redirected to the employer or recruitment partner’s application website. Providing information here does not submit a job application.Contact information is optional; after verification, you may skip directly to the application site.

Verify you are human

Complete this verification to continue to the contact form.

About this position



Is this the role you are looking for If so read on for more details, and make sure to apply today.

POSITION SUMMARY/RESPONSIBILITIES

Assists Community First Health Plan (CFHP) members regain optimum health or improved functional capacity by ensuring that members have access to all of the health care services they need in the most efficient and effective manner possible. Responsibilities include but are not limited to overseeing the allocation of resources, cost and quality of health care for members; coordinating care between the primary care physician, community resources, family and member; coordinating care across the health care continuum while monitoring and managing benefit utilization; and, collaborating with multi-disciplinary health care team members in identifying the educational and discharge needs of members.



EDUCATION/EXPERIENCE

Registered Nurse (RN) is required. Bachelor of Science in Nursing (BSN) or Master’s degree is preferred. Minimum three (3) years nursing, acute care, quality management or managed care experience is required. Basic knowledge of Medicaid, Medicare, community resources and alternate funding programs is desired. Knowledge of InterQual screening criteria as well as DRG, ICD and CPT coding is preferred.



LICENSURE/CERTIFICATION

Current licensure as a Registered Nurse with the Texas State Board of Nurse Examiners is required. xhmxlyz Current certification from an appropriate professional agency, such as Case Management Society, is preferred.


Location and commute

531 W Court St, Seguin, TX 78155.

Plan your route with Google Maps. Travel times and transportation options vary; confirm the work location with the employer before commuting.

How to apply

Review the vacancy and complete the application on the employer or recruitment partner’s website. Requisition ID: WJ-3014549807.