Job Description

Date: Mar 10, 2026 Location:

BRENHAM, TX

Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. At HHSC, your contributions matter, and we support you at each stage of your life and work journey. Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more. Explore more details on the Benefits of Working at HHS webpage. Overview Functional Title: Utilization Review Nurse Job Title: Nurse II Agency: Health & Human Services Commission Department: UR Hospice Random Moment Study Posting Number: 14413 Closing Date: 05/09/2026 Posting Audience: Internal and External Occupational Category: Healthcare Practitioners and Technical Salary Range: $4,801.16 - $7,761.50 Pay Frequency: Monthly Salary Group: TEXAS-B-22 Shift: Day Telework: May be eligible (per policy); Travel: Up to 10% Regular/Temporary: Regular Full Time/Part Time: Full time FLSA: Exempt Facility Location: BRENHAM, TX Responsibilities Reviews and evaluates medical records, assigned medical necessity documents, and other documentation to support program eligibility and utilization of the Medicaid Hospice program. Uses program knowledge of Medicaid program eligibility requirements, state and federal rules, and agency policies; conducts desk reviews to validate eligibility, screening appropriateness, active services, quality of care, and service delivery documentation. Participates in hearings, produces data for program quality assurance and improvement, and provides resources, direction, and technical assistance to HHSC employees, private and public stakeholders, and other entities as directed. Works under the general supervision of the Hospice Utilization Review Manager with latitude for initiative and independent judgment. Performs other duties as assigned and attends work on a regular and predictable schedule. Essential Job Functions Review physician narratives, medical records, and other documentation to determine program eligibility at the time of service delivery (approx. 20%). Review, evaluate, and document Medicaid Hospice services provided to Medicaid eligible individuals (approx. 10%). Participate in quality assurance reviews and quality improvement studies; evaluate compliance with Medicaid program requirements, state rules, regulations, policies, and procedures (approx. 5%). Collaborate with various agency units and stakeholders (approx. 5%). Ensure UR policies and procedures are applied consistently (approx. 5%). Develop and provide resources to providers; respond to internal and external correspondence; evaluate unit or policy changes; develop and maintain UR policy and procedures (approx. 5%). Analyze paid service claims (approx. 10%). Compose written responses to agency staff, providers, and advocates (approx. 10%). Interpret Texas Medicaid and state program rules, regulations, policies, and procedures (approx. 10%). Conduct research to resolve and track issues and problems (approx. 5%). Participate in and facilitate workgroups for policy and operational changes; provide program information to address suggestions for policy changes. Write summaries and reports (approx. 10%). Performs other duties as assigned. Qualifications L icensure Requirements or Certifications: Must be licensed as a professional nurse (RN) in good standing in the state of Texas or a state that recognizes Licensure Compact. Knowledge, Skills, and Abilities: Knowledge of nursing techniques and procedures; health care laws, rules, and standards; accepted medical treatment patterns and practices; community and nursing procedures; quality management, utilization management and review principles for the elderly and disabled; Medicaid hospice program standards, policies and procedures, and oversight mechanisms for services to the elderly and disabled. Ability to write clearly and concisely with proper grammar and punctuation. Ability to make oral presentations. Initial Screening Criteria: Minimum 2 years in direct patient care. Experience conducting quality assurance or utilization review activities. Palliative Care or End of Life Experience: Preferred. Education: BSN or higher preferred. Other Requirements Active Duty, Military, Reservists, Guardsmen, And Veterans: Military occupations that relate to the initial selection criteria and licensure requirements may apply; all qualified veterans are encouraged to apply. ADA Accommodations: Reasonable accommodation available during the hiring process; contact HHSC. Pre-Employment Checks and Work Eligibility: Background checks may be required; HHSC uses E-Verify. Bring I-9 documentation on first day. Telework Disclaimer: This position may be eligible for telework per state and agency policies. Notes Tips for Success when applying for jobs at DFPS, DSHS and HHSC are provided in the posting. #J-18808-Ljbffr

Job Tags

Full time, Temporary work, Part time, Remote work, Shift work

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