Description
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.
Functional Title: Utilization Review Nurse
Job Title: Nurse II
Agency: Health & Human Services Comm
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
Additional Shift:
Telework:
Travel: Up to 10%
Regular/Temporary: Regular
Full Time/Part Time: Full time
FLSA Exempt/Non-Exempt: Exempt
Facility Location:
Job Location City: BRENHAM
Job Location Address: 2248 S MARKET ST
Other Locations: Austin
MOS Codes: 290X,46AX,46FX,46NX,46PX,46SX,46YX,66B,66C,66E,66F,66G,66H,66N,66P,66R,66S,66T,66W
Brief Job Description
The Medicaid Hospice Utilization Review Nurse reviews and evaluates medical records, assigned medical necessity documents, along with other documentation to support program eligibility and utilization of the Medicaid Hospice program. The Hospice UR nurse uses program knowledge of Medicaid program eligibility requirements and service requirements, state and federal rules, and agency policies. The UR nurse conducts desk reviews to validate eligibility, appropriateness of screening, active services and quality of care as reflected by the choice of services provided, type of staff utilized, and delivery/ implementation and documentation of services provided. The UR nurse participates in hearings, produces data and information for program quality assurance and improvement, provides resources, direction and technical assistance to HHSC employees, private and public stakeholders and other entities as directed. This position works under the general supervision of the Hospice Utilization Review Manager with latitude for initiative and independent judgment. Performs other duties as assigned.
Essential Job Functions
Reviews physician narratives, medical records and other supporting documentation to determine program eligibility at the time of service delivery 20%.
Reviews, evaluates, and documents Medicaid Hospice services provided to Medicaid eligible individuals 10%.
Participates in quality assurance reviews and quality improvement studies and evaluates compliance with Medicaid Program requirements, state rules, regulations, policies and procedures 5%.
Works collaboratively with various agency units and stakeholders 5%.
Ensures UR policies and procedures are applied consistently 5%.
Develops and provides resources to providers, respond internal and external correspondence, evaluate unit, policy or rule changes proposed, develop and maintain policy and procedure for UR reviews 5%.
Work involves conducting in-depth analysis of paid service claims 10%
Composing written responses to agency staff, providers, and advocates 10%
Interpreting Texas Medicaid and state program rules, regulations, policies, and procedures 10%
Conducts research to resolve and track issues and problems 5%.
Participate and facilitate in workgroups charged with developing and revising policy and operational changes and provide relevant program information to ensure that suggestions for developing and changing policy and operations are addressed 5%.
Write summaries and reports 10%.
Performs other duties as assigned. Attends work on a regular and predictable schedule.
Licensure 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 and practices 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 in a clear, concise manner, using correct grammar and punctuation.
Ability to make oral
presentations.
Intitial 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.
BSN or higher preferred.
Review our Tips for Success when applying for jobs at DFPS, DSHS and HHSC.
Active Duty, Military, Reservists, Guardsmen, and Veterans:
Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to those listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor's Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditor's Office - Job Descriptions.
ADA Accommodations:
In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.
Pre-Employment Checks and Work Eligibility:
Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks.
HHSC uses E-Verify. You must bring your I-9 documentation with you on your first day of work. Download the I-9 Form
Telework Disclaimer:
This position may be eligible for telework. Please note, all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business needs.
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