Utilization Management Clinical Supervisor RN

Position: Utilization Management Clinical Supervisor RN

Job ID: 402053

Location: US-TX-Houston

Department: Utilization Mgmt - Admin

Talent Area: Registered Nurse

Full/Part Time: Full time

Regular/Temporary: Regular

Shift: 9a-6p

About Texas Children's Hospital

Since 1954, Texas Children’s has been leading the charge in patient care, education and research to accelerate health care for children and women around the world. When you love what you do, it truly shows in the smiles of our patient families, employees and our numerous accolades such as being consistently ranked as the best children’s hospital in Texas, and among the top in the nation by U.S.News & World Report as well as recognition from Houston Business Journal as one of this city’s Best Places to Work for ten consecutive years.

Texas Children’s comprehensive health care network includes our primary hospital in the Texas Medical Center with expertise in over 40 pediatric subspecialties; the Jan and Dan Duncan Neurological Research Institute (NRI); the Feigin Center for pediatric research; Texas Children’s Pavilion for Women, a comprehensive obstetrics/gynecology facility focusing on high-risk births; Texas Children’s Hospital West Campus, a community hospital in suburban West Houston; and Texas Children’s Hospital The Woodlands, the first hospital devoted to children’s care for communities north of Houston. We have also created the nation’s first HMO for children, established the largest pediatric primary care network in the country and a global health program that is channeling care to children and women all over the world. Texas Children’s Hospital is also academically affiliated with Baylor College of Medicine, one of the largest, most diverse and successful pediatric programs in the nation.

To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.

Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.



Being fully vaccinated against COVID-19, including any booster dose(s) of the COVID-19 vaccine recommended by the Centers for Disease Control when eligible, is required for all employees at Texas Children’s, unless approved for a medical or religious exemption.


  • Bachelor’s, associate’s, or diploma in nursing
  • RN license with the Texas Board of Nursing
  • 3 years of licensed nursing experience
  • 5 years of utilization management experience
  • Strongly Preferred: BSN and 8+ years of nursing experience



· Plan, develop, organize, direct, and implement a coordinated approach to the training of new staff and updating existing staff

· Provide an analysis of authorization errors presented for review by the claims department

· Coordinate activities of the appeals, complaints and fair hearing processes in a manner which adheres to IDS TCHP and other regulatory requirements

· Support the delivery of utilization management services by understanding job functions of the unit and serving as a backup when staffing issues arise

· Identify training opportunities and develop training curriculum in collaboration with manager and education department

· Monitor appropriate work queues regularly for tracking appeals and fair hearing information, review and prep data as needed in preparation for appeal reviews and fair hearing meetings, assist in the coordination of fair hearing activities

· Maintain current knowledge and contacts related to initial and concurrent review functions

· Identify and develop specific programs and create educational training for staff in areas defined by trended data

· Design and implement quality audits for clinical application of guidelines by reviewers and process improvement projects







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