[Apply Now] RN Clinical Reviewer

Company: HCA Houston Healthcare Southeast
Location: Pasadena
Posted on: July 2, 2025

Job Description:

Job Description Description Introduction Do you have the career opportunities as a(an) RN Clinical Reviewer you want with your current employer? We have an exciting opportunity for you to join HCA Houston Healthcare Southeast which is part of the nation's leading provider of healthcare services, HCA Healthcare. Benefits HCA Houston Healthcare Southeast, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: - Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. - Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. - Free counseling services and resources for emotional, physical and financial wellbeing - 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) - Employee Stock Purchase Plan with 10% off HCA Healthcare stock - Family support through fertility and family building benefits with Progyny and adoption assistance. - Referral services for child, elder and pet care, home and auto repair, event planning and more - Consumer discounts through Abenity and Consumer Discounts - Retirement readiness, rollover assistance services and preferred banking partnerships - Education assistance (tuition, student loan, certification support, dependent scholarships) - Colleague recognition program - Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) - Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. Learn more about Employee Benefits Note: Eligibility for benefits may vary by location. Our teams are a committed, caring group of colleagues. Do you want to work as a(an) RN Clinical Reviewer where your passion for creating positive patient interactions is valued? If you are dedicated to caring for the well-being of others, this could be your next opportunity. We want your knowledge and expertise! Job Summary and Qualifications The RN Clinical Reviewer conducts a comprehensive current review of clinical documentation within the medical record to achieve, accurate and detailed documentation. Appropriate provider documentation for clinically indicated conditions or procedures, supports appropriate assignment of severity of illness, expected risk of mortality, intensity of service and resource consumption, which in return accurately, portrays the facilities, quality, outcome, ratings, reduces compliance risks, and captures appropriate reimbursement. What you will do in this role: - Reviews medical records and identify potential gaps in clinical documentation for specified facilities, patient types and payer populations, as directed on admission and throughout the hospitalization. - Performs initial concurrent review of assigned population, consistent with facility, division, or corporate program volume and frequency requirements. - Performs follow up reviews consistent with facility, division or corporate program volume frequency requirements. - Ensure the appropriate documentation of the principal diagnosis, complications or co-morbid conditions, and or valid OR procedures, including the capture of POA indicators. - Ensures, documented conditions, clarifications, and coded diagnosis are clinically supported. - Documents reviews, and other pertinent information in designated systems by established deadlines. - Uses clinical judgment to determine when and or if additional documentation is necessary. - Performs the medical record review for conflicting, imprecise, incomplete, illegible, or inconsistent documentation by requesting and obtaining additional documentation within the health record when appropriate. - Interacts with physicians to complete/resolve queries prior to patient’s discharge. What qualifications you will need: - Current RN license required with Critical Care, OR, ER experience preferred - 5-7 years relevant work experience - Preferred experience in Case Management, HIM/coding, related experience in Acute Inpatient setting HCA Houston Healthcare Southeast is a full-service 340 bed acute care hospital in Pasadena, Texas. We have been a leader of medical care in Pasadena for more than 50 years. With board-certified physicians, registered nurses and expert technicians, the community has come to rely on us for top-quality, comprehensive and compassionate healthcare. HCA Houston Southeast is the only hospital in Pasadena with both Chest Pain Center Accreditation with Primary PCI and Resuscitation by the American College of Cardiology and full accreditation by The Joint Commission on the Accreditation of Healthcare Organizations. We are members of HCA Houston Healthcare, the most comprehensive family of hospitals in the region and part of the leading provider of healthcare in the country, HCA Healthcare. Together we are stronger, smarter and more accessible in providing the patient-centered care you need close to home. HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. "Bricks and mortar do not make a hospital. People do."- Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Registered Nurse Case Manager opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. Unlock the possibilities and apply today! We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

Keywords: HCA Houston Healthcare Southeast, Baytown , [Apply Now] RN Clinical Reviewer, Healthcare , Pasadena, Texas