ZipRecruiter

Log In

1

Apprentice Utilization Management Nurse Jobs in Texas

Harris Health System

BH Utilization Manager RN

Houston, TX · On-site

$67K - $85K/yr

We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of ... Behavioral Health Utilization Manager will perform concurrent and discharge reviews on assigned ...

Medix

Utilization Management Manager

Houston, TX · On-site

$57/hr

Job Summary Our client is seeking a Utilization Management Manager to review clinical documentation ... Registered Nurse license by Texas Board of Nursing or Nursing Licensure Compact required (must have ...

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

Provides information regarding utilization management requirements and operational procedures to ... Registered Nurse (RN) with a valid, current, unrestricted license in the state of operations. * 3 ...

next page

Showing results 1-20

All JobsApprentice Utilization Management Nurse JobsApprentice Utilization Management Nurse Jobs in Texas

Apprentice Utilization Management Nurse information

See Texas salary details

$36.3K

$83.4K

$151.9K

How much do apprentice utilization management nurse jobs pay per year?

As of Sep 7, 2026, the average yearly pay for apprentice utilization management nurse in Texas is $83,367.00, according to ZipRecruiter salary data. Most workers in this role earn between $60,100.00 and $97,400.00 per year, depending on experience, location, and employer.

What is an apprentice utilization management nurse?

An Apprentice Utilization Management Nurse is a nursing professional in training who assists with the review and evaluation of healthcare services to ensure they are medically necessary and cost-effective. They work under the supervision of experienced utilization management nurses and follow established guidelines to assess patient care plans, medical records, and insurance policies. Their role is crucial in helping healthcare organizations maintain quality care while managing costs, and they may interact with physicians, patients, and insurance companies to clarify or justify treatment decisions. As apprentices, they are gaining hands-on experience to develop their skills and knowledge in utilization management.

What are the key skills and qualifications needed to thrive as an apprentice utilization management nurse, and why are they important?

To thrive as an Apprentice Utilization Management Nurse, you need a foundational understanding of nursing principles, strong analytical skills, and typically an RN license or progression toward one. Familiarity with utilization management software, electronic health records (EHR), and knowledge of insurance guidelines such as Medicare or Medicaid are often required. Attention to detail, critical thinking, and effective communication are essential soft skills for collaborating with healthcare teams and conveying clinical information. These competencies ensure accurate patient care reviews, compliance with regulations, and effective support in healthcare cost management.

What are some common challenges faced by apprentice utilization management nurses, and how can they be addressed?

Apprentice Utilization Management Nurses often encounter challenges such as learning to interpret complex medical records, understanding insurance policies, and adhering to strict regulatory guidelines. Balancing patient advocacy with cost-effective care decisions can also be demanding. These challenges can be addressed by actively participating in mentorship programs, seeking regular feedback from experienced colleagues, and utilizing ongoing training resources provided by employers. Developing strong communication and organizational skills will also help manage the workload and foster effective collaboration with physicians, case managers, and insurance representatives.

What is the difference between Apprentice Utilization Management Nurse vs Utilization Management Nurse?

AspectApprentice Utilization Management NurseUtilization Management Nurse
CredentialsLicensed RN, in training or early certification stageLicensed RN with certification in utilization review
Work EnvironmentSupervised training setting, often in healthcare or insurance companiesIndependent review in healthcare or insurance organizations
Job ResponsibilitiesAssisting with case reviews, learning utilization review processesConducting case assessments, making coverage decisions

The Apprentice Utilization Management Nurse is in training, focusing on learning review procedures under supervision, while the Utilization Management Nurse is fully qualified, responsible for independent case evaluations and decision-making. The apprentice role is a stepping stone toward becoming a licensed Utilization Management Nurse.

What are the most commonly searched types of Utilization Management Nurse jobs in Texas?

The most popular types of Utilization Management Nurse jobs in Texas are:

What cities in Texas are hiring for Apprentice Utilization Management Nurse jobs?

Cities in Texas with the most Apprentice Utilization Management Nurse job openings:

Apprentice Utilization Management Nurse jobs near you
Infographic showing various Apprentice Utilization Management Nurse job openings in Texas as of August 2026, with employment types broken down into 8% As Needed, 84% Full Time, and 8% Contract. Highlights an 75% In-person, and 25% Remote job distribution, with an average salary of $83,367 per year, or $40.1 per hour.

Utilization Management Nurse II - Case Management - Full Time

CHRISTUS Health

Beaumont, TX • On-site

Full-time

Re-posted 17 days ago

CHRISTUS Health rating

6.7

Company rating: 6.7 out of 10

Based on 534 frontline employees who took The Breakroom Quiz

534th of 898 rated healthcare providers

Job description

Summary:
The Utilization Management Nurse II is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services. This Nurse is responsible for performing a variety of pre-admission, concurrent, and retrospective UM related reviews and functions. They must competently and accurately utilize approved screening criteria (InterQual/MCG/Centers for Medicare and Medicaid Services "CMS" Inpatient List). They effectively and efficiently manage a diverse workload in a fast-paced, rapidly changing regulatory environment and are responsible for maintaining current and accurate knowledge regarding commercial and government payors and Joint Commission regulations and guidelines related to UM. This Nurse effectively communicates with internal and external clinical professionals, efficiently organizes the financial insurance care of the patients, and relays clinical data to insurance providers and vendors to obtain approved certification for services. The Utilization Management Nurse collaborates as necessary with other members of the health care team to ensure the above according to the mission of CHRISTUS.
Responsibilities:
  • Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
  • Applies demonstrated clinical competency and judgment in order to perform comprehensive assessments of clinical information and treatment plans and apply medical necessity criteria in order to determine the appropriate level of care.
  • Resource/Utilization Management appropriateness: Assess assigned patient population for medical necessity, level of care, and appropriateness of setting and services. Utilizes MCG/InterQual Care Guidelines and/or health system-approved tools to track impact and variance.
  • Uses appropriate criteria sets for admission reviews, continued stay reviews, outlier reviews, and clinical appropriateness recommendations.
  • Coordinate and facilitate correct identification of patient status.
  • Analyze the quality and comprehensiveness of documentation and collaborate with the physician and treatment team to obtain documentation needed to support the level of care.
  • Facilitates joint decision-making with the interdisciplinary team regarding any changes in the patient status and/or negative outcomes in patient responses.
  • Demonstrates, maintains, and applies current knowledge of regulatory requirements relative to the work process in order to ensure compliance, i.e. IMM, Code 44.
  • Demonstrate adherence to the CORE values of CHRISTUS.
  • Utilize independent scope of practice to identify, evaluate and provide utilization review services for patients and analyze information supplied by physicians (or other clinical staff) to make timely review determinations, based on appropriate criteria and standards.
  • Take appropriate follow-up action when established criteria for utilization of services are not met.
  • Proactively refer cases to the physician advisor for medical necessity reviews, peer-to-peer reviews, and denial avoidance.
  • Effectively collaborate with the Interdisciplinary team including the Physician Advisor for secondary reviews.
  • Proactively review patients at the point of entry, prior to admission, to determine the medical necessity of a requested hospitalization and the appropriate level of care or placement for the patient.
  • Review surgery schedule to ensure planned surgeries are ordered in the appropriate status and that necessary authorization has been obtained as required by the payor or regulatory guidance (i.e., CMS Inpatient Only List, Payor Prior Authorization matrix, etc.)
  • Regularly review patients who are in the hospital in Observation status to determine if the patient is appropriate for discharge or if conversion to inpatient status is appropriate.
  • Proactively identify and resolve issues regarding clinical appropriateness recommendations, coverage, and potential or actual payor denials.
  • Maintain consistent communication and exchange of information with payors as per payor or regulatory requirements to coordinate certification of hospital services.
  • Coordinate and facilitate patient care progression throughout the continuum and communicate and document to support medical necessity at each level of care.
  • Evaluate care administered by the interdisciplinary health care team and advocate for standards of practice.
  • Analyze assessment data to identify potential problems and formulate goals/outcomes.
  • Follows the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability ACT (HIPPA) designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI).
  • Attend scheduled department staff meetings and/or interdepartmental meetings as appropriate.
  • Possesses and demonstrates technology literacy and the ability to work in multiple technology systems.
  • Act as a catalyst for change in the organization; respond to change with flexibility and adaptability; demonstrate the ability to work together for change.
  • Translate strategies into action steps; monitor progress and achieve results.
  • Demonstrate the confidence, drive, and ability to face and overcome challenges and obstacles to achieve organizational goals.
  • Demonstrate competence to perform assigned responsibilities in a manner that meets the population-specific and developmental needs of patients served by the department.
  • Possess negotiating skills that support the ability to interact with physicians, nursing staff, administrative staff, discharge planners, and payers.
  • Excellent verbal and written communication skills, knowledge of clinical protocol, normative data, and health benefit plans, particularly coverage and limitation clauses.
  • Must adjust to frequently changing workloads and frequent interruptions.
  • May be asked to work overtime or take calls.
  • May be asked to travel to other facilities to assist as needed.
  • Actively participates in Multidisciplinary/Patient Care Progression Rounds.
  • Escalates cases as appropriate and per policy to Physician Advisors and/or CM Director.
  • Documents in the medical record per regulatory and department guidelines.
  • May be asked to assist with special projects.
  • May serve as a preceptor or orienter to new associates.
  • Assumes responsibility for professional growth and development.
  • Familiarity with criteria sets including InterQual and MCG preferred.
  • Must have excellent verbal and written communication and ability to interact with diverse populations.
  • Must have critical and analytical thinking skills.
  • Must have demonstrated clinical competency.
  • Must have the ability to Multitask and to function in a stressful and fast-paced environment.
  • Must have working knowledge of discharge planning, utilization management, case management, performance improvement, and managed care reimbursement.
  • Must have an understanding of pre-acute and post-acute levels of care and community resources.
  • Must have the ability to work independently and exercise sound judgment in interactions with physicians, payors, patients, and their families.
  • Must have an understanding of internal and external resources and knowledge of available community resources.
  • Other duties as assigned.

Job Requirements:
Education/Skills
  • Graduate of an accredited School of Nursing OR demonstrated success in the Utilization Management Nurse I role for at least five years at CHRISTUS Health on top of required experience in lieu of education required.

Experience
  • Two or more years of clinical experience with at least one year in the acute care setting OR demonstrated success as Utilization Management Nurse I role at CHRISTUS Health required.

Licenses, Registrations, or Certifications
  • RN License in state of employment or compact required.
  • LPN or LVN license accepted for associates with 5+ years of demonstrated success and experience in the Utilization Management Nurse I role at CHRISTUS Health.
  • Certification in Case Management preferred.
  • BLS preferred.

Work Schedule:
8AM - 5PM Monday-Friday
Work Type:
Full Time

What CHRISTUS Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

CHRISTUS Health logo

About CHRISTUS Health

Sourced by ZipRecruiter

CHRISTUS Health is a prominent name in the healthcare industry, with its headquarters situated in Irving, TX, USA. Established in 1999, the company has since been devoted to providing comprehensive care and extending the healing ministry of Jesus Christ. This not-for-profit health system primarily operates more than 600 healthcare services and programs, including long-term care facilities, health insurance products, community clinics, and outreach services, serving both urban and rural populations.

Industry

Outpatient health care

Company size

1,001 - 5,000 Employees

Headquarters location

Irving, TX, US

Year founded

1999

View All CHRISTUS Health Jobs

Apply