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Discharge Planner Utilization Review Jobs in Dallas, TX

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

This position is responsible for performing initial, concurrent review activities; discharge care ... Provides information regarding utilization management requirements and operational procedures to ...

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How much do discharge planner utilization review jobs pay per hour?

As of May 28, 2026, the average hourly pay for discharge planner utilization review in Dallas, TX is $32.27, according to ZipRecruiter salary data. Most workers in this role earn between $22.84 and $38.75 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Discharge Planner Utilization Review, and why are they important?

To thrive as a Discharge Planner Utilization Review professional, you generally need a clinical background such as RN or social worker licensure, strong knowledge of discharge planning protocols, and familiarity with healthcare regulations. Proficiency with electronic health records (EHRs), case management software, and utilization review tools is typically required. Excellent communication, problem-solving, and organizational skills help in coordinating care and advocating for patient needs. These competencies ensure safe, efficient patient transitions and compliance with healthcare policies, ultimately optimizing patient outcomes and resource use.

How does a Discharge Planner Utilization Review professional collaborate with interdisciplinary teams to ensure effective patient transitions?

Discharge Planner Utilization Review professionals work closely with physicians, nurses, social workers, and insurance representatives to coordinate safe and timely patient discharges. They facilitate communication between team members, assess patients' post-hospital needs, and help secure appropriate resources such as home health care or rehabilitation services. Their role is vital in preventing readmissions by ensuring that all aspects of a patient's care plan are addressed and that transitions occur smoothly. Regular interdisciplinary meetings and case conferences are common practices to align on patient care goals.

What are Discharge Planner Utilization Review professionals?

Discharge Planner Utilization Review professionals are healthcare workers who coordinate patient discharges from hospitals or medical facilities while ensuring appropriate utilization of healthcare services. They assess patients' continuing care needs, develop safe discharge plans, and review the necessity and efficiency of the care provided. Their role bridges clinical care and administrative requirements, helping to prevent unnecessary hospital stays and ensuring patients transition smoothly to home or other care settings. These professionals often work closely with physicians, nurses, social workers, and insurance companies to promote optimal patient outcomes and cost-effective healthcare.

How to become a discharge planner?

To become a discharge planner, typically a healthcare professional such as a social worker, nurse, or case manager, needs to obtain relevant education like a bachelor's or master's degree in social work, nursing, or healthcare administration. Certification or licensure may be required depending on the state or employer, and experience in patient care or healthcare coordination is often preferred. Strong communication, organizational skills, and knowledge of healthcare systems are essential for this role.

What is the difference between Discharge Planner Utilization Review vs Discharge Planner?

AspectDischarge Planner Utilization ReviewDischarge Planner
Primary RoleEvaluates medical necessity and appropriateness of patient discharges for insurance and healthcare complianceCoordinates patient discharges, ensures proper placement, and communicates with healthcare teams
CredentialsTypically requires a social work, nursing, or healthcare background with certification in utilization reviewUsually requires social work or nursing credentials, with focus on discharge planning
Work EnvironmentHospitals, insurance companies, or healthcare facilities involved in utilization reviewHospitals, rehab centers, or skilled nursing facilities

While both roles involve discharge processes, Discharge Planner Utilization Review focuses on assessing medical necessity for insurance purposes, whereas Discharge Planner manages patient discharge logistics and coordination. Understanding these differences helps clarify career paths and employer expectations in healthcare settings.

What are popular job titles related to Discharge Planner Utilization Review jobs in Dallas, TX? For Discharge Planner Utilization Review jobs in Dallas, TX, the most frequently searched job titles are:
What job categories do people searching Discharge Planner Utilization Review jobs in Dallas, TX look for? The top searched job categories for Discharge Planner Utilization Review jobs in Dallas, TX are:
What cities near Dallas, TX are hiring for Discharge Planner Utilization Review jobs? Cities near Dallas, TX with the most Discharge Planner Utilization Review job openings:
Discharge Planner Utilization Review jobs near you
Infographic showing various Discharge Planner Utilization Review job openings in Dallas, TX as of May 2026, with employment types broken down into 84% Full Time, and 16% Part Time. Highlights an 100% In-person job distribution, with an average salary of $67,122 per year, or $32.3 per hour.
RN Utilization Review Coordinator, Full-time

RN Utilization Review Coordinator, Full-time

Surgery Partners

Addison, TX • On-site

Full-time

Posted 17 days ago

Surgery Partners rating

7.5

Company rating: 7.5 out of 10

Based on 78 frontline employees who took The Breakroom Quiz

217th of 864 rated healthcare providers

Job description

Hiring Now for RN Utilization Review Coordinator
Department: Case Management
Shift: Full-time Hybrid
Job Summary:
The RN Case Manager/Utilization Review is responsible for performing prospective, concurrent, and post-discharge utilization reviews to ensure appropriate patient status, medical necessity, and compliance with hospital policy, payer requirements, and applicable local, state and federal regulations, including Centers for Medicare & Medicaid Services (CMS) guidelines. The role supports accurate admission status determinations, active denial management, and collaboration with physicians, case managers, and interdisciplinary team members to promote efficient patient progression through the episode of care. This position also assists with discharge planning activities and contributes to quarterly and annual utilization review reporting and performance improvement initiatives.
Utilization Review and Medical Necessity
  1. Conduct comprehensive medical record reviews using specific criteria and guidelines as approved and/or established by medical staff, CMS, and other state and federal agencies while ensuring physician and nurse documentation meets set standards.
  2. Perform prospective (pre-admission and pre-operative), concurrent, and post-discharge utilization reviews to verify medical necessity and appropriate level of care throughout the episode of care using the hospital-approved criteria software.
  3. Screen and determine appropriate admission status (inpatient, observation, outpatient, or outpatient in a bed) based on clinical documentation, hospital-approved medical-necessity guidelines, and payer requirements.
  4. Facilitate appropriate admission status determinations based on clinical documentation and payer requirements.
  5. Review clinical documentation for accuracy, completeness, and compliance with regulatory and payer standards.
  6. Collaborate with physicians and nursing staff to ensure timely, accurate orders and documentation supporting medical necessity.
  7. Communicate with physicians when cases do not meet admission or continued stay criteria and assist with resolution.
  8. Submit timely admission, continued stay, and discharge notification and appropriate clinicals to insurance companies as required.
  9. Complete admission status changes as needed in the hospital computer system.

Denial Management:
  1. Identify, track, and manage utilization review denials related to admission status, level of care, length of stay, and medical necessity.
  2. Draft, write, and submit denial appeal letters using clinical judgment, medical record review, applicable payer, CMS, and regulatory guidelines to support medical necessity determinations.
  3. Collaborate with physicians, case managers, physician advisors, and leadership to obtain supporting clinical documentation, physician statements, and peer-to-peer review input for appeals to support denial resolution.
  4. Monitor denial outcomes, appeal success rates, and payer trends; analyze root causes and provide feedback, education, and recommendations to reduce future denials.
  5. Maintain accurate documentation of denials and appeals in accordance with hospital policy and regulatory requirements.

Discharge Planning Support
  1. When needed, collaborate with the Case Management team to support timely and safe discharge planning.
  2. Serve as the patient advocates and enhances collaborative relationships with the healthcare team, physicians, patients, and families to maximize the patient's and family's ability to make informed healthcare decisions.
  3. When needed, assist in identifying and addressing barriers to discharge, including durable medical equipment (DME), home health services, medications, and therapy need.
  4. Reinforce patient and family education to promote successful transitions of care.
  5. When needed, transmit Continuity of Care Documents to appropriate post-acute providers to ensure follow-up care.

Reporting, Compliance & Quality
  1. Monitor, track, and analyze avoidable days and extended lengths of stay; identify contributing factors related to utilization, payer processes, discharge barriers, and system delays, and collaborate with Case Management, physicians, and interdisciplinary teams to support timely resolution.
  2. Assist the Case Management Manager and Quality Director with data collection and analysis for quarterly and annual utilization review reports.
  3. Participate in regulatory audits, surveys, and internal reviews related to utilization management.
  4. Investigate and report adverse occurrences and trends related to utilization, discharge planning, or resource management.
  5. Provide staff education related to utilization review processes, medical necessity, and resource utilization.

Professional Responsibilities:
Must demonstrate high attention to detail, the ability to multi-task, prioritize, and have strong critical thinking skills to address issues that arise unexpectedly.
  1. Must encompass the skill to follow through with tasks and situations while providing clear communication to others throughout the process.
  2. Maintain a high standard of professionalism and ethical conduct in accordance with hospital policies and the Methodist Hospital for Surgery Code of Conduct.
  3. Support and facilitate initiatives enhancing patient outcomes, patient satisfaction, and regulatory compliance.
  4. Communicate effectively, professionally, accurately, and timely with all staff and patients.
  5. Demonstrates the spirit of philosophy, mission, and values of the hospital through words and actions and implements them into departmental processes, programs, and the working environment
  6. Perform other duties as assigned or required.

Minimum Requirements:
Education: Bachelor of Science in Nursing preferred.
Certification, Licensure: Active RN license in Texas; current CPR certification. Case Management Certification(s) preferred.
Experience, Training, Knowledge: At least five years of experience with Case Management, Discharge Planning, and Utilization Review.
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

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