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Insurance Utilization Review Jobs in Texas (NOW HIRING)

Houston Methodist

Recent work experience in a hospital or insurance company providing utilization review services * Knowledge of Medicare, Medicaid, and Managed Care requirements * Progressive knowledge of community ...

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$19

$39

$64

How much do insurance utilization review jobs pay per hour?

As of Jun 29, 2026, the average hourly pay for insurance utilization review in Texas is $39.39, according to ZipRecruiter salary data. Most workers in this role earn between $31.15 and $45.24 per hour, depending on experience, location, and employer.

What are the most common challenges faced by Insurance Utilization Review professionals?

One common challenge in Insurance Utilization Review is balancing the need for cost-effective care with the clinical needs of patients, which often requires careful analysis and decision-making. Professionals in this role frequently navigate complex medical records, strict policy guidelines, and collaborate with healthcare providers who may advocate strongly for particular treatments. Managing challenging conversations while maintaining professionalism and ensuring timely determinations are also a regular part of the role. Developing expertise in these areas can make the job both demanding and rewarding, while building a strong foundation for career growth within healthcare administration.

What are the key skills and qualifications needed to thrive in the Insurance Utilization Review position, and why are they important?

To thrive in Insurance Utilization Review, you generally need a strong background in healthcare or nursing, an understanding of medical terminology, and analytical thinking skills, often supported by an RN license or relevant clinical experience. Familiarity with utilization management software, coding systems like ICD-10, and knowledge of regulatory requirements (such as Medicare or Medicaid) are important. Strong communication, attention to detail, and problem-solving abilities help professionals excel when interacting with providers and insurers. These skills are essential to ensure appropriate care is authorized while maintaining regulatory compliance and cost-effectiveness.

What is an Insurance Utilization Review job?

An Insurance Utilization Review job involves evaluating medical treatments and services to determine if they are necessary, appropriate, and covered by a patient's insurance plan. Professionals in this role review medical records, treatment plans, and insurance policies to ensure compliance with guidelines and cost-effectiveness. They work closely with healthcare providers, insurance companies, and patients to facilitate approvals or appeals. The goal is to balance quality patient care with cost containment in the healthcare system.

What are the most commonly searched types of Insurance Utilization Review jobs in Texas? The most popular types of Insurance Utilization Review jobs in Texas are:
What are popular job titles related to Insurance Utilization Review jobs in Texas? For Insurance Utilization Review jobs in Texas, the most frequently searched job titles are:
What job categories do people searching Insurance Utilization Review jobs in Texas look for? The top searched job categories for Insurance Utilization Review jobs in Texas are:
What cities in Texas are hiring for Insurance Utilization Review jobs? Cities in Texas with the most Insurance Utilization Review job openings:
Insurance Utilization Review jobs near you
Infographic showing various Insurance Utilization Review job openings in Texas as of June 2026, with employment types broken down into 2% As Needed, 90% Full Time, 3% Part Time, 3% Contract, and 2% Nights. Highlights an 90% In-person, and 10% Remote job distribution, with an average salary of $81,936 per year, or $39.4 per hour.
Utilization Review Nurse (55697)

Utilization Review Nurse (55697)

El Paso Children's Hospital

El Paso, TX • On-site

Full-time

Posted 7 days ago

El Paso Children's Hospital rating

7.5

Company rating: 7.5 out of 10

Based on 12 frontline employees who took The Breakroom Quiz

286th of 1,003 rated hospitals

Job description

To monitor adherence to the hospital's utilization review plan to ensure the effective and efficient use of hospital services. Responsible for ensuring the appropriateness of hospital admissions and extended hospital stays. An understanding of the severity of an array of illnesses, intensity of service, and care coordination needs are the key, as the nurse must integrate clinical knowledge with billing knowledge to review, evaluate and arrange peer to peers when clinical denials related to medical necessity of the patient while hospitalized. UM nurse will work closely in collaboration with physician advisers to support policy development, and process improvement.
Work Experience:
  • Two (2) years prior experience with Utilization Management.
  • Previous training and demonstrated competence in negotiations, quality assurance, case management outcomes, and keyboarding/computer use.
  • Experience with InterQual and/or Milliman Care Guidelines. Strong organizational and time management skills.
  • Ability to work on extremely complex problems where analysis of situation or data requires an evaluation of intangible variance factors.

License/Registration/Certification:
  • Current RN License to practice in the State of Texas.

Education and Training:
  • Associate's Degree in Nursing, BSN preferred.

Skills:
  • Ability to utilize proficient verbal, written and interpersonal communication skills.
  • Ability to work on extremely complete problems where analysis of situations or data requires an evaluation of intangible variance factors.
  • Knowledge of managed care, reimbursement and utilization management.
  • Knowledge of current International Classification of Disease (ICD-10), Diagnostic Related Groups (DRGs), and medical necessity criteria.
  • Knowledge of claims denials and appeals processing
  • Ability to coordinate and manage multiple priorities, projects simultaneously, reprioritizing as necessary
  • Ability to self-motivate, multi-task and prioritize in a fast paced environment.
  • Ability to use analytical and problem solving skills.
  • Knowledge of HIPAA standards.
  • Knowledge of various insurance plan coverages for Home Health, DME, SNF, LTAC agencies.
  • Works well with people of all social, economic, and cultural backgrounds.
  • Strong customer service orientation.
  • Knowledgeable regarding community resources.
  • Knowledge of basic computer, word-processing, and spreadsheet skills, Microsoft.
  • Ability to operate standard office equipment.
  • Knowledge of English grammar, punctuation and spelling.

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