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Insurance Utilization Review Jobs in Texas (NOW HIRING)

HealthCare Support

Utilization Management

Houston, TX · On-site

$38 - $42/hr

Microsoft Office (Word, Outlook, Excel) Benefits for RN Outpatient Utilization Review Remote Texas: * Health Insurance * Dental Insurance * Life Insurance * Employee Assistance Program (EAP) * Access ...

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 ...

Corvel

Utilization Review Intake Specialist

Dallas, TX · Remote

$16.74 - $26.92/hr

The Utilization Review (UR) Intake Specialist provides staff support services including typing ... Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and ...

Corvel

Utilization Review Intake Specialist

Dallas, TX · On-site

$16.74 - $26.92/hr

The Utilization Review (UR) Intake Specialist provides staff support services including typing ... Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and ...

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How much do insurance utilization review jobs pay per hour?

As of Aug 9, 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 insurance utilization review?

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?

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:
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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 August 2026, with employment types broken down into 8% As Needed, 84% Full Time, and 8% Part Time. Highlights an 100% In-person job distribution, with an average salary of $81,936 per year, or $39.4 per hour.

RN Utilization Review Coordinator, Full-time

Methodist Hospital for Surgery

Addison, TX • On-site

Full-time

Re-posted yesterday

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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