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Insurance Utilization Review Jobs in Austin, TX (NOW HIRING)

Ascension

Registered Nurse Utilization Review

Austin, TX · Remote

$78K - $110K/yr

... and utilization review. * Review admissions and service requests for medical necessity ... Benefits Paid time off (PTO)Various health insurance options & wellness plansRetirement benefits ...

Ascension

RN-Utilization Review

Austin, TX · Remote

$84K - $118K/yr

May prepare statistical analysis and utilization review reports as necessary. * Oversee and ... Benefits Paid time off (PTO)Various health insurance options & wellness plansRetirement benefits ...

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How much do insurance utilization review jobs pay per hour?

As of Sep 15, 2026, the average hourly pay for insurance utilization review in Austin, TX is $41.90, according to ZipRecruiter salary data. Most workers in this role earn between $33.12 and $48.12 per hour, depending on experience, location, and employer.

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 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 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.

How do I get into an insurance utilization review?

To become an insurance utilization review specialist, candidates typically need a background in healthcare, nursing, or a related field, along with knowledge of insurance policies and medical terminology. Certification such as the Certified Professional in Healthcare Quality (CPHQ) or similar credentials can enhance job prospects. Relevant skills include attention to detail, analytical thinking, and familiarity with medical records and insurance software systems.

Is insurance utilization review a stressful job?

Insurance utilization review can be stressful due to the need for accuracy, attention to detail, and meeting strict deadlines. Reviewers often handle complex cases and must balance policy guidelines with patient needs, which can contribute to job pressure. However, the level of stress varies depending on workload, work environment, and individual coping skills.

What are the most commonly searched types of Insurance Utilization Review jobs in Austin, TX?

The most popular types of Insurance Utilization Review jobs in Austin, TX are:

What are popular job titles related to Insurance Utilization Review jobs in Austin, TX?

For Insurance Utilization Review jobs in Austin, TX, the most frequently searched job titles are:

What job categories do people searching Insurance Utilization Review jobs in Austin, TX look for?

The top searched job categories for Insurance Utilization Review jobs in Austin, TX are:

What cities near Austin, TX are hiring for Insurance Utilization Review jobs?

Cities near Austin, TX with the most Insurance Utilization Review job openings:

Infographic showing various Insurance Utilization Review job openings in Austin, TX as of September 2026, with employment types broken down into 1% As Needed, 77% Full Time, 17% Part Time, and 5% Contract. Highlights an 84% Physical, 1% Hybrid, and 15% Remote job distribution, with an average salary of $87,153 per year, or $41.9 per hour.

RN - Utilization Review

Austin, TX • On-site

Ascension Seton - Texas Administrative Offices
See more jobs at Ascension Seton - Texas Administrative Officesexternal

$1.7K/wk

Other

Posted 11 days ago

Job description

Details
Client Name
Ascension Seton - Texas Administrative Offices
Job Type
Travel
Offering
Nursing
Profession
RN
Specialty
Utilization Review
Job ID
38104294
Job Title
RN - Utilization Review
Weekly Pay
$1788.83
Shift Details
Shift
8 hour days
Scheduled Hours
40
Job Order Details
Start Date
10/06/2026
End Date
01/05/2027
Duration
13 Week(s)
Job Description
The Registered Nurse (RN) - Utilization Review (UR) is responsible for ensuring that healthcare services provided to patients are medically necessary, appropriate, and efficient. The RN in this role works with healthcare providers, insurance companies, and patients to review medical records, treatment plans, and clinical data to determine the appropriate level of care and ensure compliance with healthcare policies and regulations. This role requires a strong understanding of clinical care, health insurance guidelines, and hospital operations to make informed decisions that optimize patient care and resource utilization.
Key Responsibilities:
  1. Utilization Review and Clinical Evaluation:
    • Review patient medical records, treatment plans, and clinical data to assess the appropriateness of the care being provided and the necessity for continued hospitalization or services.
    • Assess the medical necessity of procedures, tests, and treatments to ensure they align with established guidelines and criteria, such as those from the InterQual or Milliman Care Guidelines.
    • Evaluate whether the care provided is appropriate, efficient, and meets the standards of care based on clinical evidence.
  2. Collaboration with Healthcare Providers:
    • Collaborate with physicians, case managers, and other healthcare professionals to ensure that patient care plans are appropriate and cost-effective.
    • Communicate with healthcare teams to discuss any discrepancies or concerns regarding the utilization of resources, care plans, or treatment goals.
    • Provide recommendations or alternative care options to improve patient outcomes and optimize resource utilization.
  3. Insurance and Payer Interaction:
    • Work closely with insurance companies, managed care organizations, and government payers (e.g., Medicare, Medicaid) to review cases for coverage, authorization, and reimbursement.
    • Submit necessary documentation and justification to insurance companies to support medical necessity determinations and secure prior authorization for treatments, procedures, or extended hospital stays.
    • Resolve any issues related to denied claims or requests for additional documentation to ensure that services are covered by insurance providers.
  4. Monitoring of Length of Stay and Discharge Planning:
    • Monitor patient length of stay (LOS) to identify potential delays in discharge and ensure that patients are not staying in the hospital longer than necessary.
    • Work with case management teams to develop appropriate discharge plans, ensuring that the patient is ready for discharge and has the necessary resources and follow-up care.
    • Identify potential barriers to discharge and collaborate with the interdisciplinary team to address these issues and facilitate a timely discharge.
  5. Compliance and Quality Assurance:
    • Ensure that utilization review practices comply with regulatory standards, including The Joint Commission (TJC), Centers for Medicare & Medicaid Services (CMS), and other state or federal regulations.
    • Assist with audits to evaluate the efficiency and accuracy of utilization management processes, making improvements where necessary.
    • Maintain up-to-date knowledge of healthcare regulations, coding guidelines (ICD-10, CPT), and payer-specific policies to ensure accurate documentation and compliance.
  6. Documentation and Reporting:
    • Document findings from utilization reviews in the appropriate systems and ensure accurate record-keeping for insurance purposes and quality improvement efforts.
    • Prepare reports on utilization metrics, including patterns in hospital admissions, readmissions, and discharge delays, for management and leadership review.
    • Provide detailed, evidence-based rationales for medical necessity determinations and collaborate with the healthcare team to ensure compliance with UR protocols.
  7. Case Review and Decision-Making:
    • Perform retrospective and concurrent review of patient cases to determine if the level of care aligns with guidelines and if resources are being utilized efficiently.
    • Recommend the appropriate level of care (e.g., inpatient, outpatient, skilled nursing facility) based on clinical findings and guidelines.
    • Provide feedback to clinicians and healthcare teams regarding any areas for improvement in care planning or resource utilization.
  8. Education and Training:
    • Educate staff and providers on the importance of utilization review processes, medical necessity criteria, and compliance with payer requirements.
    • Stay current on the latest healthcare policies, clinical guidelines, and best practices for utilization management.
    • Participate in continuing education and training programs related to UR, case management, or quality improvement initiatives.

Client Details
Address
1345 Philomena Street
City
Austin
State
TX
Zip Code
78723
Job Board Disclaimer
Magnet Medical is committed to providing accurate and transparent information regarding advertised pay for job positions. However, it's important to note the following factors, including health insurance elections by the employee:
1.Health Insurance Impact: The overall compensation package may be affected by the health insurance plan elected by the employee. Health insurance contributions, deductibles, or other related factors can influence the total compensation offered.
2.Market Conditions: Compensation rates may be influenced by market conditions and industry standards.
3.Errors and Omissions: While we strive for accuracy, inadvertent errors or omissions may occur. Magnet Medical is not liable for any inaccuracies in the advertised pay.

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