Utilization Review RN
$41.14 - $61.20/hr
Every day, you will meticulously review medical records, authorize services, and prepare cases for ... Collaborates with facility RN Care Coordinators to ensure progression of care. Job Requirements ...
New
Utilization Review RN
$41.14 - $61.20/hr
Every day, you will meticulously review medical records, authorize services, and prepare cases for ... Collaborates with facility RN Care Coordinators to ensure progression of care. Job Requirements ...
New
Utilization Review RN
Houston, TX · On-site
$41.14 - $61.20/hr
Luke's Medical Center is an 881-bed quaternary care academic medical center that is a joint venture ... review outcomes. * Collaborates with facility RN Care Coordinators to ensure progression of care.
New
Utilization Review RN
Houston, TX · On-site
$41.14 - $61.20/hr
Luke's Medical Center is an 881-bed quaternary care academic medical center that is a joint venture ... review outcomes. * Collaborates with facility RN Care Coordinators to ensure progression of care.
New
Utilization Review RN
$41.14 - $61.20/hr
Every day, you will meticulously review medical records, authorize services, and prepare cases for ... Collaborates with facility RN Care Coordinators to ensure progression of care. Job Requirements ...
New
Utilization Review RN
$41.14 - $61.20/hr
Every day, you will meticulously review medical records, authorize services, and prepare cases for ... Collaborates with facility RN Care Coordinators to ensure progression of care. Job Requirements ...
New
Lukes Medical Center is an 881-bed quaternary care academic medical center that is a joint venture ... review outcomes. * Collaborates with facility RN Care Coordinators to ensure progression of care.
New
Lukes Medical Center is an 881-bed quaternary care academic medical center that is a joint venture ... review outcomes. * Collaborates with facility RN Care Coordinators to ensure progression of care.
New
UTILIZATION REVIEW NURSE - RN
Houston, TX · On-site
Working collaboratively within a multidisciplinary team, the UR RN conducts comprehensive reviews of clinical documentation, assesses medical necessity, and coordinates with healthcare providers and ...
Quick apply
UTILIZATION REVIEW NURSE - RN
Houston, TX · On-site
Working collaboratively within a multidisciplinary team, the UR RN conducts comprehensive reviews of clinical documentation, assesses medical necessity, and coordinates with healthcare providers and ...
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RN/Medical Claims Analyst
Houston, TX · Remote
$32.50 - $34/hr
The position requires the Registered Nurse to conduct medical record reviews and to apply sound clinical judgment to claim payment decisions. Responsibilities may include additional research on ...
Quick apply
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RN/Medical Claims Analyst
Houston, TX · Remote
$32.50 - $34/hr
The position requires the Registered Nurse to conduct medical record reviews and to apply sound clinical judgment to claim payment decisions. Responsibilities may include additional research on ...
Nurse Analyst
Houston, TX · On-site
... Medical Review Management team. Must have an unencumbered, current, active, state issued nursing license or registration. [ Licensed Vocational Nurse. Registered Nurse .] KNOWLEDGE, SKILLS AND ...
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Nurse Analyst
Houston, TX · On-site
... Medical Review Management team. Must have an unencumbered, current, active, state issued nursing license or registration. [ Licensed Vocational Nurse. Registered Nurse .] KNOWLEDGE, SKILLS AND ...
... (RN) who comprehensively conducts point of entry and concurrent medical record review for medical necessity and level of care using nationally recognized acute care indicators and criteria as ...
... (RN) who comprehensively conducts point of entry and concurrent medical record review for medical necessity and level of care using nationally recognized acute care indicators and criteria as ...
RN Tele-Health Triage - Kelsey-Seybold Clinic - Remote
Pearland, TX · Remote
$29 - $52/hr
Collects pertinent information needed for medical review from referring provider to ensure service decisions are determined within appropriate timeframes. The Primary Care at Home Desk RN will own ...
RN Tele-Health Triage - Kelsey-Seybold Clinic - Remote
Pearland, TX · Remote
$29 - $52/hr
Collects pertinent information needed for medical review from referring provider to ensure service decisions are determined within appropriate timeframes. The Primary Care at Home Desk RN will own ...
... medical necessity criteria, including: Admission reviews Continued stay reviews Transitional care ... RN graduate from an accredited school of nursing (BSN preferred) Current, active unrestricted RN ...
... medical necessity criteria, including: Admission reviews Continued stay reviews Transitional care ... RN graduate from an accredited school of nursing (BSN preferred) Current, active unrestricted RN ...
... medical necessity criteria, including: • Admission reviews • Continued stay reviews • ... • RN graduate from an accredited school of nursing (BSN preferred) • Current, active ...
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... medical necessity criteria, including: • Admission reviews • Continued stay reviews • ... • RN graduate from an accredited school of nursing (BSN preferred) • Current, active ...
Nurse, Concurrent Review
Houston, TX · On-site +1
... medical necessity criteria, including: • Admission reviews • Continued stay reviews • ... • RN graduate from an accredited school of nursing (BSN preferred) • Current, active ...
Nurse, Concurrent Review
Houston, TX · On-site +1
... medical necessity criteria, including: • Admission reviews • Continued stay reviews • ... • RN graduate from an accredited school of nursing (BSN preferred) • Current, active ...
The RN ensures that medical, medication, and health-related supports are delivered safely ... Review and monitor individuals' medical conditions, medications, and health supports. * Participate ...
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The RN ensures that medical, medication, and health-related supports are delivered safely ... Review and monitor individuals' medical conditions, medications, and health supports. * Participate ...
Registered Nurse (RN)
Houston, TX · On-site
Voluntary Benefits reviewed and provided at your one-on-one benefit meeting. * Exceptional ... I.V. Certification Preferred. * Must be knowledgeable of nursing and medical practices and ...
Registered Nurse (RN)
Houston, TX · On-site
Voluntary Benefits reviewed and provided at your one-on-one benefit meeting. * Exceptional ... I.V. Certification Preferred. * Must be knowledgeable of nursing and medical practices and ...
Voluntary Benefits reviewed and provided at your one-on-one benefit meeting . * Exceptional ... I.V. Certification Preferred. * Must be knowledgeable of nursing and medical practices and ...
Quick apply
Voluntary Benefits reviewed and provided at your one-on-one benefit meeting . * Exceptional ... I.V. Certification Preferred. * Must be knowledgeable of nursing and medical practices and ...
Voluntary Benefits reviewed and provided at your one-on-one benefit meeting . * Exceptional ... I.V. Certification Preferred. * Must be knowledgeable of nursing and medical practices and ...
Quick apply
Voluntary Benefits reviewed and provided at your one-on-one benefit meeting . * Exceptional ... I.V. Certification Preferred. * Must be knowledgeable of nursing and medical practices and ...
Medical Surgical RN
$33 - $52.80/hr
Job Summary and Responsibilities As a Registered Nurse (RN), you will be responsible for delivering ... Where You'll Work Patients Medical Center (PMC) provides inpatient and outpatient medical and ...
Medical Surgical RN
$33 - $52.80/hr
Job Summary and Responsibilities As a Registered Nurse (RN), you will be responsible for delivering ... Where You'll Work Patients Medical Center (PMC) provides inpatient and outpatient medical and ...
Medical Surgical RN
$33 - $52.80/hr
Job Summary and Responsibilities As a Registered Nurse (RN), you will be responsible for delivering ... Where You'll Work Patients Medical Center (PMC) provides inpatient and outpatient medical and ...
Medical Surgical RN
$33 - $52.80/hr
Job Summary and Responsibilities As a Registered Nurse (RN), you will be responsible for delivering ... Where You'll Work Patients Medical Center (PMC) provides inpatient and outpatient medical and ...
Medical Surgical RN
$35.45 - $55.36/hr
Demonstrated competence in Registered Nurse I performance expectations or meets experience requirements upon hire Where You'll Work Baylor St. Luke's Medical Center is an internationally recognized ...
Medical Surgical RN
$35.45 - $55.36/hr
Demonstrated competence in Registered Nurse I performance expectations or meets experience requirements upon hire Where You'll Work Baylor St. Luke's Medical Center is an internationally recognized ...
REGISTERED NURSE
Brookshire, TX · On-site
Reviews Return to Work notices and clears associates to return to work. * Administers Flu shots ... Collaborates with a multidisciplinary team including attorneys, medical providers and clinic staff ...
REGISTERED NURSE
Brookshire, TX · On-site
Reviews Return to Work notices and clears associates to return to work. * Administers Flu shots ... Collaborates with a multidisciplinary team including attorneys, medical providers and clinic staff ...
Medical Review Rn information
See Houston, TX salary details
$22.96 - $26.96
5% of jobs
$26.96 - $30.97
15% of jobs
$32.56 is the 25th percentile. Wages below this are outliers.
$30.97 - $34.98
13% of jobs
$34.98 - $38.98
15% of jobs
The median wage is $39.75 / hr.
$38.98 - $42.99
14% of jobs
$42.99 - $47
11% of jobs
$48.63 is the 75th percentile. Wages above this are outliers.
$47 - $51
8% of jobs
$51 - $55.01
6% of jobs
$55.01 - $59.02
8% of jobs
$59.02 - $63.02
3% of jobs
$63.02 - $67.03
2% of jobs
$22
$42
$67
How much do medical review rn jobs pay per hour?
As of Jul 30, 2026, the average hourly pay for medical review rn in Houston, TX is $42.89, according to ZipRecruiter salary data. Most workers in this role earn between $32.84 and $50.96 per hour, depending on experience, location, and employer.
What is a Medical Review RN?
A Medical Review RN is a registered nurse who specializes in reviewing medical records and claims to ensure they meet established guidelines and standards. These nurses often work for insurance companies, government agencies, or healthcare organizations, evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. Their role may include determining medical necessity, performing utilization reviews, and supporting appeals or audits. They use their clinical knowledge to interpret complex medical information and collaborate with healthcare providers to support accurate decision-making.
Can I make $500,000 as a nurse?
Medical Review RNs typically do not earn $500,000 annually, as most nursing salaries are below that level. High earnings in nursing usually require advanced roles, specialized certifications, management positions, or work in high-paying industries or locations. Achieving such a salary may involve additional education, experience, and responsibilities beyond standard nursing roles.
What does a medical review RN do?
A Medical Review RN evaluates insurance claims, medical records, and provider documentation to determine coverage and compliance with policies. They ensure accurate assessment of medical necessity, often working with healthcare providers and insurance companies, and may require knowledge of medical coding and documentation standards.
How to make $300,000 as a nurse?
Medical Review RNs can increase their earnings by gaining specialized certifications, such as in case management or legal nurse consulting, and working in high-demand settings like telehealth or insurance companies. Advancing to senior or managerial roles, working overtime, or taking on consulting projects can also boost income toward $300,000 annually.
How does a Medical Review RN collaborate with other healthcare professionals during the review process?
A Medical Review RN often works closely with physicians, case managers, and insurance representatives to ensure that medical claims and treatment plans meet regulatory and clinical guidelines. Collaboration may involve participating in interdisciplinary meetings, discussing complex cases, and providing clinical expertise to support utilization management decisions. Effective communication and teamwork are essential, as you'll need to relay findings, request additional information, and sometimes clarify medical necessity with providers. This collaborative environment helps ensure quality care for patients while maintaining compliance with payer policies.
How to make an extra 2000 a month as a nurse?
Medical Review RNs can increase their income by taking on additional freelance or per diem review assignments, working overtime, or obtaining specialized certifications to qualify for higher-paying roles. Developing expertise in specific medical areas or coding can also lead to higher-paying opportunities outside regular hours.
What are the key skills and qualifications needed to thrive as a Medical Review RN, and why are they important?
To thrive as a Medical Review RN, you need a strong clinical background, critical thinking skills, and an active RN license, often supported by experience in case management or utilization review. Familiarity with medical coding, claims management software, and knowledge of regulatory guidelines such as Medicare and Medicaid are typically required. Strong attention to detail, excellent written communication, and the ability to work independently are essential soft skills for this role. These competencies ensure accurate and compliant medical record reviews, which are critical for proper claims adjudication and regulatory adherence.
What cities near Houston, TX are hiring for Medical Review Rn jobs? Cities near Houston, TX with the most Medical Review Rn job openings:
$41.14 - $61.20/hr
Full-time
Posted 3 days ago
New
Job description
Job Summary and Responsibilities
As our Utilization Management Professional, you will be a critical guardian of healthcare efficiency and quality, ensuring integrity in clinical decision-making, regulatory compliance, and responsible resource utilization.
Every day, you will meticulously review medical records, authorize services, and prepare cases for physician review in partnership with UM teams. You'll monitor patient care for appropriateness, quality, and cost-effectiveness, aligning decisions with established criteria.
To be successful in this role, you will possess a strong clinical background, deep UM/regulatory knowledge, and exceptional analytical/organizational skills. Your ability to manage charts, apply criteria precisely, and communicate effectively with enthusiasm, efficiency, and empathy is paramount for optimal patient care and operational flow.
- Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted based on established criteria and critical thinking.
- Reviews include admission, concurrent and post discharge for appropriate status determination.
- Ensures compliance with principles of utilization review, hospital policies and external regulatory agencies, Peer Review Organization (PRO), Joint Commission, and payer defined criteria for eligibility.
- Reviews the records for the presence of accurate patient status orders and addresses deficiencies with providers.
- Ensures timely communication and follow up with physicians, payers, Care Coordinators and other stakeholders regarding review outcomes.
- Collaborates with facility RN Care Coordinators to ensure progression of care.
- Diploma Of Nursing Graduate of an accredited school of nursing, upon hire and
- Minimum two (2) years of acute hospital clinical experience , upon hire or
- Registered Nurse: TX, upon hire and
Preferred
- Bachelors Of Nursing Bachelor's Degree in Nursing (BSN) or related healthcare field. , upon hire
- At least five (5) years of nursing experience., upon hire
- Certified Case Manager, upon hire or
- Accredited Case Manager, upon hire or
Baylor St. Luke's Medical Center is an 881-bed quaternary care academic medical center that is a joint venture between Baylor College of Medicine and CHI St. Luke's Health. Located in the Texas Medical Center, the hospital is the home of the Texas Heart Institute, a cardiovascular research and education institution founded in 1962 by Denton A. Cooley, MD. The hospital was the first facility in Texas and the Southwest designated a Magnet hospital for Nursing Excellence by the American Nurses Credentialing Center, receiving the award five consecutive times. Baylor St. Luke's also has three community emergency centers offering adult and pediatric care for the Greater Houston area.Qualifications:Required
- Diploma Of Nursing Graduate of an accredited school of nursing, upon hire and
- Minimum two (2) years of acute hospital clinical experience , upon hire or
- Registered Nurse: TX, upon hire and
Preferred
- Bachelors Of Nursing Bachelor's Degree in Nursing (BSN) or related healthcare field. , upon hire
- At least five (5) years of nursing experience., upon hire
- Certified Case Manager, upon hire or
- Accredited Case Manager, upon hire or