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Rn Utilization Management Jobs in Texas (NOW HIRING)

GuideWell

Utilization Management RN

Irving, TX · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Utilization Management (UM) nurses will provide our clients with appropriate and comprehensive utilization of health care services and benefits as designated. This requires an experienced RN with a ...

Allmed Staffing Inc

Utilization Management Rep

Pearland, TX · Remote

  • Medical

  • Dental

  • Vision

  • Retirement

Coordinate with clinical review staff, including RNs, LVNs, and Medical Directors, to appropriately ... Utilization Management * Insurance operations * Medical office environments * Managed care settings

Allmed Staffing Inc

Utilization Management Rep

Pearland, TX · Remote

  • Medical

  • Dental

  • Vision

  • Retirement

Coordinate with clinical review staff, including RNs, LVNs, and Medical Directors, to appropriately ... Utilization Management * Insurance operations * Medical office environments * Managed care settings

Allmed Staffing Inc

Utilization Management Rep

Pearland, TX · Remote

  • Medical

  • Dental

  • Vision

  • Retirement

Coordinate with clinical review staff, including RNs, LVNs, and Medical Directors, to appropriately ... Utilization Management * Insurance operations * Medical office environments * Managed care settings

HealthCare Support

Utilization Management

Houston, TX · On-site

$38 - $42/hr

  • Medical

  • Dental

  • Life

RN Outpatient Utilization Review Remote Texas HealthCare Support is actively seeking multiple ... Communicates concerns that arise in these discussions to the Manager and/or Medical Director.

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

... ** RN working in the insurance or managed care industry using medically accepted criteria to ... Provides information regarding utilization management requirements and operational procedures to ...

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All JobsRn Utilization Management JobsRn Utilization Management Jobs in Texas

Rn Utilization Management information

See Texas salary details

$36.3K

$83.4K

$151.9K

How much do rn utilization management jobs pay per year?

As of Aug 13, 2026, the average yearly pay for rn utilization management in Texas is $83,367.00, according to ZipRecruiter salary data. Most workers in this role earn between $60,100.00 and $97,400.00 per year, depending on experience, location, and employer.

How does an RN Utilization Management typically collaborate with physicians and other healthcare team members?

RN Utilization Management professionals work closely with physicians, case managers, and insurance representatives to ensure patients receive appropriate, high-quality care while managing healthcare costs. They review patient records, communicate clinical findings, and may participate in interdisciplinary meetings to discuss care plans and discharge needs. Building strong relationships and maintaining open lines of communication with the care team is essential for timely authorizations and effective care coordination. This collaborative approach helps optimize patient outcomes and resource utilization.

What skills and qualifications are needed to thrive as an RN Utilization Management?

To thrive as an RN Utilization Management Nurse, you need a current RN license, strong clinical assessment skills, and experience in care coordination or case management. Familiarity with utilization review tools, electronic health records, and knowledge of insurance guidelines or InterQual/MCG criteria are typically required. Exceptional communication, critical thinking, and negotiation skills help facilitate collaboration among providers, payers, and patients. These abilities are crucial for ensuring appropriate resource use, compliance with regulations, and optimal patient outcomes.

How to get into utilization management as an RN?

To become an RN in utilization management, gain experience as a registered nurse, often in case management or clinical roles, and obtain knowledge of insurance policies and healthcare regulations. Certifications such as Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ) can enhance prospects. Strong communication skills and familiarity with electronic health records (EHR) systems are also beneficial.

What is the difference between Rn Utilization Management vs Rn Case Management?

AspectRn Utilization ManagementRn Case Management
CertificationsRN license, possibly certifications in utilization reviewRN license, case management certification often preferred
Work EnvironmentUtilization review departments, insurance companies, hospitalsCommunity clinics, hospitals, insurance companies
Primary FocusReviewing medical necessity and appropriateness of servicesCoordinating patient care and discharge planning

Both roles require an RN license, but Rn Utilization Management focuses on reviewing the necessity of services, while Rn Case Management emphasizes coordinating patient care. Understanding these differences helps professionals choose the right career path and employers.

What does a utilization management registered nurse do?

A utilization management registered nurse reviews patient cases to determine the necessity, appropriateness, and efficiency of healthcare services and treatments. They analyze medical records, collaborate with healthcare providers, and ensure compliance with insurance and regulatory guidelines, often using electronic health records and clinical judgment. Certification in case management or utilization review is commonly required for this role.

What is an RN Utilization Management?

RN Utilization Management nurses are registered nurses who specialize in reviewing healthcare services to ensure patients receive appropriate and cost-effective care. They evaluate the necessity, efficiency, and quality of medical treatments and procedures, often working with insurance companies, hospitals, or healthcare organizations. Their responsibilities include reviewing patient records, coordinating with clinical staff, making coverage recommendations, and ensuring compliance with healthcare regulations. This role helps manage healthcare costs while maintaining high standards of patient care.
What are popular job titles related to Rn Utilization Management jobs in Texas? For Rn Utilization Management jobs in Texas, the most frequently searched job titles are:
What job categories do people searching Rn Utilization Management jobs in Texas look for? The top searched job categories for Rn Utilization Management jobs in Texas are:
What cities in Texas are hiring for Rn Utilization Management jobs? Cities in Texas with the most Rn Utilization Management job openings:
Rn Utilization Management jobs near you
Infographic showing various Rn Utilization Management job openings in Texas as of August 2026, with employment types broken down into 1% As Needed, 84% Full Time, 13% Part Time, and 2% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution, with an average salary of $83,367 per year, or $40.1 per hour.

Registered Nurse (RN) - Utilization Management

Spectrum Healthcare Resources

San Antonio, TX • On-site

Other

Medical, Dental, Vision, Retirement, PTO

Posted 5 days ago

Job description

Registered Nurse Utilization Management

Spectrum Healthcare Resources has a potential opportunity for a Registered Nurse Utilization Management at Lackland AFB in San Antonio, TX.

This contract position offers:

  • Monday-Friday 730am-430pm
  • Outpatient Clinic
  • No Nights, Weekend or Holidays
  • No On-Call
  • Stable Patient Population
  • Paid time off and paid holidays
  • Benefits package including Medical, Dental, Vision and 401(k) and more…

Requirements:

  • Associate Degree of Nursing. Must possess a bachelor's degree in relevant health sciences or health informatics from an accredited university.
  • Graduate from a college or university accredited by the ACEN or CCNE
  • Active RN license in any state
  • 2+ years of clinical and utilization management RN experience
  • Basic Life Support Certification from American Heart

Core Duties:

  • Supports a comprehensive MTF Utilization Management plan/program as prescribed in the DoD Medical Management Guide and by the MTF Utilization Management Director.
  • Actively and retrospectively reviews medical cases to confirm receipt of appropriate care, monitor for patterns/trends and develop action plan for areas requiring improvement.
  • Reports on utilization patterns; briefs provider staff and executive staff.
  • Maintains reports on which cases have been denied or received reduced third party payments and reports provider profiles to the MTF management for corrective action.
  • Participates on multi-disciplinary teams to resolve recurring problems in the healthcare delivery process for care within or outside the MTF including referrals
  • Research and Analysis: Investigate and resolve queries from MTF clinics by analyzing reports and data.
  • Education and Training: Provide education and guidance on reporting systems and tools to ensure effective utilization by clinic staff.
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About Spectrum Healthcare Resources

Sourced by ZipRecruiter

Spectrum is a leading organization that provides program management and physician and clinical staffing services to United States Military Treatment Facilities, VA Clinics and Federal Agencies. We are dedicated to the markets we serve, leading our organization’s experience for almost three decades.

Industry

Health care and social assistance

Company size

1,001 - 5,000 Employees

Headquarters location

Saint Louis, MO, US

Year founded

1988

Social media

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