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Rn Utilization Management Jobs in Texas (NOW HIRING)

GuideWell

Utilization Management RN

Irving, TX · On-site

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 ...

HealthCare Support

Utilization Management

Houston, TX · On-site

$38 - $42/hr

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 11, 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.

Utilization Management RN

GuideWell

Irving, TX • On-site

Other

Medical, Dental, Vision, Life, Retirement, PTO

Posted 8 days ago

Job description

Job Title

Utilization Management Nurse

Job Description

Get To Know Us!

WebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30+ years of experience building unique benefit solutions and managing customized health plans.

What is your impact?

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 diverse clinical background, as well as experience within the managed care industry and specifically in the self-funded arena. The UM Nurse will work with providers, hospitals, members and clients to achieve optimal outcomes through appropriate use of services and benefits.

What is your impact?

  • Pre-Certification of emergency, urgent and elective admissions, and the determination of length of stay based on age, multiple or single diagnoses, and the nature of the diagnosis. Medical record review to determine medical necessity of requested services.
  • Concurrent review and the determination of the extension of the length of stay based on the severity of illness and the intensity of service. Medical record review to determine medical necessity of requested services.
  • Assist with Discharge Planning to ensure compliance with benefit plan and use of preferred providers/networks. Steerage to high quality, cost-effective domestic and in-network providers.
  • Identification of alternative treatment plans, which are to be approved by all parties. These alternative care plans will be based on quality care within cost containment guidelines allowing available claims dollars to be used in the most judicious manner possible (10%)
  • Establishing identification of services, resources, providers and facilities that could best serve clientele in a timely and cost- effective manner in order to obtain optimum value for the client and reimbursement source.
  • Interpreting individual health plans and authorizing/coordinating care in accordance with plan provisions.
  • Evaluate the cost effectiveness of the elected treatment plan, pre-implementation and post- implementation. This outcome measurement will be used in determining the effective results and in establishing future patient-centered care plans.
  • Referral to appropriate care management resources (i.e. Medical Director, Complex Case Management, and Chronic Condition Management teams).

Qualifications

  • 5+ years related work experience.
  • Professional background in clinical nursing and patient assessment.
  • Graduate of an accredited school of nursing. RN - Registered Nurse - Compact State Licensure in good standing.
  • Knowledgeable in medical terminology, reasonable and necessary treatment plans, delivery quality health care services and cost containment practices.
  • Ability to collaborate with cross-operational areas within the organization.
  • Good verbal and written communication skills.
  • Ability to work as a team member, effectively and collaboratively, with non-clinical teammates.
  • Maintaining client's privacy, confidentiality and safety as well as acting as an advocate for the covered member.
  • Adherence to ethical, legal and accreditation/regulatory standards.
  • Bachelor's degree in nursing preferred
  • Intensive care or higher-acuity patient experience preferred.
  • Prior experience in utilization management or case management preferred, preferably within the managed care environment.
  • Proficiency in maintaining good rapport with other staff members, physicians, health care facilities, clients, and providers.
  • Knowledge of managed care in a self-funded employer population is preferred.
  • Ability to identify problems such as underutilization or overutilization of services
  • Ability to promote and maintain quality care through analysis

What We Can Offer YOU!

To support your wellbeing, comprehensive benefits are offered. As a WebTPA employee, you will have access to:

  • Medical, dental, vision, life and global travel health insurance
  • Income protection benefits: life insurance, short- and long-term disability programs
  • Leave programs to support personal circumstances.
  • Retirement Savings Plan includes employer contribution and employer match
  • Paid time off, volunteer time off, and 11 holidays
  • Additional voluntary benefits available and a comprehensive wellness program

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for interns and part-time employees may differ.

General Physical Demands

Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally. Physical/Environmental Activities Must be able to travel to multiple locations for work (i.e. travel to attend meetings, events, conferences).

We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.

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