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Rn Utilization Management Jobs in Texas (NOW HIRING)

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 ...

Actalent

Concurrent Review Nurse

Houston, TX · On-site

... utilization management and member care. Essential Skills * Graduate of an accredited School of Nursing. * Bachelor's degree in Nursing preferred. * Active Registered Nurse (RN) license required.

Ascension

RN-Utilization Review

Austin, TX · Remote

$84K - $118K/yr

Utilization Management Schedule: Days l Part Time Salary range: $84,060.91 - $118,668.99per year ... Licensed Registered Nurse credentialed from the Texas Board of Nursing or current home state ...

Moffitt

$77K - $117K/yr

Registered Nurse (RN) Minimum Licensure (Other): Training Required ... Knowledge of utilization management principles, medical necessity determination, and denial ...

Houston Methodist

At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse ... This position collaborates with case management in the development and implementation of the plan ...

Actalent

Utilization Review Nurse

Houston, TX · On-site

$30 - $40/hr

Job Title: RN Clinical Review Nurse (Utilization Review Nurse) The Clinical Review Clinician for ... Knowledge of utilization management processes. Work Environment The role involves collaboration ...

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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 Sep 2, 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.

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 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 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 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.

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 healthcare policies and insurance processes. 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 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, 82% Full Time, 13% Part Time, 3% Contract, and 1% Nights. Highlights an 82% Physical, 3% Hybrid, and 15% Remote job distribution, with an average salary of $83,367 per year, or $40.1 per hour.

Utilization Review Nurse

Bracane Co

Plano, TX • Remote

Full-time

Re-posted 19 days ago

Job description

***REMOTE - Candidates must be based in Texas: Austin area - Travis/Williamson Counties or Richardson area - Dallas/Collin Counties***

JOB DESCRIPTION:

RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan.

JOB RESPONSIBILITIES:

  • This position is responsible for performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness, and quality of medical/surgical services, and serving as liaison between providers and medical and network management divisions.
  • Collects clinical and non-clinical data.
  • Verifies eligibility.
  • Determines benefit levels in accordance to contract guidelines.
  • Provides information regarding utilization management requirements and operational procedures to members, providers, and facilities.

JOB QUALIFICATIONS (Required):

  • Registered Nurse (RN) with a valid, current, unrestricted license in the state of operations.
  • 3 years of clinical experience in a Physician's office, Hospital/Surgical setting, or Health Care Insurance Company.
  • Knowledge of medical terminology and procedures.
  • Verbal and written communication skills.

JOB QUALIFICATIONS (Preferred):

  • MCG or InterQual experience
  • Utilization management experience

LOCATION: REMOTE in Texas ( Richardson area ? Dallas/Collin Counties).

POSITION: 6-month assignment

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