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Therapy Utilization Review Jobs in Texas (NOW HIRING)

Acadia Healthcare

Director of Utilization

El Paso, TX · On-site

Monitor utilization of services and optimize reimbursement for the facility while maximizing use of ... Collaborates with physicians, therapist and nursing staff to provide optimal review based on ...

Carrus Health

Therapist (Float)

Houston, TX · On-site

... therapy sessions as needed, and conducts community education activities (individual and community) as directed. Utilization Review role - responsible for coordinating and monitoring day-to-day ...

Carrus Health

Therapist (Float) (DFW)

Sherman, TX · On-site

... therapy sessions as needed, and conducts community education activities (individual and community) as directed. Utilization Review role - responsible for coordinating and monitoring day-to-day ...

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All JobsTherapy Utilization Review JobsTherapy Utilization Review Jobs in Texas

Therapy Utilization Review information

See Texas salary details

$14

$29

$49

How much do therapy utilization review jobs pay per hour?

As of Aug 26, 2026, the average hourly pay for therapy utilization review in Texas is $29.76, according to ZipRecruiter salary data. Most workers in this role earn between $20.82 and $37.84 per hour, depending on experience, location, and employer.

What is therapy utilization review?

Therapy Utilization Review is a process used by healthcare organizations and insurance companies to evaluate the necessity, efficiency, and appropriateness of therapy services being provided to patients. This review ensures that treatments such as physical, occupational, or speech therapy are medically necessary and align with established guidelines. The goal is to optimize patient care while managing costs and preventing overuse or misuse of therapy services. Professionals in this role review patient records, treatment plans, and progress notes, often collaborating with therapists and other healthcare providers.

What are the key skills and qualifications needed to thrive as a therapy utilization review specialist?

To thrive as a Therapy Utilization Review specialist, you need a solid background in clinical therapy practice (such as physical, occupational, or speech therapy), often supported by licensure and clinical experience. Familiarity with medical review software, electronic health records (EHRs), and utilization management systems is typically required, along with knowledge of insurance guidelines and regulatory standards. Strong analytical thinking, attention to detail, and clear communication skills help professionals effectively assess treatment plans and collaborate with both providers and payers. These skills and qualities are essential for ensuring that patients receive medically necessary, cost-effective therapy while maintaining compliance with regulations.

What are some common challenges faced by professionals in therapy utilization review, and how can they be managed?

One of the main challenges in Therapy Utilization Review is balancing the clinical needs of patients with insurance guidelines and organizational policies. Professionals often need to make difficult decisions about treatment approvals while communicating effectively with both therapists and insurance providers. Staying current on clinical guidelines, maintaining strong documentation skills, and developing firm but empathetic communication abilities can help manage these challenges. Collaboration with interdisciplinary teams is also essential to ensure patients receive appropriate care while meeting regulatory requirements.

What is the difference between Therapy Utilization Review vs Speech-Language Pathologist?

AspectTherapy Utilization ReviewSpeech-Language Pathologist
CredentialsTypically requires healthcare or insurance-related certificationsRequires a master's degree in speech-language pathology and state licensure
Work EnvironmentInsurance companies, healthcare organizations, or utilization review departmentsHospitals, clinics, schools, or private practice
Industry UsageFocuses on evaluating therapy necessity and coverageProvides direct therapy services to patients with speech or language disorders

While Therapy Utilization Review involves assessing the necessity of therapy services for insurance coverage, Speech-Language Pathologists provide direct patient care. Both roles require healthcare knowledge, but they differ in focus: one is review-based, the other is clinical service delivery.

What are popular job titles related to Therapy Utilization Review jobs in Texas?

For Therapy Utilization Review jobs in Texas, the most frequently searched job titles are:

What job categories do people searching Therapy Utilization Review jobs in Texas look for?

The top searched job categories for Therapy Utilization Review jobs in Texas are:

What cities in Texas are hiring for Therapy Utilization Review jobs?

Cities in Texas with the most Therapy Utilization Review job openings:

Therapy Utilization Review jobs near you
Infographic showing various Therapy Utilization Review job openings in Texas as of August 2026, with employment types broken down into 1% As Needed, 84% Full Time, 12% Part Time, 2% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $61,895 per year, or $29.8 per hour.

RN Utilization Review Coordinator, Full-time

Surgery Partners

Addison, TX • On-site

Full-time

Re-posted 18 days ago

Surgery Partners rating

7.7

Company rating: 7.7 out of 10

Based on 85 frontline employees who took The Breakroom Quiz

160th of 893 rated healthcare providers

Job description

Hiring Now for RN Utilization Review Coordinator
Department: Case Management
Shift: Full-time Hybrid
Job Summary:
The RN Case Manager/Utilization Review is responsible for performing prospective, concurrent, and post-discharge utilization reviews to ensure appropriate patient status, medical necessity, and compliance with hospital policy, payer requirements, and applicable local, state and federal regulations, including Centers for Medicare & Medicaid Services (CMS) guidelines. The role supports accurate admission status determinations, active denial management, and collaboration with physicians, case managers, and interdisciplinary team members to promote efficient patient progression through the episode of care. This position also assists with discharge planning activities and contributes to quarterly and annual utilization review reporting and performance improvement initiatives.
Utilization Review and Medical Necessity
  1. Conduct comprehensive medical record reviews using specific criteria and guidelines as approved and/or established by medical staff, CMS, and other state and federal agencies while ensuring physician and nurse documentation meets set standards.
  2. Perform prospective (pre-admission and pre-operative), concurrent, and post-discharge utilization reviews to verify medical necessity and appropriate level of care throughout the episode of care using the hospital-approved criteria software.
  3. Screen and determine appropriate admission status (inpatient, observation, outpatient, or outpatient in a bed) based on clinical documentation, hospital-approved medical-necessity guidelines, and payer requirements.
  4. Facilitate appropriate admission status determinations based on clinical documentation and payer requirements.
  5. Review clinical documentation for accuracy, completeness, and compliance with regulatory and payer standards.
  6. Collaborate with physicians and nursing staff to ensure timely, accurate orders and documentation supporting medical necessity.
  7. Communicate with physicians when cases do not meet admission or continued stay criteria and assist with resolution.
  8. Submit timely admission, continued stay, and discharge notification and appropriate clinicals to insurance companies as required.
  9. Complete admission status changes as needed in the hospital computer system.

Denial Management:
  1. Identify, track, and manage utilization review denials related to admission status, level of care, length of stay, and medical necessity.
  2. Draft, write, and submit denial appeal letters using clinical judgment, medical record review, applicable payer, CMS, and regulatory guidelines to support medical necessity determinations.
  3. Collaborate with physicians, case managers, physician advisors, and leadership to obtain supporting clinical documentation, physician statements, and peer-to-peer review input for appeals to support denial resolution.
  4. Monitor denial outcomes, appeal success rates, and payer trends; analyze root causes and provide feedback, education, and recommendations to reduce future denials.
  5. Maintain accurate documentation of denials and appeals in accordance with hospital policy and regulatory requirements.

Discharge Planning Support
  1. When needed, collaborate with the Case Management team to support timely and safe discharge planning.
  2. Serve as the patient advocates and enhances collaborative relationships with the healthcare team, physicians, patients, and families to maximize the patient's and family's ability to make informed healthcare decisions.
  3. When needed, assist in identifying and addressing barriers to discharge, including durable medical equipment (DME), home health services, medications, and therapy need.
  4. Reinforce patient and family education to promote successful transitions of care.
  5. When needed, transmit Continuity of Care Documents to appropriate post-acute providers to ensure follow-up care.

Reporting, Compliance & Quality
  1. Monitor, track, and analyze avoidable days and extended lengths of stay; identify contributing factors related to utilization, payer processes, discharge barriers, and system delays, and collaborate with Case Management, physicians, and interdisciplinary teams to support timely resolution.
  2. Assist the Case Management Manager and Quality Director with data collection and analysis for quarterly and annual utilization review reports.
  3. Participate in regulatory audits, surveys, and internal reviews related to utilization management.
  4. Investigate and report adverse occurrences and trends related to utilization, discharge planning, or resource management.
  5. Provide staff education related to utilization review processes, medical necessity, and resource utilization.

Professional Responsibilities:
Must demonstrate high attention to detail, the ability to multi-task, prioritize, and have strong critical thinking skills to address issues that arise unexpectedly.
  1. Must encompass the skill to follow through with tasks and situations while providing clear communication to others throughout the process.
  2. Maintain a high standard of professionalism and ethical conduct in accordance with hospital policies and the Methodist Hospital for Surgery Code of Conduct.
  3. Support and facilitate initiatives enhancing patient outcomes, patient satisfaction, and regulatory compliance.
  4. Communicate effectively, professionally, accurately, and timely with all staff and patients.
  5. Demonstrates the spirit of philosophy, mission, and values of the hospital through words and actions and implements them into departmental processes, programs, and the working environment
  6. Perform other duties as assigned or required.

Minimum Requirements:
Education: Bachelor of Science in Nursing preferred.
Certification, Licensure: Active RN license in Texas; current CPR certification. Case Management Certification(s) preferred.
Experience, Training, Knowledge: At least five years of experience with Case Management, Discharge Planning, and Utilization Review.
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

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