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Utilization Management Non Clinical Jobs in Texas

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

Collects clinical and non-clinical data. * Verifies eligibility. * Determines benefit levels in accordance to contract guidelines. * Provides information regarding utilization management requirements ...

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Utilization Management Non Clinical information

Can you do a utilization review without being a nurse?

Utilization Management Non Clinical roles typically do not require a nursing license, as they focus on reviewing medical necessity and appropriateness of services based on guidelines and policies. These positions often require strong analytical skills, knowledge of healthcare policies, and sometimes certifications like Certified Professional in Healthcare Quality (CPHQ), but do not usually mandate nursing credentials.

Which non-clinical healthcare jobs pay the most?

In non-clinical healthcare roles, positions such as healthcare administrators, health information managers, and utilization management directors tend to have the highest salaries. These roles often require advanced degrees, certifications, and strong management or technical skills, and they typically offer six-figure compensation depending on experience and location.

What jobs pay 4000 a week without a degree?

Utilization Management Non Clinical roles typically do not pay $4,000 a week without a degree, as they often require healthcare knowledge or certifications. High-paying jobs that can reach this level without a degree include certain sales positions, real estate brokers, or specialized trades like commercial pilots or skilled trades, which may require licenses or experience. Most roles paying this amount without a degree involve sales, entrepreneurship, or skilled labor with relevant certifications or experience.

What is the difference between Utilization Management Non Clinical vs Utilization Review Nurse?

AspectUtilization Management Non ClinicalUtilization Review Nurse
CredentialsCertifications like CCM, RN (optional), but primarily non-clinical certificationsRN license, certifications such as CCM or CUC
Work EnvironmentOffice-based, administrative setting, telecommuting optionsClinical settings, hospitals, or insurance companies, often with direct patient or provider interaction
Employer & Industry UsageHealth insurance companies, managed care organizationsHospitals, insurance companies, healthcare providers
Search & Comparison IntentUnderstanding non-clinical roles in utilization managementClinical review roles involving direct patient care assessment

Utilization Management Non Clinical roles focus on administrative, policy, and documentation tasks without direct patient care, while Utilization Review Nurses perform clinical assessments to determine care necessity. Both roles are essential in healthcare utilization but differ mainly in clinical involvement and required credentials.

What is an example of a non-clinical position?

A non-clinical position in utilization management, such as Utilization Management Non-Clinical roles, involves reviewing medical records and insurance policies to determine coverage and appropriateness of care without direct patient interaction. These roles typically require knowledge of healthcare policies, strong analytical skills, and familiarity with healthcare management systems.
What are popular job titles related to Utilization Management Non Clinical jobs in Texas? For Utilization Management Non Clinical jobs in Texas, the most frequently searched job titles are:
What job categories do people searching Utilization Management Non Clinical jobs in Texas look for? The top searched job categories for Utilization Management Non Clinical jobs in Texas are:
What cities in Texas are hiring for Utilization Management Non Clinical jobs? Cities in Texas with the most Utilization Management Non Clinical job openings:
Utilization Management Non Clinical jobs near you
Infographic showing various Utilization Management Non Clinical job openings in Texas as of July 2026, with employment types broken down into 100% Full Time. Highlights an 50% In-person, and 50% Remote job distribution.
Utilization Review Nurse

Utilization Review Nurse

Bracane Co

Plano, TX • Remote

Full-time

Posted 12 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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