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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 ...

GuideWell

Utilization Management RN

Irving, TX · On-site

Utilization Management (UM) nurses will provide our clients with appropriate and comprehensive ... Ability to work as a team member, effectively and collaboratively, with non-clinical teammates.

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All JobsUtilization Management Non Clinical JobsUtilization Management Non Clinical Jobs in Texas

Utilization Management Non Clinical information

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.

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For Utilization Management Non Clinical jobs in Texas, the most frequently searched job titles are:

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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 August 2026, with employment types broken down into 6% As Needed, and 94% Full Time. Highlights an 75% In-person, and 25% Remote job distribution.

Utilization Review Nurse

Bracane Co

Plano, TX • Remote

Full-time

Re-posted 4 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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