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Utilization Management Nurse Jobs in Spring, TX (NOW HIRING)

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.

Harris Health System

BH Utilization Manager RN

Houston, TX · On-site

$67K - $85K/yr

We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of ... Behavioral Health Utilization Manager will perform concurrent and discharge reviews on assigned ...

Medix

Utilization Management Manager

Houston, TX · On-site

$57/hr

Job Summary Our client is seeking a Utilization Management Manager to review clinical documentation ... Registered Nurse license by Texas Board of Nursing or Nursing Licensure Compact required (must have ...

Actalent

Concurrent Review Nurse

Houston, TX · On-site

Actalent is Hiring a Team of Concurrent Review Nurses (Utilization Management)!! This role performs concurrent reviews of inpatient acute and post-acute cases to determine medical necessity, evaluate ...

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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All JobsUtilization Management Nurse JobsUtilization Management Nurse Jobs in Spring, TX

Utilization Management Nurse information

See Spring, TX salary details

$34.7K

$79.6K

$145.1K

How much do utilization management nurse jobs pay per year?

As of Aug 31, 2026, the average yearly pay for utilization management nurse in Spring, TX is $79,630.00, according to ZipRecruiter salary data. Most workers in this role earn between $57,400.00 and $93,000.00 per year, depending on experience, location, and employer.

What is a utilization management nurse?

A Utilization Management Nurse is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services provided to patients. They review medical records and treatment plans to ensure that care meets established guidelines and is cost-effective. Utilization Management Nurses work with healthcare providers, insurance companies, and patients to coordinate care and prevent unnecessary procedures or hospitalizations. Their goal is to support high-quality patient care while managing healthcare costs.

What does a utilization management nurse do?

A utilization management nurse ensures that healthcare services are administered appropriately. Their job responsibilities include working in a hospital, health practice, or other clinical setting reviewing patient clinical records, drafting clinical appeals, and overseeing staff members. The qualifications for a utilization management nurse include a nursing degree and a registered nursing license. Most people in this job also have career experience in case management and utilization review.

What are the key skills and qualifications needed to thrive as a utilization management nurse?

To thrive as a Utilization Management Nurse, you need a registered nursing license, strong clinical judgment, and experience in case management or utilization review. Familiarity with medical management software, InterQual or Milliman guidelines, and insurance authorization processes is typically required. Excellent analytical thinking, communication, and negotiation skills help you coordinate with providers and advocate for patients. These competencies ensure appropriate resource use, compliance with regulations, and optimal patient outcomes.

What are some common challenges a utilization management nurse faces when coordinating care between providers and insurance companies?

A Utilization Management Nurse often navigates the challenge of balancing patient advocacy with insurance guidelines, ensuring that care recommendations meet both clinical standards and payer requirements. Communicating complex medical information to both providers and insurance representatives can be demanding, especially when there are disagreements about coverage or medical necessity. Additionally, staying updated on changing policies and maintaining thorough documentation under tight deadlines are frequent aspects of the role. Strong collaboration skills and attention to detail are essential for success in this position.

What is the difference between Utilization Management Nurse vs Case Manager?

AspectUtilization Management NurseCase Manager
CredentialsRN license, certifications in utilization reviewRN license, case management certification often preferred
Work EnvironmentInsurance companies, healthcare organizations, utilization review departmentsHospitals, community health agencies, insurance companies
Primary FocusReviewing medical necessity and appropriateness of servicesCoordinating patient care and discharge planning

Utilization Management Nurses primarily focus on reviewing medical necessity and approving healthcare services, while Case Managers coordinate patient care and facilitate discharge planning. Both roles require RN licensure and work within healthcare or insurance settings, but their core responsibilities differ in scope and focus.

More about Utilization Management Nurse jobs

What are the most commonly searched types of Utilization Management Nurse jobs in Spring, TX?

The most popular types of Utilization Management Nurse jobs in Spring, TX are:

What are popular job titles related to Utilization Management Nurse jobs in Spring, TX?

For Utilization Management Nurse jobs in Spring, TX, the most frequently searched job titles are:

What job categories do people searching Utilization Management Nurse jobs in Spring, TX look for?

The top searched job categories for Utilization Management Nurse jobs in Spring, TX are:

What cities near Spring, TX are hiring for Utilization Management Nurse jobs?

Cities near Spring, TX with the most Utilization Management Nurse job openings:

Utilization Management Nurse jobs near you
Infographic showing various Utilization Management Nurse job openings in Spring, TX as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 14% Part Time, and 2% Contract. Highlights an 82% Physical, 3% Hybrid, and 15% Remote job distribution, with an average salary of $79,630 per year, or $38.3 per hour.

Utilization Management

Houston, TX • On-site

HealthCare Support
Recruiting and Staffing Services • 201 - 500 employees
Learn more about HealthCare Supportexternal

$38 - $42/hr

Other

Medical, Dental, Life

Posted 27 days ago

Job description

RN Outpatient Utilization Review Remote Texas
HealthCare Support is actively seeking multiple Outpatient Utilization Review Registered Nurses with our prestigious Healthcare Client. Applications must reside in Texas. Houston, TX candidates are preferred.
Daily Responsibilities for RN Outpatient Utilization Review Remote Texas:
  • Review telephonic and faxed clinical information to authorize medically necessary inpatient and outpatient care, utilizing nationally recognized evidenced based clinical criteria or approved medical guidelines. Refers cases that do not meet criteria to Medical Director for review.
  • Assists in discharge planning especially Home Health Nursing requests and DME requests for members at the time of discharge as well as new requests for members who have not had recent hospitalization. Review any requests for extension of these services and if not meeting criteria, refer to the Medical Director.
  • Participates in Community Nursing Rounds if applicable with Medical Director and is adequately prepared. Assists co-workers with difficult cases through open discussion. Communicates concerns that arise in these discussions to the Manager and/or Medical Director.
  • Monday to Friday 8-5 six positions available
    Thurs- Sun 10 hr days six positions available
Required Qualifications for RN Outpatient Utilization Review Remote Texas:
  • RN, current Texas License
  • 3 years of UR/UM
  • Highlight lines of business worked- Texas Medicaid, CHIP, marketplace
  • Highlight experience - was it inpatient or outpatient
  • Microsoft Office (Word, Outlook, Excel)
Benefits for RN Outpatient Utilization Review Remote Texas:
  • Health Insurance
  • Dental Insurance
  • Life Insurance
  • Employee Assistance Program (EAP)
  • Access to Investment Accounts
  • Career and educational tools within our Ingenovis ACT (advocacy) Program
Pay Details: $38 - $42/ Hour
Interested in Being Considered?
If you are interested in applying to this position, please click Apply Now for immediate consideration.
For additional questions, you may contact us at Ryan.Chojnacki@healthcaresupport.com. Please include your phone number, Job Title, and location and our recruiters will reach out.
Healthcare Support Staffing, LLC is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.
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About Healthcare Support

Sourced by ZipRecruiter

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Maitland, FL, US

Year founded

2003

Social media

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