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Utilization Review Case Management Rn Jobs in Allen, TX

USPI, INC.

Case Manager | Registered Nurse

Dallas, TX · On-site

... quarterly Utilization Management Committee Meetings. * Review medical records to evaluate the ... Current Texas RN License. * Current Basic Life Support (BLS) certification accredited by American ...

Uniti Med

RN - Case Manager

Dallas, TX · On-site

Referral bonus up to $700 Registered Nurse (RN), Case Management/Utilization Review About the Company: Uniti Med is an award-winning healthcare staffing company with a mission to provide staffing ...

A-Line Staffing Solutions

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Clinical Review Nurse - Medicare Utilization Management

Dallas, TX · Remote

$43/hr

Work with healthcare providers, authorization teams, case management, and internal departments to ... Support RN-to-Medical Director referral and alignment metrics * Follow all applicable policies ...

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Valor Healthcare, Inc.

RN Case Manager

Dallas, TX · On-site

Prepare and review case files for Medical Evaluation Board and Physical Evaluation Board processes ... Minimum 2 years of case management, care coordination, or utilization management experience

TEKsystems

Utilization Review Specialist

Addison, TX

$70K - $100K/yr

Utilization review experience Additional Skills & Qualifications * Perform utilization review ... Collaborate with physicians, case management teams, and payers to support authorization and ...

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Utilization Review Case Management Rn information

See Allen, TX salary details

$17

$44

$74

How much do utilization review case management rn jobs pay per hour?

As of Sep 15, 2026, the average hourly pay for utilization review case management rn in Allen, TX is $44.21, according to ZipRecruiter salary data. Most workers in this role earn between $32.88 and $53.46 per hour, depending on experience, location, and employer.

What cities near Allen, TX are hiring for Utilization Review Case Management Rn jobs?

Cities near Allen, TX with the most Utilization Review Case Management Rn job openings:

Medical Case Manager

Dallas, TX • On-site

AmTrust Financial Services, Inc.
Insurance Services • 5 - 10K employees
Learn more about AmTrust Financial Services, Inc.external

Full-time

Medical, Dental, Life, Retirement, PTO

Re-posted 12 hours ago

Job description

Overview
AmTrust Financial Services, a fast growing commercial insurance company, has a need for a Telephonic Medical Case Manager, RN.
PRIMARY PURPOSE: To provide comprehensive quality telephonic case management to proactively drive a medically appropriate return to work through engagement with the injured employee, provider and employer. Our nurses will be empathetic informative medical resources for our injured employees and they will partner with our adjusters to develop a personalized holistic approach for each claim. These responsibilities may include utilization review, pharmacy oversight and care coordination.
This position is remote in Texas.
Responsibilities
  • Uses clinical/nursing skills to determine whether all aspects of a patient's care, at every level, are medically necessary and appropriately delivered.
  • Perform Utilization Review activities prospectively, concurrently or retrospectively in accordance with the appropriate jurisdictional guidelines.
  • Sends letters as needed to prescribing physician(s) and refers to physician advisor as necessary
  • Responsible for accurate comprehensive documentation of case management activities in case management system.
  • Uses clinical/nursing skills to help coordinate the individual's treatment program while maximizing quality and cost-effectiveness of care including direction of care to preferred provider networks where applicable.
  • Addresses need for job description and appropriately discusses with employer, injured employee and/or provider. Works with employers on modifications to job duties based on medical limitations and the employee's functional assessment.
  • Responsible for helping to ensure injured employees receive appropriate level and intensity of care through use of medical and disability duration guidelines, directly related to the compensable injury and/or assist adjusters in managing medical treatment to drive resolution.
  • Communicates effectively with claims adjuster, client, vendor, supervisor and other parties as needed to coordinate appropriate medical care and return to work.
  • Performs clinical assessment via information in medical/pharmacy reports and case files; assesses client's situation to include psychosocial needs, cultural implications and support systems in place
  • Objectively and critically assesses all information related to the current treatment plan to identify barriers, clarify or determine realistic goals and objectives, and seek potential alternatives.
  • Partners with the adjuster to develop medical resolution strategies to achieve maximal medical improvement or the appropriate outcome
  • Evaluate and update treatment and return to work plans within established protocols throughout the life of the claim.
  • Engage specialty resources as needed to achieve optimal resolution (behavioral health program, physician advisor, peer reviews, medical director).
  • Partner with adjuster to provide input on medical treatment and recovery time to assist in evaluating appropriate claim reserves
  • Maintains client's privacy and confidentiality; promotes client safety and advocacy; and adheres to ethical, legal, accreditation and regulatory standards.
  • Other duties as may be assigned.
  • Supports the organization's quality program(s).

Qualifications
Education & Licensing
  • Active unrestricted compact RN license in a state or territory of the United States required.
  • Bachelor's degree in nursing (BSN) from accredited college or university or equivalent work experience preferred.
  • Certification in case management, pharmacy, rehabilitation nursing or a related specialty is highly preferred.
  • Ability to acquire, and maintain, appropriate Professional Certifications and Licenses to comply with respective state laws may be required
  • Preferred for license(s) to be obtained within three - six months of starting the job.
  • Written and verbal fluency in Spanish and English preferred

Experience
3+ years of related experience or equivalent combination of education and experience required to include 2+ years of direct clinical care OR 2+ years of case management/utilization management required.
Skills & Knowledge:
  • Knowledge of workers' compensation laws and regulations
  • Knowledge of case management practice
  • Knowledge of the nature and extent of injuries, periods of disability, and treatment needed
  • Knowledge of URAC standards, ODG, Utilization review, state workers compensation guidelines
  • Knowledge of pharmaceuticals to treat pain, pain management process, drug rehabilitation
  • Knowledge of behavioral health
  • Excellent oral and written communication, including presentation skills
  • PC literate, including Microsoft Office products
  • Leadership/management/motivational skills
  • Analytic and interpretive skills
  • Strong organizational skills
  • Excellent interpersonal and negotiation skills
  • Ability to work in a team environment
  • Ability to meet or exceed Performance Competencies

WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding
Auditory/Visual: Hearing, vision and talking
The expected salary range for this role is $80,000.00-$88,000.00.
Please note that the salary information shown above is a general guideline only. Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations.
What We Offer
AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off.
AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.
AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.

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