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Utilization Review Rn Jobs in Texas (NOW HIRING)

Midland Health

Nurse Utilization Review

Midland, TX · On-site

The utilization review (UR) nurse serves to maximize the quality and cost efficiency of health care ... The UR nurse will also assist Registered Nurse (RN) Case Managers and Social Workers with helping ...

Midland Health

Nurse Utilization Review

Midland, TX · On-site

The utilization review (UR) nurse serves to maximize the quality and cost efficiency of health care ... The UR nurse will also assist Registered Nurse (RN) Case Managers and Social Workers with helping ...

Midland Health

Nurse Utilization Review

Midland, TX

The utilization review (UR) nurse serves to maximize the quality and cost efficiency of health care ... The UR nurse will also assist Registered Nurse (RN) Case Managers and Social Workers with helping ...

Midland Health

Nurse Utilization Review

Midland, TX · On-site

The utilization review (UR) nurse serves to maximize the quality and cost efficiency of health care ... The UR nurse will also assist Registered Nurse (RN) Case Managers and Social Workers with helping ...

Ascension

Registered Nurse Utilization Review

Austin, TX · Remote

$84K - $118K/yr

May prepare statistical analysis and utilization review reports as necessary. * Oversee and ... Licensed Registered Nurse credentialed from the Texas Board of Nursing or current home state ...

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How much do utilization review rn jobs pay per hour?

As of Jun 6, 2026, the average hourly pay for utilization review rn in Texas is $39.39, according to ZipRecruiter salary data. Most workers in this role earn between $31.15 and $45.24 per hour, depending on experience, location, and employer.

How does a Utilization Review RN collaborate with physicians and other healthcare professionals during the patient care review process?

A Utilization Review RN works closely with physicians, case managers, and other healthcare team members to ensure that patients receive appropriate care while adhering to regulatory and insurance guidelines. This collaboration often involves discussing clinical findings, clarifying documentation, and negotiating care plans to meet both patient needs and payer requirements. Effective communication and teamwork are essential, as Utilization Review RNs frequently serve as liaisons between clinical staff and insurance representatives to facilitate timely authorizations and prevent unnecessary delays in patient care.

What are the key skills and qualifications needed to thrive as a Utilization Review RN, and why are they important?

To thrive as a Utilization Review RN, you need a current RN license, strong clinical assessment skills, and knowledge of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or ACM is often required. Excellent critical thinking, communication, and negotiation skills help you advocate for appropriate patient care while collaborating with providers and payers. These skills ensure cost-effective, quality care and compliance with regulatory standards in healthcare delivery.

What is the difference between Utilization Review Rn vs Case Manager?

AspectUtilization Review RnCase Manager
CredentialsRN license, certifications in utilization reviewRN license, certifications in case management
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community agencies, insurance companies
Primary FocusReviewing medical necessity and appropriateness of careCoordinating patient care and discharge planning

Utilization Review Rns primarily focus on evaluating the necessity of medical treatments, while Case Managers coordinate patient care and discharge planning. Both roles require RN licensure and certifications, but their daily responsibilities and work environments differ slightly, with Utilization Review Rns concentrating on review processes and Case Managers on patient advocacy and care coordination.

What is a Utilization Review RN?

A Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, collaborate with healthcare teams, and ensure that patient care meets established guidelines and payer requirements. Their role helps control costs, optimize care, and support compliance with healthcare regulations. Utilization Review RNs often work in hospitals, insurance companies, or managed care organizations.
What are the most commonly searched types of Utilization Review Rn jobs in Texas? The most popular types of Utilization Review Rn jobs in Texas are:
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What cities in Texas are hiring for Utilization Review Rn jobs? Cities in Texas with the most Utilization Review Rn job openings:
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Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Texas as of May 2026, with employment types broken down into 5% As Needed, 85% Full Time, and 10% Part Time. Highlights an 90% In-person, and 10% Remote job distribution, with an average salary of $81,936 per year, or $39.4 per hour.

PRN Utilization Review RN - M-F Days

844107 - Utilization Management

Dallas, TX • On-site

Per diem

Medical, Retirement, PTO

Posted 17 days ago

Job description

PRN Utilization Review RN - M-F Days
Must be available to work daytime hours (between 8am-6:30pm) Monday - Friday
WHY UT SOUTHWESTERN?
With over 75 years of excellence in Dallas-Fort Worth, Texas, UT Southwestern is committed to excellence, innovation, teamwork, and compassion. As a world-renowned medical and research center, we strive to provide the best possible care, resources, and benefits for our valued employees. Ranked as the number 1 hospital in Dallas-Fort Worth according to U.S. News & World Report , we invest in you with opportunities for career growth and development to align with your future goals. Our highly competitive benefits package offers healthcare, PTO and paid holidays, on-site childcare, wage, merit increases and so much more. We invite you to be a part of the UT Southwestern team where you'll discover a culture of teamwork, professionalism, and a rewarding career!
JOB SUMMARY
Conduct medical certification review for medical necessity for acute care facility and services. Use nationally recognized, evidence-based guidelines approved by medical staff to recommend level of care to the physician and serve as a resource to the medical staff on issues related to admission qualifications, resource utilization, national and local coverage determinations and documentation requirements.
BENEFITS
UT Southwestern is proud to offer a competitive and comprehensive benefits package to eligible employees. Our benefits are designed to support your overall wellbeing, and include:
  • PPO medical plan, available day one at no cost for full-time employee-only coverage
  • 100% coverage for preventive healthcare-no copay
  • Paid Time Off, available day one
  • Retirement Programs through the Teacher Retirement System of Texas (TRS)
  • Paid Parental Leave Benefit
  • Wellness programs
  • Tuition Reimbursement
  • Public Service Loan Forgiveness (PSLF) Qualified Employer
  • Learn more about these and other UTSW employee benefits!
EXPERIENCE AND EDUCATION
Required
  • Education
    Graduate of accredited nursing program and holds an active unrestricted RN license in the State of Texas
  • Experience
    5 years experience to include 2 years of clinical experience and minimum of 3 years of recent utilization review experience. and
    Prior experience with Epic CCM.
  • Licenses and Certifications
    (RN) REGISTERED NURSE Holds an active unrestricted license in the State of Texas. and
Preferred
  • Experience
    Acute care experience preferred
JOB DUTIES
  • Collaborates with the Central Scheduling Department (CSD) team to provide accurate and complete clinical information in order to obtain authorization.
  • Conducts admission reviews for Medicare and Medicaid beneficiaries as well as private insurance members and self-pay patients utilizing evidence-based guidelines.
  • New admission reviews are done concurrently at the point of entry when the admission order is placed and necessary clinical information is available in the medical record.
  • Communicate with admitting physicians and physician advisors when documentation does not appear to support hospital level of care.
  • Use hospital approved medical necessity tool to determine level of care for inpatient or observation/outpatient services based on physician documentation, H&P, treatment plan, potential risks, and basis for expectation of a two-midnight stay.
  • Keeps current on all Federal, State and local regulatory changes that affect delivery or reimbursement of acute care services within the scope of Utilization Management. Uses knowledge of national and local coverage determinations to appropriately advise physicians.
  • Proactively collaborates with admitting physician to provide accurate level of care determination at the time of review.
  • Escalates identified progression-of-care/patient flow barriers to appropriate departments.
  • Actively participates in daily huddles, departmental meetingsand education offerings.
  • Identifies and records episodes of preventable delays or avoidable days due to failure of progression-of-care processes.
  • Educates members of the patient's care team on the appropriate access to and use of various levels of care.
  • Promotes use of evidence-based protocols and/or order sets to influence high-quality and cost-effective care.
  • Serves as a resource person to physicians, care coordinators, physician offices and billing office for coverage and compliance issues.
  • Completes all reviews within department established policies and best practice standards. Meets department quality standards as established for the department, ie: Inter-rater Reliability audits, completing all initial reviews within established time frames, completes concurrent and discharge reviews to meet department and industry standards.
  • Performs other duties as assigned.
SECURITY AND EEO STATEMENT
Security
This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information.
EEO
UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. As an equal opportunity employer, UT Southwestern prohibits unlawful discrimination, including discrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status.

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