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Utilization Review Rn Jobs in Texas (NOW HIRING)

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

Austin area - Travis/Williamson Counties or Richardson area - Dallas/Collin Counties*** RN working ... This position is responsible for performing initial, concurrent review activities; discharge care ...

Houston Methodist

At Houston Methodist, the Utilization Review Nurse (URN) PRN position is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent medical record review for medical ...

Houston Methodist

At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent medical record review for medical ...

Acadia Healthcare

Director of Utilization

El Paso, TX · On-site

Collaborates with physicians, therapist and nursing staff to provide optimal review based on ... If applicable, current licensure as an LPN or RN within the state where the facility provides ...

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Utilization Review Rn information

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$19

$39

$64

How much do utilization review rn jobs pay per hour?

As of Jun 29, 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.

How do I become a utilization review RN?

To become a utilization review RN, you typically need to hold a valid registered nurse (RN) license and have experience in clinical nursing. Additional certifications such as the Certified Professional in Healthcare Quality (CPHQ) or Utilization Review Certification (URAC) can enhance job prospects, and strong knowledge of medical coding, insurance policies, and healthcare regulations is important.

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 does an RN utilization review do?

An RN utilization review evaluates medical records and treatment plans to determine the appropriateness, necessity, and efficiency of healthcare services. They ensure compliance with insurance policies and clinical guidelines, often using electronic health records and requiring knowledge of coding and documentation standards. This role supports cost-effective patient care and involves collaboration with healthcare providers and insurance companies.

How to make $300,000 a year as a nurse?

To earn $300,000 annually as a Utilization Review RN, professionals typically need extensive experience, advanced certifications such as CCM or ANCC, and may work in high-paying settings like insurance companies or healthcare consulting firms. Increasing specialization, taking on leadership roles, or working overtime can also boost income, but reaching this level often requires a combination of skills, experience, and strategic career moves.

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.

How to make $150,000 as a nurse?

A Utilization Review RN can earn $150,000 by gaining extensive experience, obtaining certifications such as CCM or ANCC, and working in high-paying settings like insurance companies or managed care organizations. Advanced skills in case management, strong clinical knowledge, and sometimes working overtime or in leadership roles can also contribute to higher earnings.

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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Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Texas as of June 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.
Utilization Review Specialist

Utilization Review Specialist

Medical Center Hospital

Odessa, TX

Full-time

Posted 14 days ago

Key responsibilities

  • Conducts concurrent and retrospective review functions in support of the hospital Utilization Review Program.

  • Makes appropriate referrals to designated Physician Advisors.

Medical Center Health System rating

8.2

Company rating: 8.2 out of 10

Based on 30 frontline employees who took The Breakroom Quiz

53rd of 877 rated healthcare providers

Job description

Position Summary:

The Utilization Review Specialist/Outcomes Specialist conducts concurrent and retrospective review functions in support of the hospital Utilization Review Program and makes appropriate referrals to designated Physician Advisors.

Qualifications:

A. Education:

Holds a current Texas license as a Registered Nurse OR a current Texas Licensed Vocational Nurse.

B. Training and Experience:

Three years of clinical nursing experience in a general medical/surgical setting or appropriate specialty area; at least one year in an acute care setting.

C. Job Knowledge:

Excellent verbal and written skills, well-rounded critical thinking skills, self-motivated, flexible, and goal-oriented. Ability to tolerate frequent interruptions and demanding workload.

VI. Unusual Physical Demands and Working Conditions:

Must be able to work long hours on occasion. Potential for some stress in meeting deadlines.

What Medical Center Health System employees say

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