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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) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent medical record review for medical ...

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Utilization Review Rn information

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$39

$64

How much do utilization review rn jobs pay per hour?

As of Jul 21, 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 to get into utilization review as a nurse?

To become a utilization review RN, candidates typically need a valid nursing license and experience in clinical settings. Additional certifications such as Certified Professional in Healthcare Quality (CPHQ) or case management credentials can enhance prospects, and familiarity with electronic health records and insurance policies is beneficial.

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.

How to make $300,000 as a nurse?

A Utilization Review RN can earn $300,000 by gaining extensive experience, obtaining certifications such as Certified Review Officer (CRO), working in high-paying settings like insurance companies or managed care organizations, and taking on leadership or specialized roles that offer higher compensation. Advanced skills in clinical assessment, documentation, and understanding of healthcare policies can also contribute to higher earnings.

What does an RN utilization review do?

An RN utilization review evaluates medical records and treatment plans to determine the necessity, appropriateness, 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.

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 Certified Review Officer (CRO), working in high-demand settings, and possibly taking on leadership or specialized roles. Increasing your workload, working overtime, or pursuing advanced education can also contribute to higher earnings within this field.

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.
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Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Texas as of July 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 1% Temporary, 2% Contract, and 1% Nights. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $81,936 per year, or $39.4 per hour.
Registered Nurse (RN) - Utilization Review

Registered Nurse (RN) - Utilization Review

Cook Children's Health Care System

Prosper, TX • On-site

Full-time

Medical, Dental, Vision, Life, Retirement

Re-posted yesterday

Cook Children's Health Care System rating

7.7

Company rating: 7.7 out of 10

Based on 74 frontline employees who took The Breakroom Quiz

158th of 886 rated healthcare providers

Job description

Cook Children’s Health Care System is seeking a Registered Nurse (RN) Utilization Review for a nursing job in Prosper, Texas.

Job Description & Requirements
  • Specialty: Utilization Review
  • Discipline: RN
  • Start Date: 07/26/2026
  • Duration: Ongoing
  • 40 hours per week
  • Shift: 8 hours
  • Employment Type: Staff

Location:

Medical Center-Prosper

Department:

Administration-Nursing

Shift:

First Shift (United States of America)

Standard Weekly Hours:

40

Summary:

The advanced-level Clinical Risk Coordinator leads the department’s risk management strategy. This level provides expert guidance on risk mitigation, oversees risk-related initiatives, and ensures compliance with all regulatory standards.

Education and Experience

  • Bachelor’s degree in nursing, Healthcare Administration, or related field from an accredited college or university required.

  • 5 years’ minimum experience in a healthcare setting required.

  • 2 years’ experience in healthcare risk management, accreditation, quality improvement or patient safety, including project management or leadership experience.

Knowledge, Skills, & Abilities

  • Must be proficient in Microsoft Office suite (e.g. Outlook, Word, Excel, Power Point).

  • Must be proficient in incident management software. 

  • Must have expertise managing complex projects.

Licensure, Registration, and/or Certification

  • Current license to practice professional nursing in the State of Texas or minimally required experience in a healthcare setting.

About Us:

Cook Children’s is an equal opportunity employer. As such, Cook Children’s offers equal employment opportunities without regard to race, color, religion, sex, age, national origin, physical or mental disability, pregnancy, protected veteran status, genetic information, or any other protected class in accordance with applicable federal laws. These opportunities include terms, conditions and privileges of employment, including but not limited to hiring, job placement, training, compensation, discipline, advancement and termination.

The advanced-level Clinical Risk Coordinator leads the department’s risk management strategy. This level provides expert guidance on risk mitigation, oversees risk-related initiatives, and ensures compliance with all regulatory standards.

Education and Experience

  • Bachelor’s degree in nursing, Healthcare Administration, or related field from an accredited college or university required.

  • 5 years’ minimum experience in a healthcare setting required.

  • 2 years’ experience in healthcare risk management, accreditation, quality improvement or patient safety, including project management or leadership experience.

Knowledge, Skills, & Abilities

  • Must be proficient in Microsoft Office suite (e.g. Outlook, Word, Excel, Power Point).

  • Must be proficient in incident management software. 

  • Must have expertise managing complex projects.

Licensure, Registration, and/or Certification

  • Current license to practice professional nursing in the State of Texas or minimally required experience in a healthcare setting.

Cook Childrens Health Care System Job ID #JR-117962. Posted job title: RN, Utilization Review

About Cook Children’s Health Care System

About Cook Children's

When you work here, you grow here.

Promise is a strong word with deep meaning that everyone understands-especially kids. This is what drives us to blaze new trails with innovative technology, research, exceptional medical care and competitive programs that benefit children who don’t otherwise have access to quality health care. Cook Children's employees come to work every day to keep that Promise, connecting the dots between caregivers, families and communities.

Surpassing 105 years, with more than 10,000 employees, we are here for every child, every day. Our not-for-profit organization includes two medical centers, a large physician network, a home health company, three surgery centers, a health plan, health services and a health foundation. We are proud to be Forbes' #1 Best Large U.S. Employer in Health Care with nearly 100 clinical locations throughout Texas, where we invite you to call home.

Apply now and be part of this magic.

Benefits
  • Holiday Pay
  • Continuing Education
  • 403b retirement plan
  • Pet insurance
  • Sick pay
  • Wellness and fitness programs
  • Mileage reimbursement
  • Medical benefits
  • Dental benefits
  • Vision benefits
  • Life insurance
  • Discount program
  • Employee assistance programs

What Cook Children's Health Care System employees say

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Benefits

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Cook Children's Health Care System logo

About Cook Children's Health Care System

Sourced by ZipRecruiter

Cook Children's Health Care System, based in Fort Worth, Texas, operates in the healthcare industry with a primary focus on pediatric health services. Established in 1918, the system has been committed to improving the health of children through the prevention and treatment of childhood diseases. This integrated pediatric healthcare system includes a medical center, physician network, home health company, research institute, and a health plan. At the core of its operations is the mission to 'Improve the Health of Every Child' in its community, reflecting its commitment to providing quality care, research, education, and prevention and wellness services.

Industry

Health care and social assistance

Company size

5,001 - 10,000 Employees

Headquarters location

Fort Worth, TX, US

Year founded

1918

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