ZipRecruiter

Log In

1

Utilization Review Rn Jobs in Texas (NOW HIRING)

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 ...

next page

Showing results 1-20

All JobsUtilization Review Rn JobsUtilization Review Rn Jobs in Texas

Utilization Review Rn information

See Texas salary details

$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:
What are popular job titles related to Utilization Review Rn jobs in Texas? For Utilization Review Rn jobs in Texas, the most frequently searched job titles are:
What job categories do people searching Utilization Review Rn jobs in Texas look for? The top searched job categories for Utilization Review Rn jobs in Texas are:
What cities in Texas are hiring for Utilization Review Rn jobs? Cities in Texas with the most Utilization Review Rn job openings:
What are popular job titles related to Utilization Review Rn jobs in TX? For Utilization Review Rn jobs in TX, the most frequently searched job titles are:
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.
Director of Utilization

Director of Utilization

Acadia Healthcare

El Paso, TX • On-site

Full-time

Posted 10 days ago

Key responsibilities

  • Direct and manage the day-to-day operations of the Utilization Review department.

  • Monitor utilization of services and optimize reimbursement for the facility while maximizing use of the patient's provider benefits.

  • Conduct and oversee concurrent and retrospective reviews for all patients.

Acadia Healthcare rating

6.1

Company rating: 6.1 out of 10

Based on 187 frontline employees who took The Breakroom Quiz

713th of 877 rated healthcare providers

Job description

Overview
PURPOSE STATEMENT:
Direct and manage the day-to-day operations of the Utilization Review department.
Responsibilities
ESSENTIAL FUNCTIONS:
  • Monitor utilization of services and optimize reimbursement for the facility while maximizing use of the patient's provider benefits for their needs.
  • Conducts and oversees concurrent and retrospective reviews for all patients.
  • Act as a liaison between Medicaid reviewers and the staff completing required paperwork to facilitate the Utilization Review process.
  • Collaborates with physicians, therapist and nursing staff to provide optimal review based on patient needs.
  • Collaborates with ancillary services in order to prevent delays in services.
  • Evaluates the UM program for compliance with regulations, policies and procedures.
  • May review charts and make necessary recommendations to the physicians, regarding utilization review and specific managed care issues.
  • Provide staff management to including hiring, development, training, performance management and communication to ensure effective and efficient department operation.

OTHER FUNCTIONS:
  • Perform other functions and tasks as assigned.

Qualifications
EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:
  • Bachelor's Degree in nursing or other clinical field required. Master's Degree in clinical field preferred.
  • Six or more year's clinical experience with the population of the facility preferred.
  • Four or more years' experience in utilization management required.
  • Three or more years of supervisory experience required.

LICENSES/DESIGNATIONS/CERTIFICATIONS:
  • If applicable, current licensure as an LPN or RN within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.

We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual's characteristics protected by applicable state, federal and local laws.

What Acadia Healthcare employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Acadia Healthcare logo

About Acadia Healthcare

Sourced by ZipRecruiter

Acadia Healthcare is a leading provider in the healthcare and hospital industry, based in Franklin, Tennessee, United States. The company is recognised for its commitment to creating a behavioural health network that provides accessible, high-quality treatment options for individuals suffering from mental health issues, addiction, eating disorders, and PTSD. Acadia Healthcare was founded in 2005, with the mission to create a world-class organization that sets the standard of excellence in the treatment of specialty behavioural health and addiction disorders.

Industry

Hospitals

Company size

10,000+ Employees

Headquarters location

Franklin, TN, US

Year founded

2005

Social media

Facebook

View All Acadia Healthcare Jobs

Apply