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Utilization Review Rn Jobs in Austin, TX (NOW HIRING)

BCforward

Registered Nurse

Austin, TX · On-site

Pediatric, geriatric, general long term care experience, previous utilization review experience ... as a Registered Nurse. Maintains appropriate documentation and support for all requests.

UHS

UR COORDINATOR

Liberty Hill, TX

The Utilization Review Coordinator is responsible for bridging communications between the hospital ... Current Texas Registered Nurse License * Current Driver's License Knowledge and Skills: * Full ...

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All JobsUtilization Review Rn JobsUtilization Review Rn Jobs in Austin, TX

Utilization Review Rn information

See Austin, TX salary details

$20

$41

$67

How much do utilization review rn jobs pay per hour?

As of Jun 21, 2026, the average hourly pay for utilization review rn in Austin, TX is $41.23, according to ZipRecruiter salary data. Most workers in this role earn between $32.60 and $47.36 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 Austin, TX? The most popular types of Utilization Review Rn jobs in Austin, TX are:
What are popular job titles related to Utilization Review Rn jobs in Austin, TX? For Utilization Review Rn jobs in Austin, TX, the most frequently searched job titles are:
What job categories do people searching Utilization Review Rn jobs in Austin, TX look for? The top searched job categories for Utilization Review Rn jobs in Austin, TX are:
What cities near Austin, TX are hiring for Utilization Review Rn jobs? Cities near Austin, TX with the most Utilization Review Rn job openings:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Austin, TX as of June 2026, with employment types broken down into 88% Full Time, 10% Part Time, and 2% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $85,759 per year, or $41.2 per hour.
Registered Nurse, Utilization Review

Registered Nurse, Utilization Review

MMC Group

Austin, TX • On-site

Full-time

Medical, Dental, Vision, Life

Posted 3 days ago

Job description

Registered Nurse, Utilization Review (Remote)
Local Candidates in the Austin, TX Area Only
Long Term Opportunity | High Potential for Extension
Use Your Clinical Expertise to Improve Healthcare Outcomes, Without Providing Direct Patient Care
Are you an experienced Registered Nurse looking to transition away from bedside care while continuing to make a meaningful impact on patients' healthcare journeys? If you have a strong clinical background and experience evaluating medical necessity, this is an excellent opportunity to utilize your nursing expertise in a remote, collaborative environment.
Join a team dedicated to ensuring members receive medically appropriate, high quality, and cost-effective healthcare services while working alongside physicians, healthcare providers, and interdisciplinary teams.
Why You'll Love This Opportunity
  • Remote position for candidates living in the Austin, Texas area
  • No direct patient care
  • Long term contract with a high likelihood of extension
  • Monday through Friday schedule with occasional approved overtime
  • Opportunity to use your clinical knowledge to improve healthcare quality and outcomes
  • Collaborative and supportive team environment
  • Work with leading healthcare professionals and providers across Texas

Schedule
  • Must be available to work any 8-hour shift between 7:00 AM and 7:00 PM
  • Required shift availability includes 10:00 AM to 7:00 PM
  • Occasional overtime may be required and approved based on business needs

What You'll Do
As a Utilization Review Registered Nurse, you will use your clinical judgment to evaluate medical services and ensure members receive appropriate, medically necessary care.
Your responsibilities will include:
  • Conduct pre-service, concurrent, and retrospective utilization reviews
  • Evaluate medical necessity for outpatient services and out-of-network care
  • Assess the appropriateness of treatment settings using evidence based clinical guidelines
  • Collaborate with physicians, healthcare providers, and interdisciplinary teams
  • Promote high-quality, cost-effective healthcare outcomes
  • Optimize member benefits while ensuring compliance with Medicaid requirements
  • Apply Texas Administrative Code (TAC) guidelines and medical necessity criteria
  • Document review decisions accurately and thoroughly
  • Maintain productivity, quality, and compliance standards
  • Participate in team meetings, training, and continuous improvement initiatives

Qualifications
We're looking for professionals who have:
  • Current Registered Nurse (RN) license in good standing
  • Experience performing Utilization Review, Case Management, Care Management, or Medical Necessity reviews
  • Knowledge of Medicaid programs and utilization management principles
  • Experience applying medical necessity criteria
  • Understanding of the Texas Administrative Code (TAC)
  • Strong clinical assessment and critical thinking skills
  • Excellent written and verbal communication abilities
  • Strong organizational and time management skills
  • Ability to work independently in a remote environment

Technical Skills
  • Microsoft Word
  • Microsoft Excel
  • Electronic documentation systems
  • Ability to navigate multiple computer applications simultaneously

Ideal Candidate
You'll thrive in this role if you:
  • Enjoy using clinical expertise to improve healthcare outcomes
  • Have exceptional analytical and critical thinking skills
  • Are detail oriented and able to make sound clinical decisions
  • Communicate professionally with providers and interdisciplinary teams
  • Can manage multiple priorities in a fast-paced environment
  • Work independently while remaining engaged with a collaborative remote team

Apply Today!
If you're ready to leverage your nursing experience in a rewarding remote role that supports quality healthcare delivery, we'd love to hear from you.
This is an outstanding opportunity for an experienced Registered Nurse seeking a professional, non-bedside position with long term potential and meaningful impact!
Job Requirements
Throughout the past 35+ years, MMC, one of the most trusted names in workforce management services, has successfully delivered strategic solutions to large and small businesses in numerous industries.
We have built our reputation on partnering with our clients and candidates to achieve the desired results. Our recruiting professionals have extensive experience matching the right candidate, to the right client, for the right position. We provide the best opportunities to the most talented candidates in a multitude of industries.
MMC is a privately owned business with corporate headquarters in Irving, Texas. With 2,000+ employees, working in 40+ states, MMC is able to support all United States locations, and some international locations.
We appreciate your interest in reviewing this particular position and we encourage you to visit our website where you can always search and apply for opportunities at www.mmcgrp.com
Benefits with MMC Group
MMC offers health insurance plans for our active candidates on assignment, including:
  • Medical, dental, and vision coverage
  • Life and disability insurance
  • Additional voluntary benefits

Join MMC and enjoy the support of a team that values your well-being, both on and off the job!
MMC strives to ensure all job postings confirm details of the position, the rate of pay, and acknowledge that medical benefits are offered.
Get started on your career journey today! Apply to become a part of the MMC Team!
We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.

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