Uses appropriate criteria sets for admission reviews, continued stay reviews, outlier reviews, and ... Licenses, Registrations, or Certifications * RN License in state of employment or compact required ...
Uses appropriate criteria sets for admission reviews, continued stay reviews, outlier reviews, and ... Licenses, Registrations, or Certifications * RN License in state of employment or compact required ...
Uses appropriate criteria sets for admission reviews, continued stay reviews, outlier reviews, and ... Licenses, Registrations, or Certifications * RN License in state of employment or compact required ...
Uses appropriate criteria sets for admission reviews, continued stay reviews, outlier reviews, and ... Licenses, Registrations, or Certifications * RN License in state of employment or compact required ...
Voluntary Benefits reviewed and provided at your one-on-one benefit meeting . * Exceptional Corporate Support. Qualifications for Registered Nurse (RN): * Valid Texas RN License. * Valid CPR ...
Quick apply
Voluntary Benefits reviewed and provided at your one-on-one benefit meeting . * Exceptional Corporate Support. Qualifications for Registered Nurse (RN): * Valid Texas RN License. * Valid CPR ...
Voluntary Benefits reviewed and provided at your one-on-one benefit meeting . * Exceptional Corporate Support. Qualifications for Registered Nurse (RN): * Valid Texas RN License. * Valid CPR ...
Quick apply
Voluntary Benefits reviewed and provided at your one-on-one benefit meeting . * Exceptional Corporate Support. Qualifications for Registered Nurse (RN): * Valid Texas RN License. * Valid CPR ...
Registered Nurse (RN) administers skilled nursing care to patients (0-45 years) requiring ... This assessment will include a complete systems review, safety assessment, nutritional evaluation ...
Registered Nurse (RN) administers skilled nursing care to patients (0-45 years) requiring ... This assessment will include a complete systems review, safety assessment, nutritional evaluation ...
Registered Nurse
Beaumont, TX · On-site
Registered Nurse (RN) administers skilled nursing care to patients (0-45 years) requiring ... This assessment will include a complete systems review, safety assessment, nutritional evaluation ...
Registered Nurse
Beaumont, TX · On-site
Registered Nurse (RN) administers skilled nursing care to patients (0-45 years) requiring ... This assessment will include a complete systems review, safety assessment, nutritional evaluation ...
Registered Nurse
Beaumont, TX · On-site
Registered Nurse (RN) administers skilled nursing care to patients (0-45 years) requiring ... This assessment will include a complete systems review, safety assessment, nutritional evaluation ...
Registered Nurse
Beaumont, TX · On-site
Registered Nurse (RN) administers skilled nursing care to patients (0-45 years) requiring ... This assessment will include a complete systems review, safety assessment, nutritional evaluation ...
... utilization of health benefits. * Obtains a thorough and accurate member history to develop an ... reviewing and providing input on the non-RN clinicians' performance on a regular basis. Minimum ...
... utilization of health benefits. * Obtains a thorough and accurate member history to develop an ... reviewing and providing input on the non-RN clinicians' performance on a regular basis. Minimum ...
... utilization of health benefits. * Obtains a thorough and accurate member history to develop an ... reviewing and providing input on the non-RN clinicians' performance on a regular basis. Minimum ...
... utilization of health benefits. * Obtains a thorough and accurate member history to develop an ... reviewing and providing input on the non-RN clinicians' performance on a regular basis. Minimum ...
... reviewed and provided at your one-on-one benefit meeting . • Exceptional Corporate Support. Qualifications for Registered Nurse (RN) Weekend Supervisor: • Current RN license is in good standing ...
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... reviewed and provided at your one-on-one benefit meeting . • Exceptional Corporate Support. Qualifications for Registered Nurse (RN) Weekend Supervisor: • Current RN license is in good standing ...
... reviewed and provided at your one-on-one benefit meeting . • Exceptional Corporate Support. Qualifications for Registered Nurse (RN) Weekend Supervisor: • Current RN license is in good standing ...
Quick apply
... reviewed and provided at your one-on-one benefit meeting . • Exceptional Corporate Support. Qualifications for Registered Nurse (RN) Weekend Supervisor: • Current RN license is in good standing ...
... utilization of health benefits. * Obtains a thorough and accurate member history to develop an ... reviewing and providing input on the non-RN clinicians' performance on a regular basis. Minimum ...
... utilization of health benefits. * Obtains a thorough and accurate member history to develop an ... reviewing and providing input on the non-RN clinicians' performance on a regular basis. Minimum ...
... will be reviewed with you by a recruiter. Additional qualifications for this job may include ... registered nurse license or the ability to obtain one within established timelines for new ...
... will be reviewed with you by a recruiter. Additional qualifications for this job may include ... registered nurse license or the ability to obtain one within established timelines for new ...
... will be reviewed with you by a recruiter. Additional qualifications for this job may include ... registered nurse license or the ability to obtain one within established timelines for new ...
... will be reviewed with you by a recruiter. Additional qualifications for this job may include ... registered nurse license or the ability to obtain one within established timelines for new ...
... will be reviewed with you by a recruiter. Additional qualifications for this job may include ... registered nurse license or the ability to obtain one within established timelines for new ...
... will be reviewed with you by a recruiter. Additional qualifications for this job may include ... registered nurse license or the ability to obtain one within established timelines for new ...
... will be reviewed with you by a recruiter. Additional qualifications for this job may include ... registered nurse license or the ability to obtain one within established timelines for new ...
... will be reviewed with you by a recruiter. Additional qualifications for this job may include ... registered nurse license or the ability to obtain one within established timelines for new ...
... will be reviewed with you by a recruiter. Additional qualifications for this job may include ... registered nurse license or the ability to obtain one within established timelines for new ...
... will be reviewed with you by a recruiter. Additional qualifications for this job may include ... registered nurse license or the ability to obtain one within established timelines for new ...
... will be reviewed with you by a recruiter. Additional qualifications for this job may include ... registered nurse license or the ability to obtain one within established timelines for new ...
... will be reviewed with you by a recruiter. Additional qualifications for this job may include ... registered nurse license or the ability to obtain one within established timelines for new ...
... will be reviewed with you by a recruiter. Additional qualifications for this job may include ... registered nurse license or the ability to obtain one within established timelines for new ...
... will be reviewed with you by a recruiter. Additional qualifications for this job may include ... registered nurse license or the ability to obtain one within established timelines for new ...
... will be reviewed with you by a recruiter. Additional qualifications for this job may include ... registered nurse license or the ability to obtain one within established timelines for new ...
... will be reviewed with you by a recruiter. Additional qualifications for this job may include ... registered nurse license or the ability to obtain one within established timelines for new ...
Utilization Review Rn information
See Beaumont, TX salary details
$20.50 - $24.64
2% of jobs
$24.64 - $28.79
9% of jobs
$31.62 is the 25th percentile. Wages below this are outliers.
$28.79 - $32.93
21% of jobs
The median wage is $36.29 / hr.
$32.93 - $37.08
23% of jobs
$37.08 - $41.22
13% of jobs
$44.45 is the 75th percentile. Wages above this are outliers.
$41.22 - $45.37
10% of jobs
$45.37 - $49.51
8% of jobs
$49.51 - $53.66
5% of jobs
$53.66 - $57.80
5% of jobs
$57.80 - $61.95
2% of jobs
$61.95 - $66.09
2% of jobs
$20
$40
$66
How much do utilization review rn jobs pay per hour?
As of Jul 15, 2026, the average hourly pay for utilization review rn in Beaumont, TX is $40.51, according to ZipRecruiter salary data. Most workers in this role earn between $32.02 and $46.54 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?
| Aspect | Utilization Review Rn | Case Manager |
|---|---|---|
| Credentials | RN license, certifications in utilization review | RN license, certifications in case management |
| Work Environment | Hospitals, insurance companies, healthcare facilities | Hospitals, community agencies, insurance companies |
| Primary Focus | Reviewing medical necessity and appropriateness of care | Coordinating 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.
What are popular job titles related to Utilization Review Rn jobs in Beaumont, TX? For Utilization Review Rn jobs in Beaumont, TX, the most frequently searched job titles are:
What job categories do people searching Utilization Review Rn jobs in Beaumont, TX look for? The top searched job categories for Utilization Review Rn jobs in Beaumont, TX are:
- Volunteer Navihealth Utilization Review
- Full Time Cigna Utilization Review Nurse
- Contract Utilization Review
- Remote Optum Utilization Review
- Senior Rn Utilization Review Nurse
- Live In Cigna Utilization Review Nurse
- Freelance International Utilization Review Nurse
- Temporary Aetna Utilization Review Nurse
- Remote Utilization Review
What cities near Beaumont, TX are hiring for Utilization Review Rn jobs? Cities near Beaumont, TX with the most Utilization Review Rn job openings:
Full-time
This job post has expired today. Applications are no longer accepted.
CHRISTUS Health rating
6.7
Based on 524 frontline employees who took The Breakroom Quiz
527th of 885 rated healthcare providers
Job description
Summary:
The Utilization Management Nurse II is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services. This Nurse is responsible for performing a variety of pre-admission, concurrent, and retrospective UM related reviews and functions. They must competently and accurately utilize approved screening criteria (InterQual/MCG/Centers for Medicare and Medicaid Services "CMS" Inpatient List). They effectively and efficiently manage a diverse workload in a fast-paced, rapidly changing regulatory environment and are responsible for maintaining current and accurate knowledge regarding commercial and government payors and Joint Commission regulations and guidelines related to UM. This Nurse effectively communicates with internal and external clinical professionals, efficiently organizes the financial insurance care of the patients, and relays clinical data to insurance providers and vendors to obtain approved certification for services. The Utilization Management Nurse collaborates as necessary with other members of the health care team to ensure the above according to the mission of CHRISTUS.
Responsibilities:
Job Requirements:
Education/Skills
Experience
Licenses, Registrations, or Certifications
Work Schedule:
8AM - 5PM Monday-Friday
Work Type:
Full Time
The Utilization Management Nurse II is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services. This Nurse is responsible for performing a variety of pre-admission, concurrent, and retrospective UM related reviews and functions. They must competently and accurately utilize approved screening criteria (InterQual/MCG/Centers for Medicare and Medicaid Services "CMS" Inpatient List). They effectively and efficiently manage a diverse workload in a fast-paced, rapidly changing regulatory environment and are responsible for maintaining current and accurate knowledge regarding commercial and government payors and Joint Commission regulations and guidelines related to UM. This Nurse effectively communicates with internal and external clinical professionals, efficiently organizes the financial insurance care of the patients, and relays clinical data to insurance providers and vendors to obtain approved certification for services. The Utilization Management Nurse collaborates as necessary with other members of the health care team to ensure the above according to the mission of CHRISTUS.
Responsibilities:
- Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
- Applies demonstrated clinical competency and judgment in order to perform comprehensive assessments of clinical information and treatment plans and apply medical necessity criteria in order to determine the appropriate level of care.
- Resource/Utilization Management appropriateness: Assess assigned patient population for medical necessity, level of care, and appropriateness of setting and services. Utilizes MCG/InterQual Care Guidelines and/or health system-approved tools to track impact and variance.
- Uses appropriate criteria sets for admission reviews, continued stay reviews, outlier reviews, and clinical appropriateness recommendations.
- Coordinate and facilitate correct identification of patient status.
- Analyze the quality and comprehensiveness of documentation and collaborate with the physician and treatment team to obtain documentation needed to support the level of care.
- Facilitates joint decision-making with the interdisciplinary team regarding any changes in the patient status and/or negative outcomes in patient responses.
- Demonstrates, maintains, and applies current knowledge of regulatory requirements relative to the work process in order to ensure compliance, i.e. IMM, Code 44.
- Demonstrate adherence to the CORE values of CHRISTUS.
- Utilize independent scope of practice to identify, evaluate and provide utilization review services for patients and analyze information supplied by physicians (or other clinical staff) to make timely review determinations, based on appropriate criteria and standards.
- Take appropriate follow-up action when established criteria for utilization of services are not met.
- Proactively refer cases to the physician advisor for medical necessity reviews, peer-to-peer reviews, and denial avoidance.
- Effectively collaborate with the Interdisciplinary team including the Physician Advisor for secondary reviews.
- Proactively review patients at the point of entry, prior to admission, to determine the medical necessity of a requested hospitalization and the appropriate level of care or placement for the patient.
- Review surgery schedule to ensure planned surgeries are ordered in the appropriate status and that necessary authorization has been obtained as required by the payor or regulatory guidance (i.e., CMS Inpatient Only List, Payor Prior Authorization matrix, etc.)
- Regularly review patients who are in the hospital in Observation status to determine if the patient is appropriate for discharge or if conversion to inpatient status is appropriate.
- Proactively identify and resolve issues regarding clinical appropriateness recommendations, coverage, and potential or actual payor denials.
- Maintain consistent communication and exchange of information with payors as per payor or regulatory requirements to coordinate certification of hospital services.
- Coordinate and facilitate patient care progression throughout the continuum and communicate and document to support medical necessity at each level of care.
- Evaluate care administered by the interdisciplinary health care team and advocate for standards of practice.
- Analyze assessment data to identify potential problems and formulate goals/outcomes.
- Follows the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability ACT (HIPPA) designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI).
- Attend scheduled department staff meetings and/or interdepartmental meetings as appropriate.
- Possesses and demonstrates technology literacy and the ability to work in multiple technology systems.
- Act as a catalyst for change in the organization; respond to change with flexibility and adaptability; demonstrate the ability to work together for change.
- Translate strategies into action steps; monitor progress and achieve results.
- Demonstrate the confidence, drive, and ability to face and overcome challenges and obstacles to achieve organizational goals.
- Demonstrate competence to perform assigned responsibilities in a manner that meets the population-specific and developmental needs of patients served by the department.
- Possess negotiating skills that support the ability to interact with physicians, nursing staff, administrative staff, discharge planners, and payers.
- Excellent verbal and written communication skills, knowledge of clinical protocol, normative data, and health benefit plans, particularly coverage and limitation clauses.
- Must adjust to frequently changing workloads and frequent interruptions.
- May be asked to work overtime or take calls.
- May be asked to travel to other facilities to assist as needed.
- Actively participates in Multidisciplinary/Patient Care Progression Rounds.
- Escalates cases as appropriate and per policy to Physician Advisors and/or CM Director.
- Documents in the medical record per regulatory and department guidelines.
- May be asked to assist with special projects.
- May serve as a preceptor or orienter to new associates.
- Assumes responsibility for professional growth and development.
- Familiarity with criteria sets including InterQual and MCG preferred.
- Must have excellent verbal and written communication and ability to interact with diverse populations.
- Must have critical and analytical thinking skills.
- Must have demonstrated clinical competency.
- Must have the ability to Multitask and to function in a stressful and fast-paced environment.
- Must have working knowledge of discharge planning, utilization management, case management, performance improvement, and managed care reimbursement.
- Must have an understanding of pre-acute and post-acute levels of care and community resources.
- Must have the ability to work independently and exercise sound judgment in interactions with physicians, payors, patients, and their families.
- Must have an understanding of internal and external resources and knowledge of available community resources.
- Other duties as assigned.
Job Requirements:
Education/Skills
- Graduate of an accredited School of Nursing OR demonstrated success in the Utilization Management Nurse I role for at least five years at CHRISTUS Health on top of required experience in lieu of education required.
Experience
- Two or more years of clinical experience with at least one year in the acute care setting OR demonstrated success as Utilization Management Nurse I role at CHRISTUS Health required.
Licenses, Registrations, or Certifications
- RN License in state of employment or compact required.
- LPN or LVN license accepted for associates with 5+ years of demonstrated success and experience in the Utilization Management Nurse I role at CHRISTUS Health.
- Certification in Case Management preferred.
- BLS preferred.
Work Schedule:
8AM - 5PM Monday-Friday
Work Type:
Full Time
What CHRISTUS Health employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About CHRISTUS Health
Sourced by ZipRecruiter
CHRISTUS Health is a prominent name in the healthcare industry, with its headquarters situated in Irving, TX, USA. Established in 1999, the company has since been devoted to providing comprehensive care and extending the healing ministry of Jesus Christ. This not-for-profit health system primarily operates more than 600 healthcare services and programs, including long-term care facilities, health insurance products, community clinics, and outreach services, serving both urban and rural populations.
Industry
Outpatient health care
Company size
1,001 - 5,000 Employees
Headquarters location
Irving, TX, US
Year founded
1999