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

Oscar Health

Utilization Review Nurse

Dallas, TX · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate ...

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 ...

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How much do utilization review rn jobs pay per hour?

As of Aug 21, 2026, the average hourly pay for utilization review rn in Dallas, TX is $41.83, according to ZipRecruiter salary data. Most workers in this role earn between $33.08 and $48.03 per hour, depending on experience, location, and employer.

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.

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.

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 get into utilization review as a registered nurse?

To become a utilization review RN, you typically need a valid registered nurse license and experience in clinical settings. Additional certifications such as the Certified Professional in Healthcare Quality (CPHQ) or case management certification can enhance job prospects, and familiarity with electronic health records (EHR) systems is often required.

What are the most commonly searched types of Utilization Review Rn jobs in Dallas, TX?

The most popular types of Utilization Review Rn jobs in Dallas, TX are:

What are popular job titles related to Utilization Review Rn jobs in Dallas, TX?

For Utilization Review Rn jobs in Dallas, TX, the most frequently searched job titles are:

What job categories do people searching Utilization Review Rn jobs in Dallas, TX look for?

The top searched job categories for Utilization Review Rn jobs in Dallas, TX are:

What cities near Dallas, TX are hiring for Utilization Review Rn jobs?

Cities near Dallas, TX with the most Utilization Review Rn job openings:

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Dallas, TX as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 13% Part Time, 3% Contract, and 1% Nights. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $87,000 per year, or $41.8 per hour.

Supervisor Utilization Review RN

Baylor Scott & White Health

Highland Park, TX

Full-time

Posted 7 days ago

Baylor Scott & White Health rating

7.5

Company rating: 7.5 out of 10

Based on 766 frontline employees who took The Breakroom Quiz

237th of 891 rated healthcare providers

Job description

Job Summary

You supervise utilization review for RNs. You oversee processes daily. Guide on complex cases. Identify staff education opportunities. Connect departments through communication.

Essential Functions of the Role

  • Supervising Utilization Review Department, assigning tasks, assessing productivity, conducting quality reviews, and advising team on peer-to-peer appeals. Also conducting denial research.
  • Collecting data to generate weekly reports that aid in improving staff outcomes and enhancing quality metrics.
  • Collaborate with the Medical Director and Care Coordination when patients don't meet criteria. Updating Clinical Resource Manager as needed.
  • Assigning daily tasks to staff members to ensure service levels are maintained at an optimal level.
  • Monitors daily observation reports to identify and address any potential problems.
  • Handling escalations from Utilization Review Nurses and other staff members.
  • Conducting quality reviews as needed.
  • Responding to inquiries from staff members and stakeholders regarding Utilization Review.
  • Serve as a Subject Matter Expert (SME) for Utilization Review workflow issues, complex cases, denials, and customer interactions, both internal and external.

Key Success Factors

  • Possessing a helpful nature that assists others in identifying and solving challenges.
  • Skilled in mentoring and encouraging colleagues for the enhancement of their clinical proficiency.
  • Exceptional written and conversational abilities.
  • Proficient at collaborating effectively with employees of varying ranks, including those at the highest level of leadership.
  • Familiarity with discharge planning, case management, and utilization review. processes, case handling and the review of resource usage.
  • Experience in strategically directing work among team members based on established policies and protocols.
  • Aptitude in making sound hiring and termination suggestions.
  • Proficiency in training colleagues and assessing their performance.
  • Basic digital skills like using Microsoft Office, information security, managing schedules and payroll, electronic medical documentation, and email use

Qualification

  • EDUCATION - Associate's Degree
  • MAJOR - Nursing
  • EXPERIENCE - (4) Four Years of Experience

What Baylor Scott & White Health employees say

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