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

Prime Healthcare

Case Manager RN

Mesquite, TX

We are seeking an RN Case Manager , also referred to as a Registered Nurse Case Manager or RN ... Utilization Review: monitor the use of hospital resources and services to ensure appropriate care ...

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Utilization Review Rn information

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$41

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How much do utilization review rn jobs pay per hour?

As of May 30, 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 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 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 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 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.

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 May 2026, with employment types broken down into 6% As Needed, 75% Full Time, 13% Part Time, and 6% Contract. Highlights an 83% In-person, 2% Hybrid, and 15% Remote job distribution, with an average salary of $87,000 per year, or $41.8 per hour.

Utilization Management RN (Hybrid) (Dallas)

TEXASCONNECT INC

Dallas, TX • Hybrid

Part-time

Posted 7 days ago

Job description

Department: Managed Services
This position will be hybrid in the Dallas, Texas area.
Relocation assistance is available
There are 6 open positions for this role.
The Utilization Management (UM) RN performs utilization review activities, including, but not limited to, precertification, ensures appropriate level of care and status (Inpatient, Outpatient, and Observation) throughout admission and performs initial reviews, concurrent reviews, and retrospective reviews according to guidelines. Determines the medical necessity of requests by performing first level reviews. The UM nurse ensures a process that is efficient for providing care, ensuring timely and appropriate levels of care for the incoming patients. UM RN is responsible for preparing cases for Physician Advisor for 2nd level review. UM RN delegates accordingly to LVN and works in conjunction with a multi-disciplinary team to manage the care of patients in an ethical and fiduciary responsible manner. This position is hybrid with remote and in-office assignment.
SPECIFIC SKILLS NEEDED
•     Knowledge of payer requirements
•    Excellent verbal and written communication skills
•    Ability to follow chain of command
•    Highly developed ability to multi-task and maintain focus
•    Proactive, can-do approach and desire to build positive working relationships through collaborative
problem-solving
•    Self-motivated and results oriented. Must be able to demonstrate sound decision making, flexibility
and prioritization skills with minimal supervision.
•    Strong organizational skills
•     Basic computer skills: Word, Excel, PowerPoint, Outlook. Able to utilize multiple electronic systems.
Type 50 WPM
•    Ability to apply appropriate UM criteria
EDUCATION/EXPERIENCE/TRAINING
Required:
•    Current licensure as an RN in the state of California.
•    A minimum of 2 years of bedside nursing experience in an acute care setting.
•    A minimum of 2 years of case management experience.
Preferred:
•    Certified Case Manager or Accredited Case Manager
•    BSN
•    Experience with Milliman Care Guidelines (MCG)

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