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Utilization Review Rn Jobs in Fort Worth, 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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Utilization Review Rn information

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How much do utilization review rn jobs pay per hour?

As of Aug 7, 2026, the average hourly pay for utilization review rn in Fort Worth, TX is $40.52, 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 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 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 knowledge of medical coding and insurance processes can enhance your qualifications. Gaining experience in case management or health insurance companies can also improve your chances of entering the field.

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 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 Fort Worth, TX? For Utilization Review Rn jobs in Fort Worth, TX, the most frequently searched job titles are:
What job categories do people searching Utilization Review Rn jobs in Fort Worth, TX look for? The top searched job categories for Utilization Review Rn jobs in Fort Worth, TX are:
What cities near Fort Worth, TX are hiring for Utilization Review Rn jobs? Cities near Fort Worth, TX with the most Utilization Review Rn job openings:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Fort Worth, TX as of August 2026, with employment types broken down into 86% Full Time, 7% Part Time, and 7% Contract. Highlights an 84% In-person, 2% Hybrid, and 14% Remote job distribution, with an average salary of $84,287 per year, or $40.5 per hour.

AUSTIN TX Utilization Review RN

Bracane Company

Dallas, TX • On-site

Other

Posted 23 days ago

Job description

About the Role:

Bracane Company is seeking a dedicated and detail-oriented Utilization Review RN to join our team in Austin, TX. This is an exciting opportunity for a clinical professional to make a meaningful impact by ensuring patients receive the right care at the right time. If you're passionate about healthcare quality and patient advocacy, we want to hear from you!

Responsibilities:

Conduct utilization review assessments to evaluate medical necessity and appropriateness of care

Perform concurrent, prospective, and retrospective reviews of patient cases

Collaborate with physicians, case managers, and healthcare teams to coordinate patient care plans

Apply evidence-based clinical criteria (e.g., InterQual, Milliman) to support review decisions

Document and communicate review findings accurately and in a timely manner

Identify opportunities for care improvement and ensure compliance with payer guidelines

Support denial management and appeals processes as needed

Requirements:

Active and unrestricted RN license in the state of Texas

Minimum 2-3 years of clinical nursing experience required

Prior utilization review, case management, or managed care experience strongly preferred

Familiarity with InterQual or Milliman clinical criteria

Strong knowledge of medical terminology, coding, and payer guidelines

Excellent analytical, communication, and critical thinking skills

Ability to work independently and manage a high-volume caseload efficiently

About Us:

Bracane Company is a trusted name in healthcare staffing and management solutions, committed to connecting top clinical talent with organizations that need them most. Our clients rely on us for our expertise, integrity, and dedication to quality care outcomes. At Bracane Company, employees thrive in a supportive environment that values their skills and invests in their professional growth.

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