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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 Sep 1, 2026, the average hourly pay for utilization review rn in Fort Worth, 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.

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 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 95% Full Time, and 5% Contract. Highlights an 89% In-person, and 11% Remote job distribution, with an average salary of $84,287 per year, or $40.5 per hour.

Utilization Review RN, PRN

Dallas, TX

Baylor Scott & White Health
Outpatient Health Care • 10K+ employees

7.5

Company rating: 7.5 out of 10

Based on 772 frontline employees who took The Breakroom Quiz

236th of 896 rated healthcare providers

People enjoy working here

Good employer

Recommended by students

Learn more about Baylor Scott & White Healthexternal

Per diem

Medical, Retirement, PTO

Posted 4 days ago

Job description

About Us

Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well.

Our Core Values are:

  • We serve faithfully by doing what's right with a joyful heart.
  • We never settle by constantly striving for better.
  • We are in it together by supporting one another and those we serve.
  • We make an impact by taking initiative and delivering exceptional experience.
Benefits

Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include:

  • Immediate eligibility for health and welfare benefits
  • 401(k) savings plan with dollar-for-dollar match up to 5%
  • Tuition Reimbursement
  • PTO accrual beginning Day 1

Note: Benefits may vary based upon position type and/or level.

Job Summary

Are you seeking an impactful nursing role? As a Utilization Review RN, review cases to determine medical suitability for insured patients. Your expertise shines through meticulous clinical reviews using established criteria. You play a key role in supporting the healthcare team by optimizing resources and implementing care plans. Communication with health plan departments is important to ensure services meet medical necessity standards. This includes prospective, concurrent, and retrospective reviews.

Essential Functions of the Role
  • You will review all cases. Use medical guidelines to evaluate services.
  • Understand patient needs. Resolve complex matters when necessary.
  • Confirm admission status is correct. Collaborate with Utilization Review coordinators when needed.
  • You will communicate with insurance. Talk to doctors about patients. Make sure needed paperwork is completed.
  • You'll report insurance company issues to leadership. Identify and communicate quality assurance or risk management issues promptly when they arise.
  • You will help improve our processes by evaluating, developing, and implementing protocols, policies, and procedures.
Key Success Factors
  • Comprehensive understanding of diverse healthcare techniques, practices, and industry-related language.
  • Proficiency in customer engagement, ensuring their concerns are heard and promptly addressed.
  • Thorough understanding of discharge planning, care coordination, utilization assessment and care levels.
  • Knowledge of local and national regulations is needed, like those from the Department of Insurance and Department of Labor. Centers for Medicare and Medicaid Services, Health and Human Services Commission, and National Committee for Quality Assurance are also important.
  • Exceptional communication skills, including articulating thoughts clearly in speech and writing.
  • Personable, with the ability to interact effectively with a diverse range of stakeholders.
  • Problem-solving capability, equipped with critical thinking skills.
  • Ability to juggle multiple tasks and work under time pressures.
Belonging Statement

We believe that all people should feel welcomed, valued and supported.

Qualifications

  • Associate degree.
  • Prior experience of at least (3) three years in the nursing field.
  • Must have a valid nursing registration (RN).

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