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Utilization Review Rn Jobs in Fort Worth, TX (NOW HIRING)

CSI Pharmacy

Clinical Utilization Nurse

Plano, TX · Hybrid

$88K - $115K/yr

Summary The Clinical Utilization Nurse (CUN) is responsible for reviewing patient referrals ... Associates degree or Bachelor's degree from an accredited nursing school as a Registered Nurse ...

CSI Pharmacy

Clinical Utilization Nurse

Plano, TX · On-site

$88K - $115K/yr

Summary The Clinical Utilization Nurse (CUN) is responsible for reviewing patient referrals ... Associates degree or Bachelor's degree from an accredited nursing school as a Registered Nurse ...

CSI Pharmacy

Clinical Utilization Nurse

Plano, TX · On-site

$88K - $115K/yr

Summary The Clinical Utilization Nurse (CUN) is responsible for reviewing patient referrals ... Associates degree or Bachelor's degree from an accredited nursing school as a Registered Nurse ...

GuideWell

Utilization Management RN

Irving, TX · On-site

... utilization of health care services and benefits as designated. This requires an experienced RN ... Concurrent review and the determination of the extension of the length of stay based on the ...

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All JobsUtilization Review Rn JobsUtilization Review Rn Jobs in Fort Worth, TX

Utilization Review Rn information

See Fort Worth, TX salary details

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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:
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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.

Hybrid LVN Utilization Management - Dallas (Relocation)

A Hiring Company

Dallas, TX • Hybrid

Full-time

Posted 10 days ago

Job description

Position Summary Department: Managed Services. This position will be hybrid in the Dallas, Texas area. Relocation assistance is available. There are 3 open positions for this role. Responsibilities Perform utilization review activities, including precertification, ensuring appropriate level of care and status (Inpatient, Outpatient, Observation) throughout admission. Conduct concurrent reviews and retrospective reviews following guidelines. Delegate initial reviews to UM RN and determine medical necessity of requests by performing first‐level reviews. Ensure efficient process for providing care, ensuring timely and appropriate levels of care for incoming patients. Prepare cases for Physician Advisor for 2nd level review. Work both remotely and in‐office as needed. Key Skills 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; sound decision making, flexibility, and prioritization skills with minimal supervision. Strong organizational skills. Basic computer skills: Word, Excel, PowerPoint, Outlook; ability to utilize multiple electronic systems and type 50 WPM. Ability to apply appropriate UM criteria. Education, Experience & Training Required: Current licensure as an LVN in the state of California. Minimum of 2 years of case management experience. Knowledge of payer requirements. Preferred: Certified Case Manager or Accredited Case Manager. Experience with Milliman Care Guidelines (MCG). Minimum of 2 years of bedside nursing experience in an acute care setting. #J-18808-Ljbffr

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