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

HealthCare Support

Utilization Management

Houston, TX · On-site

$38 - $42/hr

RN Outpatient Utilization Review Remote Texas HealthCare Support is actively seeking multiple Outpatient Utilization Review Registered Nurses with our prestigious Healthcare Client. Applications must ...

GQR Healthcare

Travel RN Case Management

Pasadena, TX · On-site

$1.3K - $1.4K/wk

Travel Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Pasadena, Texas Start Date: August 31, 2026 Profession: Registered Nurse (RN) Facility: Short Term Acute ...

New

WNS Global Services

Nurse - Clinical Review

Houston, TX · Remote

$65K - $75K/yr

... RN, LPN/LVN license in the state or territory of the U.S. Minimum of one (1) year experience in utilization review, or utilization management Proficient technical skills in Microsoft Office (Word ...

WNS Global Services

Nurse - Clinical Review

Houston, TX · On-site +1

$65K - $75K/yr

... RN, LPN/LVN license in the state or territory of the U.S. • Minimum of one (1) year experience in utilization review, or utilization management • Proficient technical skills in Microsoft Office ...

Nexus Health Systems

RN Case Manager

Shenandoah, TX · On-site

RN Case Manager Nexus Children's Hospital - Shenandoah specializes in providing comprehensive ... Practices "minimum information necessary" when performing utilization review, case management, and ...

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All JobsUtilization Review Rn JobsUtilization Review Rn Jobs in Houston, TX

Utilization Review Rn information

See Houston, TX salary details

$18

$36

$59

How much do utilization review rn jobs pay per hour?

As of Aug 23, 2026, the average hourly pay for utilization review rn in Houston, TX is $36.55, according to ZipRecruiter salary data. Most workers in this role earn between $28.89 and $41.97 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 Houston, TX?

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

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

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

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

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

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

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

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Houston, TX as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $76,016 per year, or $36.5 per hour.

Remote UTILIZATION REVIEW NURSE - RN

Nexus Health Systems

Houston, TX • On-site

Other

Medical, Dental, Vision, Retirement, PTO

Posted 14 days ago

Nexus Health Systems rating

6.3

Company rating: 6.3 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

Job description

Remote Utilization Review Registered Nurse (UR RN)

Nexus Health Systems is seeking an experienced Utilization Review Registered Nurse (UR RN) to join our growing Utilization Management team. This fully remote position plays a critical role in ensuring patients receive medically necessary, high-quality care while promoting appropriate resource utilization and regulatory compliance.

If you're a detail-oriented RN with experience in utilization review, case management, or behavioral health and enjoy collaborating with interdisciplinary teams to improve patient outcomes, we'd love to hear from you.

What You'll Do
  • Conduct concurrent and retrospective utilization reviews to determine medical necessity and appropriate level of care.
  • Apply evidence-based criteria, including InterQual (or similar), to support clinical decision-making and payer compliance.
  • Collaborate with physicians, case managers, and interdisciplinary teams to facilitate timely authorizations, discharge planning, and appropriate transitions of care.
  • Review clinical documentation to ensure accuracy, completeness, and compliance with payer and regulatory requirements.
  • Manage insurance authorizations, denials, appeals, and level-of-care determinations.
  • Monitor utilization trends and contribute to quality improvement initiatives that enhance patient outcomes and operational efficiency.
  • Participate in multidisciplinary utilization review meetings and provide recommendations to optimize care delivery.
  • Maintain accurate documentation within the electronic health record (EHR) while ensuring HIPAA compliance.
Qualifications

Required

  • Associate Degree in Nursing (ADN) from an accredited nursing program.
  • Current, unrestricted Texas RN license or Compact RN license.
  • Minimum of 2 years of acute care clinical nursing experience.
  • At least 3 years of Utilization Review or Case Management experience involving complex medical/surgical and/or behavioral health patients.
  • Strong knowledge of payer guidelines, medical necessity criteria, and utilization management principles.
  • Excellent critical thinking, communication, and organizational skills.
  • Proficiency with electronic health records (EHRs) and Microsoft Office applications.

Preferred

  • Bachelor of Science in Nursing (BSN).
  • Experience with InterQual or MCG criteria.
  • Behavioral health utilization review experience.
  • Experience with Meditech.
  • Professional certifications such as CCM, CPHQ, or HCQM.
Why Nexus Health Systems?

At Nexus Health Systems, our mission is to improve lives through compassionate, high-quality care. As a member of our Utilization Review team, you'll collaborate with dedicated healthcare professionals while helping ensure patients receive the right care at the right time.

We offer:

  • Competitive compensation
  • Comprehensive medical, dental, and vision benefits
  • Paid time off and company holidays
  • 401(k) with company match
  • Professional development and continuing education opportunities
  • A collaborative, mission-driven culture
  • Fully remote work environment

If you're ready to make a meaningful impact in healthcare while enjoying the flexibility of working remotely, we'd love to hear from you.

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