Utilization Mgmt Clinical RN
Bellaire, TX · On-site
We're searching for a Utilization Management Clinical Registered Nurse, someone who works well in a ... telephonic and/or concurrent review of inpatient hospitalizations and extended courses of ...
Utilization Mgmt Clinical RN
Bellaire, TX · On-site
We're searching for a Utilization Management Clinical Registered Nurse, someone who works well in a ... telephonic and/or concurrent review of inpatient hospitalizations and extended courses of ...
Travel RN Case Management
Pasadena, TX · On-site
Work in the Case Management/QA/Utilization Review department of a hospital setting * 13-week assignment * Day shift schedule, 8:00 AM to 5:00 PM Requirements * Active TX or compact RN license ...
New
Travel RN Case Management
Pasadena, TX · On-site
Work in the Case Management/QA/Utilization Review department of a hospital setting * 13-week assignment * Day shift schedule, 8:00 AM to 5:00 PM Requirements * Active TX or compact RN license ...
New
Utilization Mgmt Clinical RN
Bellaire, TX · On-site
We're searching for a Utilization Management Clinical Registered Nurse, someone who works well in a ... telephonic and/or concurrent review of inpatient hospitalizations and extended courses of ...
Utilization Mgmt Clinical RN
Bellaire, TX · On-site
We're searching for a Utilization Management Clinical Registered Nurse, someone who works well in a ... telephonic and/or concurrent review of inpatient hospitalizations and extended courses of ...
Travel RN Case Management - $1,646 per week
Pasadena, TX · On-site
$1.6K/wk
Work in the Case Management/QA/Utilization Review department of a hospital setting * 13-week assignment * Day shift schedule, 8:00 AM to 5:00 PM Requirements * Active TX or compact RN license ...
New
Travel RN Case Management - $1,646 per week
Pasadena, TX · On-site
$1.6K/wk
Work in the Case Management/QA/Utilization Review department of a hospital setting * 13-week assignment * Day shift schedule, 8:00 AM to 5:00 PM Requirements * Active TX or compact RN license ...
New
Nurse - Clinical Review
Houston, TX · Remote
Current, active unrestricted 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 ...
Quick apply
Nurse - Clinical Review
Houston, TX · Remote
Current, active unrestricted 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 ...
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 ...
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 ...
Nurse Utilization Management (Um) Registered Nurse (Rn) In Quality And Patient Safety The Nurse Utilization Management (UM) Registered Nurse (RN) in Quality and Patient Safety is responsible and ...
New
Nurse Utilization Management (Um) Registered Nurse (Rn) In Quality And Patient Safety The Nurse Utilization Management (UM) Registered Nurse (RN) in Quality and Patient Safety is responsible and ...
New
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 ...
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 ...
Uses UM Criteria to perform complicated reviews. * The UM RN activities include collecting ... utilization. * The individual will assist in directing the provision of nursing education ...
New
Uses UM Criteria to perform complicated reviews. * The UM RN activities include collecting ... utilization. * The individual will assist in directing the provision of nursing education ...
New
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 ...
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 ...
RN Case Manager
Conroe, TX · On-site
RN Case Manager Nexus Children's Hospital - Shenandoah Full-Time | Monday-Friday | Day Shift About ... Practices "minimum information necessary" when performing utilization review, case management, and ...
Quick apply
RN Case Manager
Conroe, TX · On-site
RN Case Manager Nexus Children's Hospital - Shenandoah Full-Time | Monday-Friday | Day Shift About ... Practices "minimum information necessary" when performing utilization review, case management, and ...
Review doctor's schedule, abstract as needed, print PVS for each patient and request other relevant ... Knows how to access the a resource RN when needed * Seeks clarification or guidance with questions ...
Review doctor's schedule, abstract as needed, print PVS for each patient and request other relevant ... Knows how to access the a resource RN when needed * Seeks clarification or guidance with questions ...
Maintains direct accountability for the review, interpretation, implementation, and approval of all ... Active Texas Registered Nurse (RN) license or valid multistate compact RN license. * 10 years of ...
New
Maintains direct accountability for the review, interpretation, implementation, and approval of all ... Active Texas Registered Nurse (RN) license or valid multistate compact RN license. * 10 years of ...
New
Director, Utilization Management, RN - ONSITE - Kelsey Seybold Clinics
Pearland, TX · On-site
$112K - $193K/yr
Maintains direct accountability for the review, interpretation, implementation, and approval of all ... Active Texas Registered Nurse (RN) license or valid multistate compact RN license. * 10+ years of ...
New
Director, Utilization Management, RN - ONSITE - Kelsey Seybold Clinics
Pearland, TX · On-site
$112K - $193K/yr
Maintains direct accountability for the review, interpretation, implementation, and approval of all ... Active Texas Registered Nurse (RN) license or valid multistate compact RN license. * 10+ years of ...
New
Review doctor's schedule, abstract as needed, print PVS for each patient and request other relevant ... Knows how to access the a resource RN when needed * Seeks clarification or guidance with questions ...
New
Review doctor's schedule, abstract as needed, print PVS for each patient and request other relevant ... Knows how to access the a resource RN when needed * Seeks clarification or guidance with questions ...
New
Review doctor's schedule, abstract as needed, print PVS for each patient and request other relevant ... Knows how to access the a resource RN when needed * Seeks clarification or guidance with questions ...
Review doctor's schedule, abstract as needed, print PVS for each patient and request other relevant ... Knows how to access the a resource RN when needed * Seeks clarification or guidance with questions ...
Review doctor's schedule, abstract as needed, print PVS for each patient and request other relevant ... Knows how to access the a resource RN when needed * Seeks clarification or guidance with questions ...
Review doctor's schedule, abstract as needed, print PVS for each patient and request other relevant ... Knows how to access the a resource RN when needed * Seeks clarification or guidance with questions ...
Review doctor's schedule, abstract as needed, print PVS for each patient and request other relevant ... Knows how to access the a resource RN when needed * Seeks clarification or guidance with questions ...
Review doctor's schedule, abstract as needed, print PVS for each patient and request other relevant ... Knows how to access the a resource RN when needed * Seeks clarification or guidance with questions ...
Review doctor's schedule, abstract as needed, print PVS for each patient and request other relevant ... Knows how to access the a resource RN when needed * Seeks clarification or guidance with questions ...
Review doctor's schedule, abstract as needed, print PVS for each patient and request other relevant ... Knows how to access the a resource RN when needed * Seeks clarification or guidance with questions ...
Review doctor's schedule, abstract as needed, print PVS for each patient and request other relevant ... Knows how to access the a resource RN when needed * Seeks clarification or guidance with questions ...
Review doctor's schedule, abstract as needed, print PVS for each patient and request other relevant ... Knows how to access the a resource RN when needed * Seeks clarification or guidance with questions ...
Utilization Review Rn information
See Houston, TX salary details
$18.49 - $22.23
2% of jobs
$22.23 - $25.97
9% of jobs
$28.53 is the 25th percentile. Wages below this are outliers.
$25.97 - $29.71
21% of jobs
The median wage is $32.74 / hr.
$29.71 - $33.45
23% of jobs
$33.45 - $37.19
13% of jobs
$40.10 is the 75th percentile. Wages above this are outliers.
$37.19 - $40.93
10% of jobs
$40.93 - $44.67
8% of jobs
$44.67 - $48.41
5% of jobs
$48.41 - $52.15
5% of jobs
$52.15 - $55.89
2% of jobs
$55.89 - $59.63
2% of jobs
$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?
| Aspect | Utilization Review Rn | Case Manager |
|---|---|---|
| Credentials | RN license, certifications in utilization review | RN license, certifications in case management |
| Work Environment | Hospitals, insurance companies, healthcare facilities | Hospitals, community agencies, insurance companies |
| Primary Focus | Reviewing medical necessity and appropriateness of care | Coordinating 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:
- Remote Utilization Review Nurse
- No Experience Utilization Review Nurse
- Clinical Review Nurse Remote
- Remote Utilization Review Rn
- Per Diem Chart Review Nurse
- Night Utilization Review Nurse
- Remote Utilization Management Nurse
- Remote Hedis Review Nurse
- Per Diem Utilization Review Nurse
- Part Time Utilization Review Nurse
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:
Full-time
Posted 7 days ago
Texas Children's Hospital rating
8.3
Based on 176 frontline employees who took The Breakroom Quiz
73rd of 1,062 rated hospitals
Job description
We're searching for a Utilization Management Clinical Registered Nurse, someone who works well in a fast-paced setting. In this position, you'll be responsible for providing precertification of inpatient hospitalizations and all outpatient procedures and services requiring authorization, and performing telephonic and/or concurrent review of inpatient hospitalizations and extended courses of outpatient treatment.
Think you've got what it takes?
Job Duties & Responsibilities
- Analyzes unique situation of request, identifying appropriate guideline and regulatory requirements for each request
- Applies clinical decision making to assessment of clinical acuity and appropriateness of suggested treatment/services
- Creates a case summary evaluation for requests failing medical necessity criteria, and has collaborative discussion with the medical director or designee for review and disposition
- Researches clinical guidelines for potential investigative service requests, researches weekly changes to Medicaid manual to assure coverage determinations, and maintains currency of clinical guideline elements
- Ensures the timeliness of all denial letters within the regulations mandated
- Creates communication pieces to providers, which meet accrediting and regulatory guidelines for clinical content and readability levels describing decision making rationale for service requests and notifies providers through written correspondence
- Collaborates with all disciplines within the health plan to meet goals and objectives meeting with contracting and provider relations on routine basis
- Screens, identifies, and refers potential members to case management and evaluation for programs or coverage
- Identifies potential quality of care issues, and/or fraud and abuse, and refers to appropriate department
As part of our commitment to maintaining a safe and healthy workplace, all successful candidates will be required to undergorespiratoryfit testing in compliance with occupational health and safety standards.
Skills & Requirements
- Diploma in nursing required or
- Associates degree in nursing or an associate's degree in a related field accepted by the Texas Board of Nursing for the purposes of obtaining and maintaining an RN license required or
- Bachelor's degree in nursing preferred
- RN - Lic-Registered Nurses by Texas Board of Nursing or Nursing Licensure Compact required
- 3 years of nursing experience required
Founded in 1996, Texas Children's Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.
To join our community of 15,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities.
Texas Children's is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
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