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

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 two (2) years experience in utilization review, case management, or clinical quality improvement Proficient technical skills in ...

HealthHelp

Nurse Clinical Review

Houston, TX · On-site

$65K - $75K/yr

... RN, LPN/LVN license in the state or territory of the U.S. • Minimum of two (2) years experience in utilization review, case management, or clinical quality improvement • Proficient technical ...

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 two (2) years experience in utilization review, case management, or clinical quality improvement • Proficient technical ...

Nexus Health Systems

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 ...

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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 7, 2026, the average hourly pay for utilization review rn in Houston, TX is $40.38, according to ZipRecruiter salary data. Most workers in this role earn between $31.92 and $46.39 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 67% In-person, and 33% Remote job distribution, with an average salary of $83,986 per year, or $40.4 per hour.

UR LVN Utilization/Clinical Claim Review | , | -Seybold Clinic

Reliant Medical Group

Pearland, TX • On-site

$20 - $36/hr

Other

Medical, Retirement

Posted 12 days ago

Reliant Medical Group rating

7.3

Company rating: 7.3 out of 10

Based on 26 frontline employees who took The Breakroom Quiz

Job description

Utilization Review Lvn Nurse

Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together.

The Utilization Review LVN nurse will perform documentation review for medical necessity and benefit correlation of requested medical and surgical procedures, services and admissions for HMO, PPO and POS products. The UR LVN nurse will serve as facilitator of communication with clinic, payor and other customers.

Primary Responsibilities:

  • Data entry of all UR requests into the Kelsey-Seybold data system
  • Verifies eligibility
  • Obtains benefit interpretation from insurance company
  • Reviews request and chart to determine medical necessity by using internal criteria
  • Approves request or defers to insurance review and assists with MD review
  • Communicates with respective payor to obtain pre-certification authorization
  • Serves as resource to physicians, staff and patients regarding review process
  • Clarifies UR request discrepancies with office submitting or insurance company
  • Other duties as assigned

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • Licensed Vocational Nurse
  • CEU requirement
  • TX LVN license
  • 2+ years of utilization review experience at heath plan, ACO, IPA, or provider group OR 3+ years of diverse clinical experience, including acute care or similar care
  • Good organization and communication skills
  • HMO, PPO and POS insurance knowledge
  • Valid Driver's license

Preferred Qualifications:

  • Computer and Coding experience

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The hourly pay for this role will range from $20.00 to $36.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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