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

Actalent

Utilization Review Nurse

Houston, TX · On-site

$30 - $40/hr

Job Title: RN Clinical Review Nurse (Utilization Review Nurse) The Clinical Review Clinician for Appeals is responsible for performing clinical reviews to resolve and process appeals by examining ...

Actalent

Concurrent Review Nurse

Houston, TX · On-site

Actalent is Hiring a Team of Concurrent Review Nurses (Utilization Management)!! This role performs ... Active Registered Nurse (RN) license required. * Eligibility for or possession of a compact RN ...

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 · 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 ...

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 ...

Delight Care

Be Seen First

Registered Nurse Supervisor Home Health

Houston, TX · On-site

$35 - $42.35/hr

Manage case management activities including discharge planning, utilization review, and ... Valid TX RN license * Proven supervisory experience within home health or similar healthcare ...

Nexus Health Systems, Inc.

Clinical Reviewer

Houston, TX · On-site

$85 - $115/hr

We are specifically seeking an experienced Registered Nurse (RN) or Nurse Practitioner (NP) with ... Previous experience with clinical review, utilization review, care management, admissions ...

Harris Health System

BH Utilization Manager RN

Houston, TX · On-site

$67K - $85K/yr

Notifies Medical Director regarding the review of medical records submitted by providers for peer ... Current state Registered Nurse License. Work Experience (Years and Area): Two (2) years' experience ...

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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 5, 2026, the average hourly pay for utilization review rn in Katy, TX is $38.79, according to ZipRecruiter salary data. Most workers in this role earn between $30.67 and $44.57 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 Katy, TX?

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

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

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

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

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

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

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

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Katy, TX as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 15% Part Time, 3% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $80,689 per year, or $38.8 per hour.

Registered Nurse - Utilization Review - RNUR 26-10215

Compu-Vision - South

Houston, TX • Remote

$1.9K - $2.1K/wk

Full-time

This job post has expired 2 days ago. Applications are no longer accepted.

Job description

Job Title: Registered Nurse – Utilization Review

Job Location: Fort Myers, FL

Work Arrangement: Remote

Duration: 13 Weeks

Compensation: $1,900–$2,100 Gross Weekly (Based on Experience)

Shift: Day Shift

Schedule:

  • Monday–Friday
  • 8:00 AM – 4:30 PM
  • 40 Hours Per Week

Position Type: Contract

Work Setting: Remote

Position Overview

We are seeking an experienced Registered Nurse (RN) – Utilization Review/Utilization Management for a 13-week remote contract assignment. The RN will review clinical information and medical records to support appropriate levels of care, medical necessity, resource utilization, and positive patient outcomes.

The ideal candidate will have provider-side utilization management experience, strong clinical judgment, excellent computer skills, and hands-on experience with Epic and DragonFly. Candidates must be comfortable working independently in a remote environment while maintaining productivity, accuracy, and quality standards.

Responsibilities
  • Perform utilization review and utilization management activities.
  • Review patient medical records, clinical documentation, and treatment information.
  • Assess medical necessity and appropriateness of level of care.
  • Collaborate with healthcare providers regarding patient care and utilization needs.
  • Communicate effectively with providers and members of the interdisciplinary care team.
  • Utilize DragonFly as the primary utilization management platform.
  • Accurately and promptly document utilization reviews and clinical determinations.
  • Navigate and document within the Epic EMR.
  • Support appropriate resource utilization and optimal patient outcomes.
  • Work independently in a remote environment while meeting productivity and quality expectations.
  • Float to other affiliated campuses as required based on staffing needs; travelers may be expected to float first when coverage is needed.
  • Perform other utilization management duties as assigned.
Required Qualifications Licensure
  • Active Registered Nurse (RN) license required.
Experience
  • Minimum 2 years of relevant nursing experience.
  • Provider-side utilization management experience required.
  • Candidates with exclusively payer-side utilization management experience do not meet the requirement.
  • Previous remote-work experience preferred.
  • Prior travel nursing experience highly preferred.
Technical Skills
  • DragonFly experience required.
  • Epic EMR experience required.
  • Strong computer literacy and clinical documentation skills.
  • Ability to efficiently navigate multiple electronic systems while working remotely.
Certifications
  • CCM or CMCN certification required.
Education
  • Degree accreditation must be verified, or candidate must have at least 5 years of relevant experience.