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

ScionHealth

Case Manager PRN

Sugar Land, TX · On-site

Graduate of an accredited program required: LPN/LVN or RN. * Master of Social Work with licensure ... Experience in case management, utilization review, or discharge planning a plus.

Paradigm Health Care Services

Hybrid MDS Nurse

Houston, TX · On-site

$33.25 - $43.75/hr

Coordinate and attend daily Casemix Meetings, weekly Utilization Review Meetings, and monthly ... A Registered Nurse License is preferred. * 2 years' experience in Long-Term Care experience ...

PARADIGM HEALTHCARE

Registered Nurse

Richmond, TX · On-site

$60 - $80/hr

Night Calling on all compassionate, fun‑spirited, and driven RNs! Come join the Paradigm Health ... Strong utilization knowledge of Point Click Care preferred. * Computer literacy skills (Microsoft ...

Paradigm Health Care Services

MDS Coordinator

Richmond, TX · On-site

$28 - $35.75/hr

Paradigm Healthcare is seeking a motivated LVN/RN to join our team as MDS Coordinator! Job Duties ... Coordinate and attend daily Casemix Meetings, weekly Utilization Review Meetings, and monthly ...

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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:

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

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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.

Manager, Emergency Department (ED) and Observation Case Management

Career Land Center, LLC

Houston, TX • On-site

$108K - $130K/yr

Full-time

This job post has expired today. Applications are no longer accepted.

Job description

A leading acute care hospital in Houston is seeking an experienced Manager of Emergency Department (ED) and Observation Case Management to lead care management services within the ED and Observation units. This leadership role is responsible for directing clinical and operational case management activities, promoting efficient patient flow, supporting appropriate resource utilization, and ensuring high-quality transitions of care.

The selected candidate will oversee a team of case management professionals and collaborate with physicians, nursing staff, social workers, and hospital leadership to enhance patient outcomes, regulatory compliance, and operational effectiveness.

Key Responsibilities

• Direct daily operations of case management services in the Emergency Department and Observation areas
• Manage utilization review activities to ensure appropriate level-of-care determinations and payer compliance
• Lead discharge planning and care transition processes to support timely and safe patient movement across the continuum of care
• Supervise, mentor, and evaluate case management team members
• Monitor departmental performance metrics and implement process improvement initiatives
• Collaborate with interdisciplinary teams to improve patient throughput and reduce avoidable delays in care
• Ensure adherence to federal, state, and organizational regulations, policies, and standards
• Serve as a resource for complex patient care and discharge planning situations
• Support quality, patient satisfaction, and financial performance goals through effective case management practices

Required Qualifications

• Current Texas Registered Nurse (RN) license or Licensed Master Social Worker (LMSW) credential
• Licensed Clinical Social Worker (LCSW) designation preferred for social work candidates
• Active Case Management Certification required
• Minimum of five years of experience in case management, utilization review, and care coordination/discharge planning within a healthcare setting
• At least three years of leadership, supervisory, or management experience
• Minimum of three years of hospital-based nursing or social work experience
• Strong knowledge of healthcare regulations, utilization management principles, and care transition practices

Preferred Skills

• Experience in emergency services, observation care, or acute care settings
• Proven ability to lead multidisciplinary teams in a fast-paced environment
• Excellent communication, problem-solving, and organizational skills
• Knowledge of patient flow management and resource optimization strategies
• Ability to analyze data, drive performance improvements, and achieve operational goals

Benefits:

Compensation. $108,867 - $130,000 per year

Relocation Assistance: Available