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

Prime Healthcare

Case Manager RN

Mission, TX · On-site

An RN Case Manager will oversee and coordinate patient care from admission through discharge to ... Utilization Review: monitor the use of hospital resources and services to ensure appropriate care ...

Hidalgo County

Registered Nurse IV

Edinburg, TX · On-site

$81K/yr

Must be registered as a Registered Nurse by the State of Texas or a state that recognizes ... utilization review and control measures. Fluent in English and Spanish (speak, read, and write)

Hidalgo County, TX

Registered Nurse IV

Edinburg, TX · On-site

$81K/yr

Must be registered as a Registered Nurse by the State of Texas or a state that recognizes ... utilization review and control measures. Fluent in English and Spanish (speak, read, and write)

Hidalgo Co.

Registered Nurse IV

Edinburg, TX · On-site

$81K/yr

Must be registered as a Registered Nurse by the State of Texas or a state that recognizes ... utilization review and control measures. Fluent in English and Spanish (speak, read, and write)

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Utilization Review Rn information

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How much do utilization review rn jobs pay per hour?

As of Aug 28, 2026, the average hourly pay for utilization review rn in McAllen, TX is $40.17, according to ZipRecruiter salary data. Most workers in this role earn between $31.73 and $46.15 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 McAllen, TX?

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

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

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

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

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

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

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

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in McAllen, TX as of August 2026, with employment types broken down into 4% As Needed, 84% Full Time, 4% Part Time, and 8% Contract. Highlights an 96% In-person, and 4% Remote job distribution, with an average salary of $83,551 per year, or $40.2 per hour.

Case Manager RN

Mission, TX • On-site

Prime Healthcare
Hospitals • 10K+ employees

6.4

Company rating: 6.4 out of 10

Based on 286 frontline employees who took The Breakroom Quiz

644th of 894 rated healthcare providers

Free food

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Recommended by students

Learn more about Prime Healthcareexternal

Per diem

Medical, Retirement

Re-posted 2 days ago

Job description

Shift’s Available:  Days 

Employment Type: Per-Diem (PRN / PD) 

Location: Mission Regional Medical Center, Mission TX

We are seeking an RN Case Manager, also referred to as a Registered Nurse Case Manager or RN Clinical Case Manager. An RN Case Manager will oversee and coordinate patient care from admission through discharge to ensure quality, cost-effective outcomes. They assess patients’ needs, develop care plans, and collaborate with physicians, nurses, social workers, and other providers to manage care transitions. RN Case Managers also conduct discharge planning, utilization review, and helping patients navigate insurance and healthcare systems. This position is on a per diem basis, meaning PD/PRN as needed. 

Here are some of the benefits of working at Prime Healthcare: 

  • Competitive compensation  
  • Medical insurance benefit plan 
  • 401K   

Mission Regional Medical Center is a 297-bed, non-profit hospital that provides inpatient and outpatient hospital services to the people of the Rio Grande Valley. Rated one of the top hospitals in the country for clinical excellence in many services including maternity and orthopedic care, Mission Regional Medical Center has been offering quality healthcare, close to home, for over 60 years. For more information visit www.missionrmc.org.


Essential Duties and Responsibilities (includes, but not limited to): 

  • Patient Assessment: evaluate patients’ medical, psychosocial, and discharge needs upon admission and throughout their stay 
  • Care Coordination: develop and implement individualized care plans in collaboration with the healthcare team to ensure effective treatment and timely interventions 
  • Discharge Planning: coordinate safe and appropriate discharge plans, including referrals to rehab, home health, or long-term care facilities 
  • Utilization Review: monitor the use of hospital resources and services to ensure appropriate care and avoid unnecessary treatments or extended stays 
  • Patient and Family Education: help patients and families understand care plans, post-discharge instructions, and available resources 
  • Advocacy: advocate for patient needs and preferences, ensuring care is aligned with their goals and values 

EDUCATION, EXPERIENCE, TRAINING

Required qualifications:

1. BSW or other bachelor's degree in a related field.  At least one year experience in case management, discharge planning or nursing management; or
2. Experience and knowledge in basic to intermediate computer skills.
 

Preferred qualifications:

1. Minimum 5 years of acute care experience preferred.
2. CCM or obtained within 1year
3. Current BCLS certificate preferred.
4. Knowledge of Milliman Criteria and InterQual Criteria preferred.

#LI-AG1


Per Diem
Days

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

 

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