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

Oscar Health

Sr. Quality of Care Review Nurse

Dallas, TX · Remote

$83K - $109K/yr

Licensed Registered Nurse with active, unrestricted license in state of residence and willingness ... Health plan utilization management experience or case management experience. * Experience in health ...

GuideWell

Care Mgmt Referral Analyst RN

Irving, TX · On-site

Job Title RN Referral Analyst Get To Know Us! WebTPA, a GuideWell Company, is a healthcare third ... Monitor and review referrals received from Utilization Management authorization triggers, high ...

AA2IT

Registered Nurse

Rowlett, TX · On-site

$55 - $65/hr

Registered Nurse Title: Registered Nurse Work Location: Rowlett Rate: $55-$65 /HR (Including Per ... Supports evidence-based practice changes through research utilization and experiential learning.

Coralvita

Registered Nurse

Richardson, TX · On-site

... review. Participates in staff and other facility team meetings 25% Develop, document, and implement ... utilization of the nursing process of assessment, planning, intervention and evaluation of the ...

Coralvita

Registered Nurse

Richardson, TX · On-site

... review. Participates in staff and other facility team meetings 25% Develop, document, and implement ... utilization of the nursing process of assessment, planning, intervention and evaluation of the ...

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All JobsUtilization Review Rn JobsUtilization Review Rn Jobs in McKinney, TX

Utilization Review Rn information

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$19

$39

$64

How much do utilization review rn jobs pay per hour?

As of Aug 8, 2026, the average hourly pay for utilization review rn in McKinney, TX is $39.24, according to ZipRecruiter salary data. Most workers in this role earn between $31.01 and $45.05 per hour, depending on experience, location, and employer.

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.

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 knowledge of medical coding and insurance processes can enhance your qualifications. Gaining experience in case management or health insurance companies can also improve your chances of entering the field.

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.

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.
What are the most commonly searched types of Utilization Review Rn jobs in McKinney, TX? The most popular types of Utilization Review Rn jobs in McKinney, TX are:
What are popular job titles related to Utilization Review Rn jobs in McKinney, TX? For Utilization Review Rn jobs in McKinney, TX, the most frequently searched job titles are:
What job categories do people searching Utilization Review Rn jobs in McKinney, TX look for? The top searched job categories for Utilization Review Rn jobs in McKinney, TX are:
What cities near McKinney, TX are hiring for Utilization Review Rn jobs? Cities near McKinney, TX with the most Utilization Review Rn job openings:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in McKinney, TX as of August 2026, with employment types broken down into 1% As Needed, 84% Full Time, 12% Part Time, and 3% Contract. Highlights an 89% Physical, 2% Hybrid, and 9% Remote job distribution, with an average salary of $81,618 per year, or $39.2 per hour.

Registered Nurse - Care Coordinator - Care Management

Parkland Health and Hospital System

Dallas, TX • On-site

Full-time

Re-posted 5 days ago

Parkland Health and Hospital System rating

8.2

Company rating: 8.2 out of 10

Based on 90 frontline employees who took The Breakroom Quiz

55th of 887 rated healthcare providers

Job description

Location: Main Hospital Bldg - 1st Flr
Shift: DAYS
Work Hours: 8:30am-4pm (Monday-Friday)
*This position will be onsite only**
Employment Type: Full Time
Primary Purpose
Establishes and maintains an efficient, cost effective care management process by determining patient financial and medical eligibility, medical necessity, and by developing, implementing and monitoring individual patient plans of care and communicating these plans to patients, families, and Parkland staff to ensure quality patient care throughout the healthcare continuum and compliance with program/Parkland policies and procedures. Responsible for the maintaining the knowledge and skill set related to utilization review, care coordination, performance improvement and professional licensure and certification.
Minimum Specifications
Education
  • Must be a graduate of an accredited school of Nursing.

Experience
  • Must have two (2) years of hospital or community based patient care nursing, preferably in assigned clinical area.

Equivalent Education and/or Experience
Certification/Registration/Licensure
  • Must have current, valid RN license or temporary RN license from the Texas Board of Nursing; or, valid Compact RN license.
  • Must have current healthcare provider BLS for Healthcare Providers certification from one of the following:
    • American Heart Association
    • American Red Cross
    • Military Training Network

Required Tests for Placement
Skills or Special Abilities
  • Provides care to assigned patient population in accordance with the current State of Texas Nursing Practice Act, established protocols, multidisciplinary plan of care, and clinical area specific standards.
  • Must be able to communicate and collaborate effectively with a diverse group of patients, families and healthcare staff.
  • Must be able to demonstrate a working knowledge of specific patient populations, and be able to demonstrate knowledge of disease processes affecting this group.
  • Must be able to demonstrate a working knowledge of PC operations and the ability to use word processing software in a Windows environment.
  • Must be able to demonstrate a working knowledge of the laws and regulations governing Medicare, Medicaid and community-based funding sources.
  • Must be self-directed and capable of priority setting and problem solving.
  • Must be able to demonstrate patient centered/patient valued behaviors.

Responsibilities
  • Conducts assessment of patients on assigned Care Coordination team to develop a case management plan of care. Gathers information from patient, physicians, other pertinent members of the healthcare team. Determines funding sources for patients and potential eligibility if appropriate. Plans and develops specific objectives, goals and actions designed to meet the patient's needs as identified through the assessment process. Utilizes hospital approved review criteria to ensure appropriate bed status. Identifies at-risk populations using approved screening tool and follows established reporting procedures. Ensures appropriate admission status is documented.
  • Collaborates with all members of the multidisciplinary team and the patient to implement the plan of care. Monitors the patient's progress, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective. Communicates all financial counseling as appropriate. Addresses and resolves system barriers impeding diagnostic or treatment progress. Proactively identifies and resolves delays and obstacles to discharge. Ensures/maintains plan consensus from patient/family, physician, and payer. Serves as patient advocate to secure coverage for needed community services. Mobilizes resources and coordinates the effort to the health care team to achieve a positive patient transition to appropriate next level of care.
  • Communicates plan of care to patient and their family providing updates and reassesses the plan of care to determine effectiveness. Completes appropriate coordinator management documentation. Evaluates the plan of care at appropriate intervals to determine effectiveness in meeting outcomes and goals. Works with nursing and other disciplines to ensure that discharge needs, including teaching, are met.
  • Collaborates with the healthcare team to identify 'best' practices for achieving patient outcomes. Develops reporting mechanisms to communicate outcomes to physicians and other members of the health care team.
  • Responsible for Utilization Management activities for assigned patients. Applies approved utilization criteria to monitor appropriateness of admissions and continued stays, and documents findings based on department standards. Monitors length of stay (LOS) and ancillary resource use on an ongoing basis and takes action to achieve continuous improvement in both areas.
  • Monitors and addresses outcome variances. Identifies causes of outcome variances and implements actions to improve the variances.
  • Seeks the most efficient, cost effective ways to provide appropriate care. Supports cost containment efforts through the recommendation of performance improvement opportunities by the health care team.
  • Communicates with Care Management team to facilitate covered-day reimbursement certification and/or authorization for assigned patients. Discusses payer criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payers as needed.
  • Transitions patients through the health care system based upon individual and patient population needs. Directs liaison activities to appropriately integrate the patient into the health care continuum including procuring of services, health promotion and counseling, disease prevention, health education and screening, and community resource linkage.
  • Engages in special projects and serves on committees, as assigned.

Requisition ID: 988988

What Parkland Health and Hospital System employees say

Pay

Benefits

Hours and flexibility

Workplace

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About Parkland Health and Hospital System

Sourced by ZipRecruiter

Parkland Health and Hospital System, based in Dallas, TX, US, is a reputed entity in the healthcare industry. Accessible through their website parklandhealth.org, this distinguished organization operates within the public sector, primarily providing medical care and services. Parkland Health was founded with a mission to take healthcare to people who need it the most and ever since its inception it has staunchly adhered to this principle. The hospital is acknowledged for its unyielding dedication to patient care, its world-class staff, and its innovative medical breakthroughs. Alongside its traditional healthcare offerings, Parkland also provides specialized services such as burn treatment and poison control, cementing their position as a comprehensive provider of critical care.

Industry

Hospitals

Company size

10,000+ Employees

Headquarters location

Dallas, TX, US

Year founded

1954

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