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

CSI Pharmacy

Clinical Utilization Nurse

Plano, TX · On-site

$88K - $115K/yr

Summary The Clinical Utilization Nurse (CUN) is responsible for reviewing patient referrals ... Associates degree or Bachelor's degree from an accredited nursing school as a Registered Nurse ...

GuideWell

Utilization Management RN

Irving, TX · On-site

... utilization of health care services and benefits as designated. This requires an experienced RN ... Concurrent review and the determination of the extension of the length of stay based on the ...

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How much do utilization review rn jobs pay per hour?

As of Aug 15, 2026, the average hourly pay for utilization review rn in Plano, TX is $40.72, according to ZipRecruiter salary data. Most workers in this role earn between $32.16 and $46.78 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 Plano, TX?

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

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

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

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

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Plano, TX as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 14% Part Time, and 3% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $84,698 per year, or $40.7 per hour.

Vascular Surgery - Utilization Review - REMOTE - Contract (1099)

MRIoA

Dallas, TX • On-site, Remote

Contractor

Re-posted yesterday

Job description

Description
Flexible Independent Contractor (1099) Opportunity
Vascular Surgeon - Requiring an OREGON state medical license.
ABOUT MRIoA
Founded in 1983, Medical Review Institute of America (MRIoA) is a nationally recognized Independent Review Organization (IRO) specializing in technology-driven utilization management and clinical medical review solutions. We're a leader in Peer and Utilization Reviews, known for excellence and continuous improvement.
THE OPPORTUNITY:
We are currently seeking Board-Certified physicians in Vascular Surgery to conduct independent Utilization Reviews. This is a flexible, fully remote opportunity requiring just 1-2 hours per week-with no minimum commitment.
ADDITIONAL INFORMATION:
  • Work remotely from anywhere in the US (Per HIPPA Regulations patient records cannot leave the US).
  • Covered under MRIoA's Errors and Omissions policy.
  • Independent Contractor (1099) opportunity.
  • Workers are required to adhere to all applicable HIPAA regulations and company policies and procedures regarding the confidentiality, privacy, and security of sensitive health information.

California Consumer Privacy Act (CCPA) Information (California Residents Only):
  • Sensitive Personal Info: MRIoA may collect sensitive personal info such as real name, nickname or alias, postal address, telephone number, email address, Social Security number, signature, online identifier, Internet Protocol address, driver's license number, or state identification card number, and passport number.
  • Data Access and Correction: Applicants can access their data and request corrections. For questions and/or requests to edit, delete, or correct data, please email the Medical Review Institute at HR@mrioa.com.

Requirements
  • Must have a Medical Degree MD or DO
  • Must have a current OREGON STATE unencumbered medical license
  • Current Board Certification in Vascular Surgery
  • Must have 5 years of clinical experience, residency can be included
  • Daytime availability is required for peer-to-peer conversations

Apply