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Utilization Review Rn Jobs in Round Rock, TX (NOW HIRING)

Adaptive Home Health, LLC

RN Clinical Manager

Austin, TX · On-site

$100 - $125/hr

Provide guidance on OASIS documentation and assist RNs with utilization reviews * Facilitate case conferences, interdisciplinary communication, and care planning * Ensure timely submission of ...

UnitiMed

RN Case Manager

Austin, TX · On-site

Referral bonus up to $700 Registered Nurse (RN),Case Management/Utilization Review, About the Company: Uniti Med is an award-winning healthcare staffing company with a mission to provide staffing ...

BCforward

Registered Nurse

Austin, TX · On-site

Pediatric, geriatric, general long term care experience, previous utilization review experience ... as a Registered Nurse. Maintains appropriate documentation and support for all requests.

Fira Health

Registered Clinical Manager

Austin, TX · On-site

$105K - $110K/yr

Provide guidance on OASIS documentation and assist RNs with utilization reviews * Facilitate case conferences, interdisciplinary communication, and care planning * Ensure timely submission of ...

Fira Health

Registered Clinical Manager

Austin, TX · On-site

$105K - $110K/yr

Provide guidance on OASIS documentation and assist RNs with utilization reviews * Facilitate case conferences, interdisciplinary communication, and care planning * Ensure timely submission of ...

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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 7, 2026, the average hourly pay for utilization review rn in Round Rock, TX is $39.43, according to ZipRecruiter salary data. Most workers in this role earn between $31.15 and $45.29 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 Round Rock, TX?

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

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

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

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

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

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Round Rock, TX as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 18% Part Time, 2% Contract, and 1% Nights. Highlights an 81% Physical, 2% Hybrid, and 17% Remote job distribution, with an average salary of $82,013 per year, or $39.4 per hour.

Utilization Review Coordinator - PRN position

Georgetown Behavioral Health Institute

Georgetown, TX • On-site

Other

Medical, Dental, Vision, Retirement, PTO

Re-posted 20 days ago

Job description

Our inpatient behavioral health hospital is seeking a PRN Utilization Review Coordinator.
This position is responsible for working with insurance companies and managed care systems for the initial authorization, concurrent and retrospective review of inpatient, partial, and intensive outpatient admissions and services. Previous experience in utilization review or case management desirable.
This position will obtain authorization for each admitted patient. Review and monitor each step of the authorization process to proactively identify potential problems to help patients access the full range of their benefits through the utilization review process.
Requirements
Education and/or Licensure - Bachelor's degree or equivalent in nursing preferred.
Experience - 3-5 years Admitting or Financial Counseling preferred. Prefer two years clinical experience in a facility with medical terminology and in criteria for acute psychiatric inpatient care. Knowledgeable of insurance coverage and billing practices preferred. Previous experience in utilization review or case management desirable.
Additional Requirements - Must possess or obtain a valid CPR certification and certified in facility approved verbal de-escalation and physical crisis management techniques within 30 days of hire and prior to completion of orientation required.
Benefits
Full-time employees are eligible for medical, dental, vision, company paid disability, 401(k) and a generous amount of paid time off.

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