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How much do utilization review rn jobs pay per hour?

As of Sep 8, 2026, the average hourly pay for utilization review rn in San Antonio, TX is $38.15, according to ZipRecruiter salary data. Most workers in this role earn between $30.14 and $43.80 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 San Antonio, TX?

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

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

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

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

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

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

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

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in San Antonio, TX as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 16% Part Time, 3% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $79,327 per year, or $38.1 per hour.

Utilization Review Care Coordinator (RN)

Dean's Professional Services

San Antonio, TX • On-site

$29/hr

Full-time

Posted 6 days ago

Job description

Utilization Review Care Coordinator (RN)

Location: San Antonio, TX

Pay Rate: Starting at $29.00/hour

Schedule: Monday-Friday | 8:00 AM-5:00 PM

Dean's Professional Services is seeking an experienced and detail-oriented Utilization Review Care Coordinator (RN) to support a leading healthcare organization in San Antonio, TX.

This is an excellent opportunity for an experienced Registered Nurse with a strong background in utilization review, care management, and clinical documentation. The ideal candidate will have strong clinical judgment, analytical skills, and the ability to collaborate with healthcare providers and payers to ensure patients receive appropriate, timely, and cost-effective care.

Responsibilities

  • Conduct utilization reviews to assess the medical necessity, appropriateness, and efficiency of healthcare services.
  • Review patient medical records, treatment plans, and clinical documentation to ensure services meet established clinical guidelines and regulatory requirements.
  • Evaluate patient cases and identify opportunities to improve care delivery and appropriate resource utilization.
  • Collaborate with physicians, nurses, case managers, and other healthcare professionals regarding patient care and utilization concerns.
  • Facilitate authorization processes for hospital admissions, treatments, procedures, and other healthcare services with insurance companies and payers.
  • Monitor patient progress and discharge plans to support timely and appropriate transitions of care.
  • Identify potential barriers to discharge and communicate concerns to the appropriate members of the care team.
  • Educate patients, families, and healthcare providers regarding utilization review processes, requirements, and available resources.
  • Maintain accurate and timely documentation of utilization reviews, clinical findings, authorizations, and actions taken.
  • Participate in interdisciplinary care management and utilization review meetings.
  • Apply established utilization management criteria and organizational policies when reviewing cases.
  • Ensure utilization review activities comply with applicable healthcare regulations, including Medicare and Medicaid guidelines.
  • Stay current with utilization review, care management, regulatory, and healthcare industry standards.
  • Handle multiple priorities and complex cases while maintaining accuracy, confidentiality, and strong patient advocacy.
  • Perform other duties as assigned.

Qualifications

  • Bachelor's degree from an accredited school of Nursing required.
  • Minimum 3 years of clinical nursing experience required.
  • Minimum 2 years of utilization review experience required.
  • Current Texas RN license or Compact RN license required.
  • Texas Board of Nursing RN license required upon hire.
  • InterQual experience preferred.
  • ACM (Accredited Case Manager) or CCM (Certified Case Manager) certification preferred.
  • CPR certification required within 7 days of hire.
  • Strong knowledge of utilization review processes, clinical guidelines, and regulatory requirements.
  • Knowledge of medical terminology, disease processes, treatment protocols, and healthcare delivery systems.
  • Understanding of insurance requirements and payer authorization processes.
  • Knowledge of Medicare and Medicaid utilization and regulatory guidelines.
  • Proficiency in reviewing and interpreting medical records and clinical documentation.
  • Strong analytical, critical-thinking, and decision-making ski