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How much do utilization review jobs pay per hour?

As of Jun 19, 2026, the average hourly pay for utilization review in Spring, TX is $37.63, according to ZipRecruiter salary data. Most workers in this role earn between $29.71 and $43.22 per hour, depending on experience, location, and employer.

What jobs pay $10,000 a month without a degree?

Utilization Review roles typically do not pay $10,000 a month without relevant experience or certifications; most positions in this field pay lower salaries. High-paying jobs that can reach this level without a degree often include specialized sales, real estate, or entrepreneurship, but they usually require significant skills, networking, or business acumen. Achieving such income without a degree generally involves gaining expertise, certifications, or building a successful independent business.

What does a typical day look like for someone working in Utilization Review?

A typical day in Utilization Review involves reviewing patient medical records, evaluating the necessity and appropriateness of proposed treatments or services, and documenting recommendations based on clinical criteria and insurance policies. Utilization Review specialists often collaborate closely with physicians, nurses, and insurance representatives to gather additional information and clarify cases. While much of the role is desk-based and may include remote work options, it requires regular communication with both clinical and administrative teams. This position offers variety and challenge, as no two cases are exactly alike, and there are often opportunities to advance into supervisory or quality improvement roles within the department.

What skills do you need for utilization review?

Utilization review professionals need strong analytical skills to assess medical necessity and appropriateness of care, attention to detail, and knowledge of healthcare regulations and insurance policies. Good communication skills are essential for coordinating with healthcare providers and explaining decisions. Familiarity with electronic health records (EHR) systems and relevant certifications, such as Certified Professional in Healthcare Quality (CPHQ), can also be beneficial.

What is a Utilization Review job?

A Utilization Review (UR) job involves assessing the medical necessity, efficiency, and appropriateness of healthcare services. UR professionals, often nurses or healthcare specialists, review patient records, insurance claims, and treatment plans to ensure they meet industry standards and payer requirements. They work with healthcare providers, insurance companies, and regulatory agencies to optimize care while controlling costs. Their goal is to balance quality patient care with cost-effective resource utilization.

What are the key skills and qualifications needed to thrive in the Utilization Review position, and why are they important?

To thrive in Utilization Review, professionals typically need a background in nursing or healthcare, strong clinical assessment capabilities, and a thorough understanding of medical guidelines and insurance regulations. Familiarity with electronic medical records (EMR) systems and utilization management software, and often certification such as Certified Utilization Review Specialist (CURN), are important. Excellent critical thinking, attention to detail, and strong communication skills enable effective case evaluation and collaboration with healthcare teams. These skills and qualifications ensure objective, accurate decisions that support cost-effective, quality patient care within compliance standards.

What is the least stressful healthcare job?

Utilization review is often considered a less stressful healthcare job because it typically involves reviewing medical cases and insurance claims in a predictable, office-based environment. It usually requires strong analytical skills and certification but involves less direct patient interaction and emergency situations compared to clinical roles.

How do I get into a utilization review?

To become a utilization review specialist, typically a healthcare professional such as a registered nurse, licensed social worker, or physician completes relevant education and obtains certification in utilization review or case management. Gaining experience in healthcare settings and understanding insurance policies and medical coding can also improve job prospects. Certification programs like the Certified Professional in Healthcare Quality (CPHQ) or Certified Case Manager (CCM) are often preferred by employers.
What are the most commonly searched types of Utilization Review jobs in Spring, TX? The most popular types of Utilization Review jobs in Spring, TX are:
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What cities near Spring, TX are hiring for Utilization Review jobs? Cities near Spring, TX with the most Utilization Review job openings:
Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Spring, TX as of June 2026, with employment types broken down into 100% Full Time. Highlights an 60% In-person, and 40% Remote job distribution, with an average salary of $78,263 per year, or $37.6 per hour.
Utilization Review Nurse

Utilization Review Nurse

Houston Methodist The Woodlands Hospital

The Woodlands, TX

Full-time

Posted 17 days ago

Houston Methodist rating

8.1

Company rating: 8.1 out of 10

Based on 293 frontline employees who took The Breakroom Quiz

69th of 873 rated healthcare providers

Job description

Full Time, Days, Not a Remote position.
Hours: 8:30-5:30, Monday - Friday
At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent medical record review for medical necessity and level of care using nationally recognized acute care indicators and criteria as approved by medical staff, payer guidelines, CMS, and other state agencies. This position prospectively or concurrently determines the appropriateness of inpatient or observation services following review of relevant medical documentation, medical guidelines, and insurance benefits and communicates information to payers in accordance with contractual obligations. The URN position serves as a resource to the physicians and provides education and information on resource utilization and national and local coverage determinations (LCDs & NCDs). This position collaborates with case management in the development and implementation of the plan of care and ensures prompt notification of any denials to the appropriate case manager, denials, and pre-bill team members, as well as management.
FLSA STATUS
Exempt
QUALIFICATIONS
EDUCATION
  • Graduate of education program approved by the credentialing body for the required credential(s) indicated below in the Certifications, Licenses and Registrations section
  • Bachelor’s degree preferred

EXPERIENCE
  • Three years of hospital clinical nursing experience

LICENSES AND CERTIFICATIONS
Required
  • RN - Registered Nurse - Texas State Licensure - Texas Board of Nursing_PSV Compact Licensure – Must obtain permanent Texas license within 60 days (if establishing Texas residency)

SKILLS AND ABILITIES
  • Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through ongoing skills, competency assessments, and performance evaluations
  • Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security
  • Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles
  • Progressive knowledge of InterQual Level of Care Criteria or Milliman Care Guidelines and knowledge of local and national coverage determinations
  • Recent work experience in a hospital or insurance company providing utilization review services
  • Knowledge of Medicare, Medicaid, and Managed Care requirements
  • Progressive knowledge of community resources, health care financial and payer requirements/issues, and eligibility for state, local, and federal programs
  • Progressive knowledge of utilization management, case management, performance improvement, and managed care reimbursement
  • Ability to work independently and exercise sound judgment in interactions with physicians, payers, and health care team members
  • Strong assessment, organizational, and problem-solving skills
  • Maintains level of professional contributions as defined in Career Path program
  • Understands and applies federal law regarding the use of Hospital Initiated Notice of Non-Coverage (HINN), Ambulatory Benefit Notice (ABN), Important Message from Medicare (IMM), Medicare Outpatient Observation Notice (MOON), and Condition Code 44 (CC44)

ESSENTIAL FUNCTIONS
PEOPLE ESSENTIAL FUNCTIONS
  • Establishes and maintains effective professional working relationships with patients, families, interdisciplinary team members, payers, and external case managers; listens and responds to the ideas of others.
  • Collaborates with the access management team to ensure accurate and complete clinical and payer information. Educates members of the patient’s healthcare team on the appropriate access to and use of various levels of care.
  • Contributes towards improvement of department scores for employee engagement, i.e., peer-to-peer accountability.

SERVICE ESSENTIAL FUNCTIONS
  • Pro-actively participates as a member of the interdisciplinary clinical team to confirm appropriateness of the treatment plan relative to the patient’s preference, reason for admission, and availability of resources. Participates in daily Care Coordination Rounds and identifies and communicates barriers to efficient utilization.
  • Reviews H&Ps and admitting orders of all direct, transfer, and emergency care patients designated for admission to ensure compliance with CMS guidelines regarding appropriateness of level of care.
  • Identifies potentially unnecessary services and care delivery settings and recommends alternatives, if appropriate, by analyzing clinical protocols.
  • Escalates appropriate cases to the Physician Advisor (or services) for appropriate second level review, peer-peer discussions, and payer denial- appeal needs. Consults with physician advisor as necessary to resolve progression-of-care barriers through appropriate administrative and medical channels.

QUALITY/SAFETY ESSENTIAL FUNCTIONS
  • Participates in quality improvement activities as stewards for resource utilization as it pertains to medical necessity and level of care. Promotes medical documentation that accurately reflects intensity of services, quality and safety indicators and patient’s need to continue stay.
  • Promotes the use of evidence-based protocols and/or order sets to influence high-quality and cost-effective care. Identifies areas for improvement based on an understanding of evidence-based practice/performance improvement projects based on these observations.
  • Identifies and records episodes of preventable delays or avoidable days due to failure of the progression of the care process

FINANCE ESSENTIAL FUNCTIONS
  • Contributes to meeting department financial targets, with a focus on appropriate utilization and denial prevention. Utilizes resources with cost effectiveness and value creation in mind. Self-motivated to independently manage time effectively and prioritize daily tasks, assisting coworkers as needed.
  • Performs review for medical necessity of admission, continued stay and resource use, appropriate level of care, and program compliance using evidence-based, nationally recognized guidelines. Manages assigned patients and communicates and collaborates with the case manager to assist with appropriate interventions to avoid denial of payment.
  • Collaborates with the revenue cycle regarding any claim issues or concerns that may require clinical review during the pre-bill, audit, or appeal process.

GROWTH/INNOVATION ESSENTIAL FUNCTIONS
  • Identifies and presents areas for improvement in patient care or department operations and offers solutions by participating in department projects and activities.
  • Seeks opportunities to identify self-development needs and takes appropriate action. Ensures own career discussions occur with appropriate management. Completes and updates the My Development Plan on an ongoing basis.

SUPPLEMENTAL REQUIREMENTS
    WORK ATTIRE
    • Uniform: No
    • Scrubs: No
    • Business professional: Yes
    • Other (department approved): No

    ON-CALL*
    *Note that employees may be required to be on-call during emergencies (ie. Disaster, Severe Weather Events, etc) regardless of selection below.
    • On Call* Yes

    TRAVEL**
    **Travel specifications may vary by department**
    • May require travel within the Houston Metropolitan area Yes
    • May require travel outside Houston Metropolitan area No
QUALIFICATIONS
EDUCATION
  • Graduate of education program approved by the credentialing body for the required credential(s) indicated below in the Certifications, Licenses and Registrations section
  • Bachelor’s degree preferred

EXPERIENCE
  • Three years of hospital clinical nursing experience

LICENSES AND CERTIFICATIONS
Required
  • RN - Registered Nurse - Texas State Licensure - Texas Board of Nursing_PSV Compact Licensure – Must obtain permanent Texas license within 60 days (if establishing Texas residency)

Company Profile:

Houston Methodist The Woodlands Hospital opened in June 2017. This 725,000-square-foot, full-service, acute-care hospital offers many of the same services as our flagship hospital in the Texas Medical Center. Also, on the beautiful hospital campus, located at the intersection of Interstate 45 and Texas State Highway 242, are two medical office buildings, which include a Breast Care Center; Cancer Center; infusion center; heart and vascular services; neurology; orthopedics and sports medicine; rehabilitation services; wellness services; an outpatient laboratory; and several other multispecialty physician practices. In January 2022, Houston Methodist The Woodlands opened Healing Tower — a $250 million expansion project that added 106 beds, focused on medical-surgical and women’s services, and provided nine operating rooms. The project also included the expansion of the endoscopy center, emergency department and diagnostic imaging department with an enhanced neurodiagnostic and interventional center.

Houston Methodist is an Equal Opportunity Employer.

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