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Utilization Review Jobs in Spring, TX (NOW HIRING)

Carrus Health

Therapist (Float) (Houston)

Houston, TX · On-site

Performs various roles including Therapist, Utilization Review, and Clinic Manager. Therapist role - provides individual psychotherapy and/or case management sessions on an as-needed basis, provides ...

Medix

Utilization Management Manager

Houston, TX · On-site

$57/hr

Job Summary Our client is seeking a Utilization Management Manager to review clinical documentation ... Review clinical documentation to justify inpatient hospital stays. * Submit reasoning to insurance ...

Nexus Health Systems Ltd

Clinical Reviewer

Houston, TX · On-site

Previous experience with clinical review, utilization review, care management, admissions evaluations, medical necessity review, or similar clinical decision-making strongly preferred. * Experience ...

Nexus Health Systems

Clinical Reviewer

Houston, TX · On-site

Previous experience with clinical review, utilization review, care management, admissions evaluations, medical necessity review, or similar clinical decision-making strongly preferred. * Experience ...

Nexus Health Systems

Lead RN Case Manager

Conroe, TX · On-site

Practices "minimum information necessary" when performing utilization review, case management, and discharge functions. * Acts as a patient advocate for all patients within the facility. * Adheres to ...

Nexus Health Systems

RN Case Manager

Conroe, TX · On-site

Practices "minimum information necessary" when performing utilization review, case management, and discharge functions. * Acts as a patient advocate for all patients within the facility. * Adheres to ...

Sanitas

Case Management Coordinator (69162)

Katy, TX · On-site

Certified Case Manager (CCM) credential or similar certification in care coordination/utilization review. * Bilingual (English and Spanish) to effectively serve diverse member populations. Financial ...

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All JobsUtilization Review JobsUtilization Review Jobs in Spring, TX

Utilization Review information

See Spring, TX salary details

$19

$37

$61

How much do utilization review jobs pay per hour?

As of Sep 12, 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 is a utilization review?

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 does a utilization review do?

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 are the key skills and qualifications needed to thrive in utilization review?

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.

How do I get into a utilization review?

To become a utilization review specialist, typically a healthcare or related degree such as nursing, health administration, or social work is required. Certification in case management or utilization review, like the Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects, and strong analytical and communication skills are essential for success in the role.

Is utilization review a stressful job?

Utilization review is a healthcare role that involves evaluating medical necessity and appropriateness of services, often under strict deadlines and documentation requirements. The job can be stressful due to high workload, the need for accuracy, and managing complex cases, but stress levels vary based on work environment and individual coping skills.

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:

What are popular job titles related to Utilization Review jobs in Spring, TX?

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

What job categories do people searching Utilization Review jobs in Spring, TX look for?

The top searched job categories for Utilization Review jobs in Spring, TX are:

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 August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 15% Part Time, 3% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $78,263 per year, or $37.6 per hour.

Longshore IME & Peer Review - Orthopedic Surgery Physicians

Houston, TX • On-site

Dane Street
Insurance Actuarial and Claim Adjusting Services • 51 - 200 employees
Learn more about Dane Streetexternal

Other

Re-posted 16 days ago

Job description

We are expanding our physician panel for Longshore and Harbor Workers' Compensation Act (LHWCA) cases and are seeking experienced Orthopedic Surgeons to perform:

  • Independent Medical Examinations (IMEs)
  • Peer Reviews
  • Or both
Primary demand is within a 50-mile range of Houston, Texas, particularly in Orthopedic Surgery.
This is an independent contractor opportunity offering flexible, case-based assignments.
Responsibilities
  • Conduct in-person, objective, defensible IMEs for Longshore cases
  • Perform comprehensive peer reviews of medical records
  • Provide detailed, timely written reports
  • Maintain compliance with LHWCA standards and documentation requirements
Requirements
  • Active, unrestricted Texas medical license
  • US Board-certified or board-eligible in Orthopedic Surgery
  • Must be AMA 6th Edition Certified (or willing to become certified)
  • Prior Longshore IME and/or Peer Review experience strongly preferred but not required
  • Strong analytical and report-writing skills
  • Ability to manage case timelines independently
Preferred Experience
  • Experience performing 30+ Longshore IMEs and/or Peer Reviews
  • Prior work with third-party administrators (TPAs), insurance carriers, employers, or IME vendors
  • Multi-state Longshore case experience
Benefits
  • Opportunity for supplemental income
  • Schedule flexibility and predictable work hours-conduct exams and reviews based on your schedule availability
  • No doctor/patient relationship is established, and no treatment is provided. These are advisory-only opinions.
  • Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertise
  • Expanded credentials as an expert in Independent Medical Exams
  • Fully prepped cases, streamlined case flow, transcription services at no cost, and a user-friendly work portal

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