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Utilization Reviewer Jobs in Texas (NOW HIRING)

Oscar Health

Utilization Review Nurse

Dallas, TX · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You will perform frequent case reviews, check medical records and speak with care providers regarding ...

Shannon Health

Utilization Review Nurse

Big Spring, TX · On-site

Job Summary The Utilization Review (UR) Nurse has acute knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the ...

Shannon Health

Utilization Review Nurse

Big Spring, TX · On-site

Job Summary The Utilization Review (UR) Nurse has acute knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the ...

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Showing results 1-20

All JobsUtilization Reviewer JobsUtilization Reviewer Jobs in Texas

Utilization Reviewer information

See Texas salary details

$28.9K

$35.4K

$41K

How much do utilization reviewer jobs pay per year?

As of Aug 7, 2026, the average yearly pay for utilization reviewer in Texas is $35,396.00, according to ZipRecruiter salary data. Most workers in this role earn between $31,700.00 and $39,100.00 per year, depending on experience, location, and employer.

What is the difference between Utilization Reviewer vs Medical Coder?

AspectUtilization ReviewerMedical Coder
Required CredentialsTypically requires healthcare-related certifications, such as RHIT, RHIA, or CPCUsually requires coding certifications like CPC, CCS, or CCS-P
Work EnvironmentHealthcare facilities, insurance companies, or utilization review organizationsHospitals, clinics, or medical billing companies
Employer & Industry UsageUsed in insurance, managed care, and healthcare administrationUsed in medical billing, coding, and health information management

While both roles work within healthcare settings, Utilization Reviewers focus on evaluating the necessity of medical services for insurance and care management, whereas Medical Coders translate medical records into standardized codes for billing and documentation. Understanding these differences helps professionals choose the right career path or job search focus.

How does a utilization reviewer typically collaborate with healthcare providers to ensure appropriate patient care?

Utilization Reviewers work closely with physicians, nurses, and other healthcare professionals to assess the necessity and efficiency of medical services provided to patients. They review clinical documentation, verify that treatments meet established guidelines, and may discuss care plans directly with providers to clarify information or suggest alternatives. This collaboration ensures that patients receive appropriate care while controlling costs and complying with insurance or regulatory requirements. Effective communication and a thorough understanding of medical protocols are essential for success in this role.

What does a utilization reviewer do?

A Utilization Reviewer is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient records, treatment plans, and insurance policies to ensure that care meets established guidelines and standards. Their role helps control healthcare costs while maintaining quality patient care and ensuring compliance with regulatory requirements. Utilization Reviewers often communicate with healthcare providers, insurance companies, and patients to gather information and make informed decisions.

What does a utilization reviewer do?

There are different types of Utilization Reviewer jobs, including Nurse Utilization Reviewers, Insurance Utilization Reviewers, Speech Therapy, Physical Therapy, and Occupational Therapy Utilization Reviewers. Regardless of the area of focus, a Utilization Reviewer is responsible for setting best practices, reviewing healthcare program requirements, ensuring the quality of care, controlling costs, and developing and implementing initiatives for review processes. Utilization Reviewers ensure compliance of programs, regularly audit patient and client records, work with staff to implement best practices and correct problem areas, monitor industry trends, and remain up-to-date and train others on industry standards and requirements.

What are the key skills and qualifications needed to thrive as a utilization reviewer?

To thrive as a Utilization Reviewer, you need a clinical background (such as RN or LCSW), in-depth knowledge of medical terminology, and an understanding of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or URAC accreditation is typically required. Strong critical thinking, attention to detail, and effective communication skills help in evaluating patient care and collaborating with providers. These competencies are crucial for ensuring appropriate, cost-effective care while maintaining compliance with healthcare standards.
More about Utilization Reviewer jobs
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What are popular job titles related to Utilization Reviewer jobs in TX? For Utilization Reviewer jobs in TX, the most frequently searched job titles are:
Utilization Reviewer jobs near you
Infographic showing various Utilization Reviewer job openings in Texas as of August 2026, with employment types broken down into 1% As Needed, 85% Full Time, 12% Part Time, and 2% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $35,396 per year, or $17 per hour.

Utilization Management Reviewer FT

StarCare Specialty Health System

Lubbock, TX • On-site

Other

Medical, Life, Retirement, PTO

Re-posted 3 days ago

Job description

Description
StarCare Specialty Health System (StarCare) is seeking a full time Utilization Management (UM) Reviewer to join its outstanding Utilization Management team supporting the agency's various mental health authorization processes.
Responsibilities:
  • Provide Utilization Management functions in Mental Health Services.
  • Authorization of services based upon UM Guidelines.
  • Coordination and management of the Discharge Process.
  • Management of capacity related to Mental Health Service authorizations, and the management of the Mental Health Waiting Lists and Pre-Authorization Lists.
  • Conduct additional specific UM Reviews as needed.
  • Assist with the administrative functions of the UM Department.
  • Participate in the MAC Time Study as required and utilize Medicaid decision-making authority.
  • Complete all required documentation.
  • Communicate information to supervisor and other agency employees or vendors.
  • Assist with special projects or assignments as needed or as requested.
Schedule: This is a full-time/non-exempt position scheduled Monday - Friday, 8am - 5pm, with flexibility to meet the needs of the department. The position is based in Lubbock and will work in a hybrid work environment (combination of remote and on-site) and must be able to work on-site when job duties require or when requested by supervisor.
Benefit Package: StarCare offers an expansive benefit package including, but not limited to: Company-paid medical coverage, fully funded employer contribution to HSA, company-paid life insurance, company paid hospital indemnity plan, retirement plan with up to 12% employer match, front loaded paid time off (PTO), thirteen (13) paid holidays, sabbatical leave, longevity augmentations, and employee referral augmentations.
Qualifications:
  • Graduation from accredited four (4) year college or university with major course work in a Human Services Field (Psychology, Sociology, Family Studies, etc.)
  • Must have at least three (3) years of clinically appropriate experience in direct care for adults and/or children with serious mental illness or emotional disturbance and/or chemical dependency.
Skills & Abilities:
  • Knowledge and skill in operating standard office equipment and personal computer with Microsoft Office products is required.
  • Ability to communicate effectively, both orally, and in writing.
  • Ability to maintain an effective working relationship with other employees and the public.
  • Ability to organize and prioritize a variety of assignments and manage time effectively.
  • Ability to problem-solve and make decisions based upon specific criteria.
  • Knowledge of current healthcare standards.
  • Knowledge of appropriate rules, regulations, and policies and procedures.
  • Knowledge of general DSM-5 language and concepts.
  • Knowledge of the Mental Health Service Delivery system.
Additional Requirements:
  • Must pass a pre-hire drug screen and criminal background check.
  • Must have a Texas driver's license, liability auto insurance, and be insurable under the Agency's insurance.

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