Utilization Review Nurse Jobs in Texas
Utilization review nurse jobs in Texas are among the most active in the country, concentrated in managed care organizations, large integrated health systems, and workers' compensation carriers, with openings ranging from entry-level UR coordinators through senior clinical reviewers and supervisors. Houston, Dallas, and San Antonio anchor the market, where employers such as UnitedHealth Group, CHRISTUS Health, and Baylor Scott and White Health maintain substantial utilization management teams. Concurrent review, prior authorization, and case management are the most in-demand specialties. Find a role that fits below and apply directly.
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Harris Health is the public healthcare safety-net provider established in 1966 to serve the residents of Harris County, Texas. As an essential healthcare system, Harris Health champions better health for the entire community, with a focus on low-income uninsured and underinsured patients, through acute and primary care, wellness, disease management and population health services. Ben Taub Hospital (Level 1 Trauma Center) and Lyndon B. Johnson Hospital (Level 3 Trauma Center) anchor Harris Health's robust network of 39 clinics, health centers, specialty locations and virtual (telemedicine) technology. Harris Health is among an elite list of health systems in the U.S. achieving Magnet® nursing excellence designation for its hospitals, the prestigious National Committee for Quality Assurance designation for its patient-centered clinics and health centers and its strong partnership with nationally recognized physician faculty, residents and researchers from Baylor College of Medicine; McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth); and The University of Texas MD Anderson Cancer Center.
At Harris Health, we prioritize the well-being of our most valuable asset-our people-ensuring a culture of compassion, collaboration and excellence in serving Harris County's most in need. With integrity and accountability at our core, we commit to 'leading with love', embodying our dedication to quality care, education, and a steadfast respect for every individual's contribution to our mission.
The Utilization Management Review Nurse (UMRN) performs technical and administrative work required to evaluate the necessity, appropriateness, and efficiency of the utilization of medical services procedures and facilities. This role supports the health system by utilizing clinical knowledge, expertise and industry standard clinical guidelines carrying the responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity. The UMRN promotes quality care and cost-effective outcomes to enhance the physical, psychosocial and vocational health of individuals, partnering with Care Management, Physician Advisors, Finance, and 3rd party payers to deliver the best holistic outcomes for all patients. This position will work with payers to reconcile denials and reconsiderations, assist with appeals as needed and arrange peer to peer level review while collecting, analyzing and addressing variances from the plan of care/care path with physician and/or other members of the healthcare team.
The UMRN participates in quality improvement activities, exemplifies professionalism, and promotes a customer-friendly environment by utilizing ServiceFIRST behaviors in interactions with Harris Health team members, payer vendors, and physicians.
Minimum Qualifications
Degrees:
- Graduated from an accredited school of Nursing with a Bachelors in Nursing.
Licenses & Certifications:
- Registered Nurse: Licensed to practice nursing in the State of Texas.
- Case Management Certification (ACM or CCM) within two years of hire.
- Basic Life Support: American Heart Association (AHA) or Red Cross approved program.
Work Experience:
- 5 Years of Experience: Strong clinical background in a variety of acute healthcare settings including 2 years in Case Management, Quality Management, Utilization Management, or Coding.
Communication Skills:
- Above Average Verbal Communication (Heavy Public Contact)
- Exceptional Verbal (Public Speaking)
- Writing/ Correspondence
- Writing/ Reports
Language:
- Bilingual Skills (Preferred)
Proficiencies:
- MS Word
- PC
- MS Excel
- MS PowerPoint
Job Attributes
Knowledge/Skills/Abilities:
- Analytical
- Mathematics
- Medical Terms
- Other: Utilization review tools: MCG and or Change healthcare (Interqual)
Work Schedule:
- Flexible: 8 hour shifts as per system need; variable to 10-12 as needed.
- Weekends: Depends on needs of system.
- Telecommute
- Holidays: Depends on needs of system.
Other Special Requirements
Equipment Operated: Standard office equipment, computer software, etc.
Job Details
- X
Harris Health is the public healthcare safety-net provider established in 1966 to serve the residents of Harris County, Texas. As an essential healthcare system, Harris Health champions better health for the entire community, with a focus on low-income uninsured and underinsured patients, through acute and primary care, wellness, disease management and population health services. Ben Taub Hospital (Level 1 Trauma Center) and Lyndon B. Johnson Hospital (Level 3 Trauma Center) anchor Harris Health's robust network of 39 clinics, health centers, specialty locations and virtual (telemedicine) technology. Harris Health is among an elite list of health systems in the U.S. achieving Magnet® nursing excellence designation for its hospitals, the prestigious National Committee for Quality Assurance designation for its patient-centered clinics and health centers and its strong partnership with nationally recognized physician faculty, residents and researchers from Baylor College of Medicine; McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth); and The University of Texas MD Anderson Cancer Center.
At Harris Health, we prioritize the well-being of our most valuable asset-our people-ensuring a culture of compassion, collaboration and excellence in serving Harris County's most in need. With integrity and accountability at our core, we commit to 'leading with love', embodying our dedication to quality care, education, and a steadfast respect for every individual's contribution to our mission.
The Utilization Management Review Nurse (UMRN) performs technical and administrative work required to evaluate the necessity, appropriateness, and efficiency of the utilization of medical services procedures and facilities. This role supports the health system by utilizing clinical knowledge, expertise and industry standard clinical guidelines carrying the responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity. The UMRN promotes quality care and cost-effective outcomes to enhance the physical, psychosocial and vocational health of individuals, partnering with Care Management, Physician Advisors, Finance, and 3rd party payers to deliver the best holistic outcomes for all patients. This position will work with payers to reconcile denials and reconsiderations, assist with appeals as needed and arrange peer to peer level review while collecting, analyzing and addressing variances from the plan of care/care path with physician and/or other members of the healthcare team.
The UMRN participates in quality improvement activities, exemplifies professionalism, and promotes a customer-friendly environment by utilizing ServiceFIRST behaviors in interactions with Harris Health team members, payer vendors, and physicians.
Minimum Qualifications
Degrees:
- Graduated from an accredited school of Nursing with a Bachelors in Nursing.
Licenses & Certifications:
- Registered Nurse: Licensed to practice nursing in the State of Texas.
- Case Management Certification (ACM or CCM) within two years of hire.
- Basic Life Support: American Heart Association (AHA) or Red Cross approved program.
Work Experience:
- 5 Years of Experience: Strong clinical background in a variety of acute healthcare settings including 2 years in Case Management, Quality Management, Utilization Management, or Coding.
Communication Skills:
- Above Average Verbal Communication (Heavy Public Contact)
- Exceptional Verbal (Public Speaking)
- Writing/ Correspondence
- Writing/ Reports
Language:
- Bilingual Skills (Preferred)
Proficiencies:
- MS Word
- PC
- MS Excel
- MS PowerPoint
Job Attributes
Knowledge/Skills/Abilities:
- Analytical
- Mathematics
- Medical Terms
- Other: Utilization review tools: MCG and or Change healthcare (Interqual)
Work Schedule:
- Flexible: 8 hour shifts as per system need; variable to 10-12 as needed.
- Weekends: Depends on needs of system.
- Telecommute
- Holidays: Depends on needs of system.
Other Special Requirements
Equipment Operated: Standard office equipment, computer software, etc.
See All 12 Utilization Review Nurse Jobs in Texas
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Find Utilization Review Nurse JobsUtilization Review Nurse Jobs by City in Texas
Where Texas roles are concentrated, by current openings.
Utilization Review Nurse Job Market in Texas
A snapshot from current Texas openings, updated as new roles post.
Who's Hiring
Top Industries Hiring
- Healthcare & Medical Services
What Texas Employers Look For
The qualifications that appear most often in utilization review nurse jobs across Texas.
- Active Texas RN license issued or recognized by the Texas Board of Nursing
- Minimum two years of recent clinical nursing experience in an acute care setting
- Demonstrated experience with InterQual or Milliman clinical decision-support criteria
- Familiarity with Medicare, Medicaid, and commercial insurance coverage guidelines
- Certified Case Manager or CPHM certification preferred or required by many Texas employers
- Strong documentation skills and proficiency with electronic health record and UM platforms
Utilization Review Nurse Jobs in Texas: Frequently Asked Questions
How do you become a utilization review nurse in Texas?
You must hold an active registered nurse license from the Texas Board of Nursing, either earned by passing the NCLEX-RN and applying through TBON or transferred via the Nurse Licensure Compact. Most Texas employers then require at least two years of clinical experience before moving into utilization review. Earning a nationally recognized credential such as the Certified Case Manager designation strengthens your candidacy and is required by several large Texas health plans and systems.
How much do utilization review nurses make in Texas?
Utilization review nurses in Texas earn a median of about $95,970 a year, based on May 2025 Bureau of Labor Statistics wage data, ranging from around $67,120 for the lowest 10% to over $127,950 for the top 10%. Pay rises with experience, specialty, and employer.
Which companies hire utilization review nurses in Texas?
Employers hiring utilization review nurses in Texas right now include JPS Health Network, Harris Health, and Central Health, based on current listings on Migrate Mate as of August 2026. Texas's concentration of large managed care payers, integrated health systems, and workers' compensation carriers means utilization management roles appear consistently across both Houston's medical center corridor and the Dallas-Fort Worth metroplex.
Which Texas cities have the most utilization review nurse jobs?
Fort Worth, Austin, and Dallas have the most utilization review nurse openings in Texas right now. Houston's unmatched density of health systems and national payer regional offices drives the largest share of postings, while Dallas-Fort Worth's concentration of insurance company headquarters and large hospital networks sustains strong demand, and San Antonio's military-connected healthcare infrastructure and growing managed care presence round out the top markets.
How can I get hired as a utilization review nurse in Texas with little or no experience?
The most realistic entry path is moving laterally from a clinical bedside role into a UR coordinator or case management associate position within a Texas hospital system. Employers such as Baylor Scott and White Health and CHRISTUS Health post internal UR coordinator roles that accept candidates with strong med-surg or ICU backgrounds and no prior UR title. Completing a Certified Case Manager prep course or an InterQual training through your current employer signals readiness and gives your application a concrete edge with Texas health plans.
Where can I find and apply to utilization review nurse jobs in Texas?
You can find and apply to utilization review nurse jobs in Texas on Migrate Mate, which lists current openings from employers actively hiring in the state. Search the listings, find a role that fits your experience and location, and apply directly to the employer.
See All 12 Utilization Review Nurse Jobs in Texas
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