Top 23 Rn utilization review Jobs in Austin Tx

Clinical Quality & Utilization Review Specialist
Central Health —Austin, TX
- Full-time
- Nursing
- Doctoral degree
- RN License
Care Manager - Remote
CareVitality Inc —Austin, TX
- $60,000 - $77,000 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- Microsoft Outlook
- Health insurance
- Dental insurance
3d
Utilization Manager
Integral Care —Austin, TX
- $78,012.56 - $99,457.45 a year
- Full-time
- Bilingual
- LMFT
- Clean driving record
- Mileage reimbursement
- Disability insurance
Transitions of Care Clinical Advocate RN
Central Health —Austin, TX
- Full-time
- Spanish
- Nursing
- RN License
Registered Nurse (RN) Case Manager
University of Texas at Austin —Austin, TX
- From $88,000 a year
- Urgently hiring
- Hybrid work
- Spanish
- Nursing
- RN License
- Retirement plan
Medical Surgical Nursing Manager
St. David's South Austin Medical Center —Austin, TX
- Full-time
- Medical-Surgical
- 1 year
- Senior level
- Employee stock purchase plan
- Disability insurance
Quick Apply
Registered Nurse Admin House Supervisor
St. David's South Austin Medical Center —Austin, TX
- Part-time
- 5 years
- Bachelor of Science
- Organizational skills
- Employee stock purchase plan
- Disability insurance
Quick Apply
Registered Nurse Admin House Supervisor
St. David's South Austin Medical Center —Austin, TX
- Part-time
- 5 years
- Bachelor of Science
- Organizational skills
- Employee stock purchase plan
- Disability insurance
Quick Apply
Operating Room Nurse
Bailey Square Surgical Center —Austin, TX
- Full-time
- Surgery
- Mid-level
- Employee stock purchase plan
- Disability insurance
Quick Apply
Neuro Med Surg Nursing Manager
St. David's South Austin Medical Center —Austin, TX
- Full-time
- Mid-level
- Neurology
- Medical-Surgical
- Employee stock purchase plan
- Disability insurance
Quick Apply
10h
Operating Room Nurse
Columbia Oakwood Surgery Center —Round Rock, TX
- Full-time
- Surgery
- Mid-level
- Employee stock purchase plan
- Disability insurance
Quick Apply
Registered Nurse Admin House Supervisor PRN
St. David's North Austin Medical Center —Austin, TX
- PRN
- Surgery
- 5 years
- Bachelor of Science
- Employee stock purchase plan
- Disability insurance
Quick Apply
Bone Marrow Transplant Coordinator
St. David's South Austin Medical Center —Austin, TX
- Full-time
- Adults
- Mid-level
- 3 years
- Employee stock purchase plan
- Disability insurance
Quick Apply
Registered Nurse Vascular Outpatient Surgery
Heart Hospital of Austin —Austin, TX
- Full-time
- Surgery
- Mid-level
- Geriatrics
- Wellness program
- Employee stock purchase plan
Quick Apply
Operating Room Nurse PRN
Careos Surgicenter —Austin, TX
- PRN
- Surgery
- Mid-level
- Employee stock purchase plan
- Disability insurance
Quick Apply
6d
Manager of Emergency Nursing Services
St. David's South Austin Medical Center —Austin, TX
- Full-time
- 1 year
- Senior level
- Leadership
- Employee stock purchase plan
- Disability insurance
Quick Apply
10h
Operating Room Nurse
St. David's Austin Area Ambulatory Surgery Center —Austin, TX
- Full-time
- Surgery
- Mid-level
- Employee stock purchase plan
- Disability insurance
Quick Apply

Discover related jobs

Based on your search for rn utilization review jobs.

Registered Nurse - Freelance AI Trainer Project
Meridial —Austin, TX
An active RN license and associate's, bachelor's, or master's degree in nursing or a closely related healthcare field are ideal; clinical experience in hospital…
$6 - $65 an hour
Registered Nurse HEDIS Performance Improvement Specialist
Ascension —Austin, TX
Licensure required relevant to state in which work is performed. Licensure required relevant to state in which work is performed.
$75,295.00 - $110,834.59 a year

Show more related jobs

Explore jobs in cities nearby

Check out jobs in cities near your current location, Columbus

Case Manager / PRN ( RN / RT / SW / LPN )
Select Specialty Hospital - Columbus Vic Village(Grant) —Columbus, OH
Current licensure in a clinical discipline either as a Nurse (RN /LPN/ LVN)or a Respiratory Therapist OR current license / certified Social Work license per…
Quick Apply
RN Case Manager - Case Management
Licking Memorial Hospital —Newark, OH
Graduate of an accredited school of nursing and licensed in the state of Ohio. The case manager is responsible for individualized management of hospital and…
Quick Apply

Show more jobs in cities nearby

I want to receive the latest job alert for rn utilization review in austin tx

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

rn utilization review jobs near austin tx

Care Manager jobs in Austin, TX

Registered Nurse Case Manager jobs in Austin, TX

Registered Nurse Operating Room jobs in Austin, TX

Telemetry Nurse jobs in Austin, TX

Nursing Supervisor jobs in Austin, TX

Registered Nurse Operating Room jobs in Round Rock, TX

Registered Nurse Bone Marrow Transplant jobs in Austin, TX

Clinical Nurse jobs in Austin, TX

Registered Nurse jobs in Austin, TX

Utility Manager jobs in Austin, TX

Utilization Review Nurse jobs in Austin, TX

Care Manager jobs in Salem, OR

School Age Child Care jobs in Rochester, MN

Foster Care jobs in Virginia

Care Manager jobs in Detroit, MI

Care Manager jobs in Boise, ID

Care Manager jobs in Hays, KS

Registered Nurse Case Manager jobs in Nashville, TN

Registered Nurse Case Manager jobs in Caribou, ME

Registered Nurse Case Manager jobs in Georgetown, TX

Clinical Quality & Utilization Review Specialist

Central Health -
Austin, TX

Apply Now

Job Details

Full-time

Qualifications

RN License

Full Job Description

Overview:

Under the supervision of the Director of Utilization Management, the Clinical Quality and Utilization Review Specialist performs a dual role encompassing utilization management and peer review. This position is responsible for assessing the medical appropriateness, efficiency, and quality of healthcare services across inpatient and outpatient settings, including authorization review and utilization oversight. In parallel, the RN coordinates peer review activities including screening, reviewing, and preparing cases and facilitating Root Cause Analyses (RCAs) to evaluate clinical performance and identify opportunities for improvement. The Clinical Quality and Utilization Review Specialist partners closely with physicians, advanced practice providers (APPs), and interdisciplinary teams to support evidence-based decision-making, optimize patient outcomes, and drive continuous improvement. Serving as a key liaison among providers, compliance, nursing, quality, and leadership, this role ensures that findings from utilization reviews, peer review, and quality activities translate into meaningful and sustainable improvements in clinical practice and systems of care.

This role works in close collaboration with medical staff leadership and the Medical Executive Board (MEB) designee to support peer review, utilization management, patient safety, and quality functions in accordance with medical staff bylaws, organizational policies, and accreditation standards.

**This role is located in Austin, Tx. Only those that reside in the greater Austin/Travis County area will be considered for this position**

Responsibilities:

JOB FUNCTIONS:

Essential Functions:

Peer Review & Clinical Quality:

Coordinate and facilitate peer review activities in alignment with medical staff bylaws, organizational policies, and accreditation standards.
Screen, review, and prepare cases for peer review committees, ensuring completeness, objectivity, and readiness for evaluation.
Partner with physician and APP reviewers to support fair, consistent, and evidence-based evaluation of clinical care.
Track, document, and communicate peer review outcomes, ensuring timely feedback, follow-up, and provider education.
Maintain strict confidentiality of peer review activities and records in accordance with legal and regulatory requirements.
Support preparation and coordination of clinical quality and peer review committee meetings and associated materials.

Quality Improvement & Patient Safety:

Participate in Root Cause Analyses (RCAs) for sentinel events, near misses, and high-risk occurrences.
Collaborate with interdisciplinary teams to identify contributing factors, system vulnerabilities, and opportunities for improvement.
Support development, implementation, and monitoring of corrective action plans.
Lead or support quality improvement initiatives informed by utilization data, peer review findings, and organizational priorities.
Apply evidence-based methodologies (e.g., PDSA, Lean, Six Sigma) to drive measurable improvements in care quality and efficiency.
Prepare and deliver reports, dashboards, and presentations on utilization, peer review, and quality outcomes.
Provide education and coaching to staff and providers on quality improvement principles and findings.

Utilization Management:

Perform comprehensive utilization reviews and manage authorizations for inpatient and outpatient services, including skilled nursing, home health, durable medical equipment (DME), and other clinical programs.
Assess medical necessity, appropriateness of care, and level of service using established clinical criteria and guidelines.
Review providers’ contracts and approve healthcare services as specified in these contracts.
Collaborate with physicians, case managers, social workers, and care teams to ensure coordinated, patient- centered care and optimal outcomes.
Conduct telephonic and email-based outreach to the provider community, as appropriate, as part of the utilization review work.
Obtain, review, and analyze clinical documentation to support authorization decisions and ensure regulatory compliance.
Communicate determinations and recommendations clearly and professionally with internal and external stakeholders.
Ensure accurate and timely documentation in the electronic health record, or utilization review database, maintaining compliance with organizational and regulatory standards.
Participate in the appeals process as needed, providing clinical expertise and supporting documentation.
Monitor utilization trends and identify opportunities to improve efficiency and care delivery.
Participate in the utilization review/utilization management committee and effectively contribute to the functioning of the committee work.

Collaboration & Organizational Support:

Partner with the Medical Executive Board (MEB) designee and medical staff leadership to support peer review, quality, and patient safety activities in alignment with medical staff bylaws and organizational priorities.
Exercise independent judgment in coordinating peer review processes, ensuring consistency, fairness, and adherence to established clinical standards.
Support and coordinate committees and workgroups related to utilization management, peer review, and clinical quality, including preparation of materials and follow-up on action items.
Serve as a liaison between administrative leadership, medical staff, and interdisciplinary teams to advance utilization and quality initiatives.
Develop and maintain collaborative working relationships across internal teams and external partners.
Promote a culture of safety, accountability, professionalism, and continuous improvement.
Demonstrate commitment to organizational mission, values, and health equity goals.

Knowledge, Skills and Abilities:

Strong clinical judgment with the ability to assess medical necessity and appropriateness of care across care settings.
Knowledge of utilization management processes, healthcare regulations, and accreditation standards.
Understanding of peer review principles, confidentiality requirements, and quality improvement methodologies.
Ability to analyze clinical data, identify trends, and translate findings into actionable insights.
Skill in facilitating discussions with physicians and interdisciplinary teams, including sensitive or complex topics.
Strong organizational and time management skills, with the ability to manage multiple priorities in a dynamic environment.
Excellent written and verbal communication skills, including report and presentation development.
Ability to maintain confidentiality and exercise discretion when handling sensitive information.
Proficiency in electronic health records and Microsoft Office Suite.
Ability to build strong relationships and work collaboratively across multidisciplinary teams.
Commitment to health equity, diversity, and inclusion in care delivery and organizational practices.
Demonstrated professionalism, accountability, and adaptability in a complex healthcare environment.

Qualifications:

QUALIFICATIONS:

Education:

Bachelor's Degree (higher degree accepted) in Nursing (BSN) Required Or Doctoral or Professional Degree Advanced Practice Provider- Required

Work Experience:

(3) Three years of hands-on, clinical experience in the nursing or a related healthcare field, -Required

PLUS the following:

Minimum of two (2) years of experience in utilization management, case management, care coordination, or clinical program development in the managed care setting or at a health system -Required

Experience in peer review, quality improvement, or patient safety initiatives during the last five (5) years of professional. -Required

Licenses and Certifications:

RN - Registered Nurse - State Licensure - Unrestricted Registered Nurse License in the State of Texas Upon Hire -Required

Apply Now

Refine Your Search

rn utilization review jobs in austin tx

Clinical Quality & Utilization Review Specialist

Care Manager - Remote

Utilization Manager

Transitions of Care Clinical Advocate RN

Registered Nurse (RN) Case Manager

Medical Surgical Nursing Manager

Registered Nurse Admin House Supervisor

Registered Nurse Admin House Supervisor

Operating Room Nurse

Neuro Med Surg Nursing Manager

Operating Room Nurse

Registered Nurse Admin House Supervisor PRN

Bone Marrow Transplant Coordinator

Registered Nurse Vascular Outpatient Surgery

Operating Room Nurse PRN

Manager of Emergency Nursing Services

Operating Room Nurse

Discover related jobs

Explore jobs in cities nearby

I want to receive the latest job alert for rn utilization review in austin tx

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected