Strengthening the management of river sand mining and preserving healthy rivers and lakes are crucial steps in building a solid barrier for national ecological security. On the basis of a comprehensive and in-depth investigation of sand mining cases in the Tibet Autonomous Region, we summarize the current status of river sand mining management and identifies major problems. In terms of the management system and mechanism, problems include an incomplete system, ineffective coordination mechanisms, and unsmooth management processes. Regarding sand mining planning, problems such as limited planning coverage, poor-quality planning reports with low guidance value exist. In the licensing process, the license content is non-standard. During the implementation of sand mining, on-site management is irregular, and supervision is lacking. For the mining business model, it is characterized by a simple operation model and low management capabilities. Based on field investigations and statistical analyses, we propose targeted countermeasures and suggestions. These suggestions can assist the water administration department of the Tibet Autonomous Region in enhancing river sand mining management.