Tubing hanger running tool systems and methods

A hanger running tool configured to set a hanger assembly within a wellhead includes a rotatable tool configured to couple to the hanger assembly via a first threaded interface having a first orientation. The hanger running tool also includes an outer sleeve coupled to the rotatable tool, and the outer sleeve includes one or more slots configured to engage a drive ring coupled to the hanger assembly via a second threaded interface having a second orientation opposite the first orientation. Rotation of the rotatable tool in a first direction is configured to loosen the rotatable tool from the hanger assembly while causing the one or more slots of the outer sleeve to drive the drive ring in the first direction, thereby tightening the drive ring about the hanger assembly and causing the drive ring to drive a lock ring radially-outwardly to engage a corresponding recess of the wellhead.