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Behavioral Health Utilization Management Jobs in Texas

GuideWell

Utilization Management RN

Irving, TX · On-site

WebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30+ years of ... Utilization Management (UM) nurses will provide our clients with appropriate and comprehensive ...

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Behavioral Health Utilization Management information

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$19

$39

$64

How much do behavioral health utilization management jobs pay per hour?

As of Aug 21, 2026, the average hourly pay for behavioral health utilization management in Texas is $39.39, according to ZipRecruiter salary data. Most workers in this role earn between $31.15 and $45.24 per hour, depending on experience, location, and employer.

What is behavioral health utilization management?

Behavioral Health Utilization Management is a process used by insurance companies and healthcare organizations to evaluate the necessity, appropriateness, and efficiency of behavioral health services such as mental health and substance use treatments. This process helps ensure that patients receive the right level of care based on clinical guidelines while managing healthcare costs. Utilization managers review treatment plans, authorize services, and coordinate with providers to promote quality outcomes and avoid unnecessary services. Their work is essential in balancing patient needs with resource allocation in the healthcare system.

What skills and qualifications are needed for behavioral health utilization management?

To thrive as a Behavioral Health Utilization Management professional, you need a background in behavioral health or clinical care, often with an RN, LCSW, LPC, or similar licensure and experience in mental health care settings. Familiarity with utilization review software, insurance guidelines, and electronic health record (EHR) systems is crucial. Strong analytical thinking, communication, and negotiation skills are essential soft skills to effectively evaluate treatment plans and coordinate with providers. These competencies are vital to ensuring appropriate, cost-effective care while maintaining compliance with regulatory and payer requirements.

What are common challenges in behavioral health utilization management and how are they addressed?

Behavioral Health Utilization Management professionals often encounter challenges such as managing high caseloads, keeping up with evolving clinical guidelines, and ensuring timely communication with providers and insurance companies. Balancing the need for cost containment with advocating for appropriate patient care can also be demanding. These challenges are typically addressed through ongoing training, strong teamwork, and the use of evidence-based criteria and decision-support tools to guide determinations and streamline workflows.

What is the difference between Behavioral Health Utilization Management vs Behavioral Health Case Manager?

AspectBehavioral Health Utilization ManagementBehavioral Health Case Manager
CredentialsLicenses (e.g., RN, LCSW), certifications in utilization reviewLicenses (e.g., LCSW, LPC), case management certifications
Work EnvironmentInsurance companies, healthcare organizations, utilization review departmentsHospitals, community clinics, outpatient facilities
Employer & Industry UsageHealth insurance providers, managed care organizationsBehavioral health agencies, hospitals, outpatient clinics

Behavioral Health Utilization Management focuses on reviewing and authorizing mental health services to ensure appropriate care and cost management. In contrast, Behavioral Health Case Managers coordinate ongoing patient care, providing support and resources to improve treatment outcomes. Both roles require relevant licenses and certifications but differ in their primary responsibilities and work settings.

What are popular job titles related to Behavioral Health Utilization Management jobs in Texas?

For Behavioral Health Utilization Management jobs in Texas, the most frequently searched job titles are:

What job categories do people searching Behavioral Health Utilization Management jobs in Texas look for?

The top searched job categories for Behavioral Health Utilization Management jobs in Texas are:

What cities in Texas are hiring for Behavioral Health Utilization Management jobs?

Cities in Texas with the most Behavioral Health Utilization Management job openings:

Behavioral Health Utilization Management jobs near you
Infographic showing various Behavioral Health Utilization Management job openings in Texas as of August 2026, with employment types broken down into 2% As Needed, 79% Full Time, 14% Part Time, and 5% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution, with an average salary of $81,936 per year, or $39.4 per hour.

Utilization Management Rep

Allmed Staffing Inc

Pearland, TX • Remote

Full-time

Medical, Dental, Vision, Retirement

Re-posted 24 days ago

Job description

Job Title: Utilization Management Representative (UMR)

Work Location: 11511 Shadow Creek Parkway
Schedule: Monday – Friday | 8:00 AM – 5:00 PM | 24–40 hours per week
Interview Process: Virtual interview via camera
Dress Code: Business Casual
Pay Rate: 13/hr (Paid Weekly)
Allmed Benefits: Vision, Health, Dental Insurance & 401(k)

Position Overview

The Utilization Management Representative (UMR) plays a critical role in supporting Utilization Management operations by ensuring the timely and accurate processing of authorization requests and communicating authorization determinations to providers and members. This role directly supports regulatory compliance, operational efficiency, and quality patient care by facilitating appropriate utilization of healthcare services.

The UMR serves as a key point of contact between providers, members, and the clinical review team while supporting overall care management strategies through efficient workflow management and effective communication.

Team Environment

The selected candidate will join a collaborative Utilization Management team consisting of approximately 20 Utilization Management Representatives (UMRs) working alongside clinical reviewers, including Registered Nurses (RNs), LVNs, and Medical Directors.

The team operates in a fast-paced, production-driven environment where accuracy, efficiency, and teamwork are critical to success. Team culture emphasizes:

  • Collaboration and strong communication
  • Accountability for productivity and quality metrics
  • Continuous learning and process improvement
  • Supportive teamwork across clinical and operational departments
  • Commitment to regulatory compliance and quality member care

Team members regularly collaborate with internal departments including clinical review teams, provider relations, claims, and appeals teams.

Key Responsibilities

  • Answer inbound calls from providers, members, and healthcare facilities regarding authorization requests, status updates, and coverage questions
  • Create authorization cases by reviewing and processing clinical requests received through fax, electronic submissions, or phone communication
  • Accurately document authorization requests within utilization management systems and/or electronic medical record systems
  • Coordinate with clinical review staff, including RNs, LVNs, and Medical Directors, to appropriately route cases requiring medical necessity review
  • Communicate authorization determinations verbally to providers and members in compliance with regulatory guidelines and organizational requirements
  • Maintain accurate records and ensure documentation standards are consistently met
  • Support workflow efficiency while managing multiple priorities in a high-volume environment
  • Provide exceptional customer service while maintaining confidentiality and professionalism

Required Qualifications

  • 1–3 years of healthcare experience, preferably within:
    • Utilization Management
    • Insurance operations
    • Medical office environments
    • Managed care settings
  • Experience handling high-volume calls in a professional and efficient manner
  • Strong data entry and documentation skills with high attention to detail
  • Ability to effectively manage multiple tasks simultaneously in a fast-paced environment
  • Strong verbal and written communication skills when interacting with providers, members, and internal teams
  • Basic understanding of healthcare authorization processes and insurance workflows
  • Experience using EMR/EHR platforms, case management systems, or related healthcare systems
  • Strong organizational and time-management skills

Preferred Qualifications

  • Experience supporting authorization processes within healthcare operations or managed care settings
  • Previous experience in health plans, hospitals, medical offices, or healthcare call center environments
  • Experience working with provider communication and care coordination activities
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