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Case Manager Utilization Review Nurse Jobs in Rosharon, TX

RN Case Manager in Pasadena, TX

Pasadena, TX ยท On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... Utilization Review Nurse (UR), Discharge Planner, Care Coordinator, Continuum of Core Management ... Case Manager, ACM Accredited Case Manager, Medical Surgical, Med Surg, Med-Surg, Med/Surg, ...

Nurse, Concurrent Review

Houston, TX ยท On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Admission reviews Continued stay reviews Transitional care reviews (Skilled Nursing Facility ... utilization management, or case management experience, preferred Experience with InterQual or ...

Case Management Manager

Houston, TX

$19 - $24.50/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Ensure effective processes for utilization review, quality screening, payer communication ... Bachelor of Science in Nursing with a current and valid Texas Registered Nurse license, or a Master ...

Nurse Concurrent Review

Houston, TX ยท On-site

$75K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

โ€ข Performs concurrent inpatient utilization review using InterQual criteria to determine if the ... nursing, utilization management, or case management experience, preferred โ€ข Experience with ...

Nurse, Concurrent Review

Houston, TX ยท On-site +1

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... reviews โ€ข Continued stay reviews โ€ข Transitional care reviews (Skilled Nursing Facility ... nursing, utilization management, or case management experience, preferred โ€ข Experience with ...

Utilization Management

Houston, TX ยท On-site

$38 - $42/hr

  • Medical

  • Dental

  • Life

... to the Manager and/or Medical Director. * Monday to Friday 8-5 six positions available Thurs- Sun 10 hr days six positions available Required Qualifications for RN Outpatient Utilization Review ...

Case Manager

Houston, TX

$19 - $24.50/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Participate in utilization review process: data collection, trend review, and resolution actions ... For Nursing, must possess minimum of an Associate Degree in Nursing, RN licensure with BSN ...

Case Manager

Houston, TX

$19 - $24.50/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Participate in utilization review process: data collection, trend review, and resolution actions ... For Nursing, must possess minimum of an Associate Degree in Nursing, RN licensure with BSN ...

Case Manager

Houston, TX

$19 - $24.50/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Participate in utilization review process: data collection, trend review, and resolution actions ... For Nursing, must possess minimum of an Associate Degree in Nursing, RN licensure with BSN ...

Case Manager

Houston, TX ยท On-site

$19 - $24.50/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Participate in utilization review process: data collection, trend review, and resolution actions ... For Nursing, must possess minimum of an Associate Degree in Nursing, RN licensure with BSN ...

Case Manager

Houston, TX

$19 - $24.50/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Participate in utilization review process: data collection, trend review, and resolution actions ... For Nursing, must possess minimum of an Associate Degree in Nursing, RN licensure with BSN ...

Utilization Management Rep

Pearland, TX ยท Remote

  • Medical

  • Dental

  • Vision

  • Retirement

Coordinate with clinical review staff, including RNs, LVNs, and Medical Directors, to appropriately ... Experience using EMR/EHR platforms, case management systems, or related healthcare systems * Strong ...

Showing results 21-40

Case Manager Utilization Review Nurse information

See Rosharon, TX salary details

$17

$42

$71

How much do case manager utilization review nurse jobs pay per hour?

As of Aug 14, 2026, the average hourly pay for case manager utilization review nurse in Rosharon, TX is $42.53, according to ZipRecruiter salary data. Most workers in this role earn between $31.63 and $51.39 per hour, depending on experience, location, and employer.

What is the difference between Case Manager Utilization Review Nurse vs Case Manager?

AspectCase Manager Utilization Review NurseCase Manager
CredentialsRN license, certification in utilization review (e.g., URAC)RN license, case management certification (e.g., CCM)
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community health, insurance providers
Primary FocusReviewing medical necessity and appropriateness of careCoordinating patient care and discharge planning

While both roles involve patient care coordination, the Case Manager Utilization Review Nurse primarily focuses on reviewing medical necessity and insurance approvals, whereas the Case Manager handles broader patient care coordination and discharge planning. Both roles require nursing credentials and are vital in healthcare settings, but their specific responsibilities differ.

How does a case manager utilization review nurse typically collaborate with physicians and other healthcare providers?

Case Manager Utilization Review Nurses regularly work with physicians, social workers, and other healthcare professionals to ensure patients receive appropriate care while managing resource utilization. They often participate in interdisciplinary team meetings to discuss care plans, review patient progress, and address any barriers to discharge. Building strong communication channels and maintaining up-to-date clinical knowledge are essential, as nurses must advocate for patients while also supporting evidence-based practices and regulatory compliance. This collaborative environment helps streamline patient care and optimize outcomes.

What is a case manager utilization review nurse?

A Case Manager Utilization Review Nurse is a registered nurse who evaluates the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, coordinate with healthcare providers, and ensure that treatments meet established guidelines and insurance requirements. Their goal is to optimize patient outcomes while controlling healthcare costs and ensuring compliance with regulations. These nurses also help facilitate communication between patients, providers, and payers to support effective care management.

What are the key skills and qualifications needed to thrive as a case manager utilization review nurse, and why are they important?

To excel as a Case Manager Utilization Review Nurse, you need a solid background in nursing, strong clinical assessment skills, and a valid RN license, often with case management certification. Familiarity with utilization review software, electronic health record (EHR) systems, and knowledge of insurance and regulatory guidelines is essential. Exceptional communication, critical thinking, and negotiation abilities set top performers apart in this role. These qualifications ensure effective patient advocacy, cost-effective care, and compliance with healthcare standards.

What does a case manager utilization review nurse do?

A case manager utilization review nurse evaluates medical cases to determine the necessity, appropriateness, and efficiency of healthcare services. They review patient records, collaborate with healthcare providers, and ensure treatment plans comply with insurance and regulatory guidelines, often using electronic health record systems. This role requires clinical nursing experience and knowledge of healthcare policies.

What job categories do people searching Case Manager Utilization Review Nurse jobs in Rosharon, TX look for?

The top searched job categories for Case Manager Utilization Review Nurse jobs in Rosharon, TX are:

What cities near Rosharon, TX are hiring for Case Manager Utilization Review Nurse jobs?

Cities near Rosharon, TX with the most Case Manager Utilization Review Nurse job openings:

Registered Nurse (RN) - Case Management

Perm Staff Jobs

Pasadena, TX โ€ข On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 12 days ago


Job description

Perm Staff Jobs is seeking a Registered Nurse (RN) Case Management for a nursing job in Pasadena, Texas.

Job Description & Requirements
  • Specialty: Case Management
  • Discipline: RN
  • Duration: Ongoing
  • Employment Type: Staff
RN Case Manager - Case Management

Work schedule: Monday - Friday, Open to 8 or 10 hour shifts/Rotating Weekends

Ready for a role that supports your unique calling in patient care and fits your life? At HCA Houston Healthcare Southeast, youโ€™ll find clear pathways to advance backed by our unmatched nationwide transfer policy that lets you grow your career when the time is right for you. With mentorship opportunities, clinical education courses, professional certification support, and educational assistance, you will have all the resources you need to build the career of a lifetime.  

Job Summary and Qualifications

As a Case Manager, your role will be to support patients and families through every step of their care journey. You will coordinate services, connect resources, and develop care plans that reflect each patientโ€™s unique needs. By partnering with physicians, nurses, and department leaders, you will help ensure safe transitions, clear communication, and consistent quality across the continuum of care. 

Your responsibilities will include:

  • Guiding patients and families through program orientation, explaining the rehabilitation philosophy, Medicare and insurance benefits, discharge criteria, and patient rights 
  • Coordinating education for patients, families, and caregivers to encourage participation in treatment planning, goal discussions, and family conferences 
  • Developing and implementing individualized treatment plans that reflect the patientโ€™s strengths, needs, and personal recovery goals 
  • Completing psychosocial assessments and discharge planning evaluations, clearly documenting findings and communicating needs across the care team 
  • Collaborating closely with the Rehab Program Director, Facility Case Management Director, and interdisciplinary team to ensure seamless, patient-centered care 
  • Promoting HCA Healthcareโ€™s values of compassion, respect, and excellence through every patient and family interaction 

What qualifications you will need:

  • Graduate of an accredited diploma, associates, or baccalaureate degree registered nursing program.
  • Bachelorโ€™s Degree in Nursing preferred.
  • Current Registered Nurse License in the State of Texas or Multi-State Compact License (Employees with RN Compact License are required to obtain Texas RN License within 90 days of hire date)
  • 2 plus years in case management OR 3 plus yearsโ€™ experience in clinical nursing

Utilization Review Nurse (UR), Discharge Planner, Care Coordinator, Continuum of Core Management, Medical Necessity, Interdisciplinary Rounds, Resource Allocation, InterQual Criteria, Milliman Care Guidelines (MCG), Allscripts, Epic Case Management, CMS Guidelines, Managed Care, CCM, Certified Case Manager, ACM Accredited Case Manager, Medical Surgical, Med Surg, Med-Surg, Med/Surg, Telemetry, Tele, Med-Tele, Med/Tele, Med Tele, Cardiac, Cardiopulmonary, Chest Pain, Neuroscience, Neuro-Stroke, Neuro Spine, Observation, Ortho Surgical Trauma, Post-Surgical, Post-Op, Critical Care, ED, ER, Emergency Department, Emergency Room, ICU, Intensive Care Unit, MICU, SICU, PICU, NICU, IMU, IMCU, Intermediate Care, PCU, Progressive Care, Stepdown, Pediatrics

Benefits

HCA Houston Healthcare Southeast, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

  • Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services
  • Wellbeing support, including free counseling and referral services
  • Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence
  • Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling
  • Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing
  • Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts

Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location.

HCA Houston Healthcare Southeast is a full-service 340+ bed acute care hospital in Pasadena, Texas. We have been a leader of medical care in Pasadena for more than 50 years. With board-certified physicians, registered nurses and expert technicians, the community has come to rely on us for top-quality, comprehensive and compassionate healthcare. HCA Houston Southeast is the only hospital in Pasadena with both Chest Pain Center Accreditation with Primary PCI and Resuscitation by the American College of Cardiology and full accreditation by The Joint Commission on the Accreditation of Healthcare Organizations. We are members of HCA Houston Healthcare, the most comprehensive family of hospitals in the region and part of the leading provider of healthcare in the country, HCA Healthcare. Together we are stronger, smarter and more accessible in providing the patient-centered care you need close to home.

HCA Healthcare has been recognized as one of the Worldโ€™s Most Ethical Companiesยฎ by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

"Nurses are essential to the delivery of healthcare and serve as its foundation. At HCA Healthcare, we are committed to equipping nurses with the tools and resources they need to deliver exceptional patient care, championing the profession, and supporting the advancement of nursingโ€™s future."

Erica Rossitto, MBA/HCM, BSN, RN, NEA-BC

Senior Vice President and Chief Nurse Executive

HCA Healthcaret

Join a family that cares about every stage in your career! We are interviewing candidates for our Registered Nurse Case Manager opening. Apply today and a member of our Talent Acquisition team will reach out.