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Case Manager Utilization Review Nurse Jobs in Rosharon, TX

Houston Methodist

Case Manager - PRN

Sugar Land, TX · On-site

Three (3) years hospital clinical nursing experience which includes two (2) years in case ... resource utilization, and continued stay. Reviews level of care denials to identify trends and ...

Memorial Hermann Health System

Case Manager

Houston, TX · On-site

$19 - $24.50/hr

... nursing facility, or wound clinic). * Experience in utilization management, case management ... Quality Review Department. * Ensures that all elements critical to the plan of care have been ...

Memorial Hermann Health System

Case Manager

Houston, TX · On-site

$19 - $24.50/hr

... nursing facility, or wound clinic) * Experience in utilization management, case management ... Quality Review Department. * Ensures that all elements critical to the plan of care have been ...

Memorial Hermann Health System

Case Manager

Houston, TX · On-site

$19 - $24.50/hr

... nursing facility, or wound clinic). * Experience in utilization management, case management ... Quality Review Department. * Ensures that all elements critical to the plan of care have been ...

Memorial Hermann Health System

Case Manager

Houston, TX · On-site

$19 - $24.50/hr

... nursing facility, or wound clinic) * Experience in utilization management, case management ... Quality Review Department. * Ensures that all elements critical to the plan of care have been ...

Memorial Hermann Health System

Case Manager

Houston, TX · On-site

$19 - $24.50/hr

... nursing facility, or wound clinic). * Experience in utilization management, case management ... Quality Review Department. * Ensures that all elements critical to the plan of care have been ...

Vivicare Health Partners, LLC

Case Manager

Houston, TX · On-site

$70 - $85/hr

The Case Manager is a qualified registered nurse empowered to provide and oversee the care of ... Participate in clinical record/utilization review of medical records and quality assurance and ...

Team Select Home Care

Case Manager

Houston, TX · On-site

$19 - $24.50/hr

The Case Manager is a qualified registered nurse with the ability to provide and oversee the care ... Participates in clinical record/utilization review of medical records and quality assurance and ...

Team Select Home Care

Case Manager

Houston, TX · On-site

$19 - $24.50/hr

The Case Manager is a qualified registered nurse with the ability to provide and oversee the care ... Participates in clinical record/utilization review of medical records and quality assurance and ...

Team Select Home Care

Case Manager

Houston, TX · On-site

$19 - $24.50/hr

The Case Manager is a qualified registered nurse with the ability to provide and oversee the care ... Participates in clinical record/utilization review of medical records and quality assurance and ...

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All JobsCase Utilization Review Nurse JobsCase Manager Utilization Review Nurse JobsCase Manager Utilization Review Nurse Jobs in Rosharon, TX

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 Sep 5, 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 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.

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 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 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.

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:

Case Manager Utilization Review Nurse jobs near you

Manager of ED & Observation (OBS) Case Management - Adult Medical Center

Taphealthcare

Houston, TX • On-site

$108K - $130K/yr

Full-time

Re-posted 13 hours ago

Key responsibilities

  • Oversee daily operations for Adult ED and Observation Case Management.

  • Improve patient throughput, length of stay, and discharge planning processes.

  • Lead and mentor case managers and social work professionals.

Job description

Position Overview

Tap Healthcare Solutions is seeking an experienced Manager of ED & Observation (OBS) Case Management to join Memorial Hermann Health System at its Adult Medical Center in Houston, Texas. This leadership role is responsible for overseeing case management services for the adult Emergency Department and Observation units, ensuring efficient patient throughput, effective care coordination, appropriate resource utilization, and safe transitions of care.

The Manager will partner with physicians, nursing leadership, social work, utilization review teams, and interdisciplinary healthcare professionals to improve patient outcomes, optimize discharge planning, and support operational excellence. This position offers competitive compensation ranging from approximately $108,000 to $130,000 annually based on experience and the opportunity to lead a high-performing team within one of the nation's premier academic medical centers.

Required Qualifications
  • Current Texas Registered Nurse (RN) license or Licensed Master Social Worker (LMSW) license.
  • Licensed Clinical Social Worker (LCSW) preferred for social work candidates.
  • Case Management Certification (CCM, ACM, or equivalent) required.
  • Minimum of five (5) years of experience in one or more of the following:
    • Utilization Management
    • Case Management
    • Discharge Planning
    • Care Coordination
  • Minimum of three (3) years of hospital-based nursing or social work experience.
  • Minimum of three (3) years of demonstrated leadership or management experience.
  • Strong knowledge of utilization review, discharge planning, patient flow, and regulatory compliance.
Preferred Qualifications
  • Leadership experience within Emergency Department (ED) and Observation Unit case management.
  • Experience in a large acute care hospital or academic medical center.
  • Knowledge of value-based care, patient throughput strategies, and quality improvement initiatives.
  • Excellent communication, collaboration, and relationship-building skills.
Ideal Candidate

The ideal candidate is a collaborative healthcare leader with expertise in emergency and observation case management. Successful candidates will have a proven ability to lead multidisciplinary teams, improve patient flow, and drive quality outcomes within a fast-paced adult acute care environment.

Leadership Expectations

We are seeking a leader who can:

  • Oversee daily operations for Adult ED and Observation Case Management.
  • Improve patient throughput, length of stay, and discharge planning processes.
  • Lead and mentor case managers and social work professionals.
  • Partner with physicians, nursing leadership, and interdisciplinary teams to optimize patient outcomes.
  • Drive quality improvement initiatives while ensuring compliance with regulatory and organizational standards.
Why Join Through Tap Healthcare Solutions?

Tap Healthcare Solutions partners with leading healthcare organizations like Memorial Hermann Health System to connect experienced healthcare leaders with opportunities that support professional growth and exceptional patient care.

This role offers the opportunity to lead a critical case management team within a nationally recognized medical center while making a significant impact on patient care, operational efficiency, and care transitions.