Case Processor Jobs in Houston, TX (NOW HIRING)

Manager of Case Management

Location: Houston, Texas

Job Type: Full-time

Work Setting: On-site adult hospital

Schedule: Full-time

Overview

Avento Health is recruiting a Manager of Case Management for an established adult hospital in Houston, Texas. This full-time hospital leadership role oversees case management operations across care coordination, utilization management, discharge planning, patient progression, and resource utilization.

The Manager of Case Management will lead an interdisciplinary team of nursing and social work professionals while partnering closely with physicians, nursing leaders, ancillary teams, payers, and community resources. The role is responsible for supporting efficient patient care across the continuum while advancing clinical quality, patient satisfaction, utilization, financial, and operational outcomes.

Responsibilities

• Lead daily hospital case management operations, workflows, staffing, and service delivery.
• Oversee care facilitation, utilization management, case management, discharge planning, and transitions of care.
• Promote timely patient progression throughout the continuum and help remove barriers that delay diagnostic care, treatment, placement, or discharge.
• Partner with physicians, nurses, social workers, care managers, ancillary departments, and community resources to support coordinated and efficient patient care.
• Support appropriate level-of-care determinations and consistent application of approved clinical appropriateness criteria for admissions and continued stays.
• Ensure effective processes for utilization review, quality screening, payer communication, reimbursement certification, and required case management documentation.
• Monitor length of stay, resource utilization, readmissions, denied days, appeals, case mix, cost per case, excess days, and other operational and quality indicators.
• Use clinical, financial, utilization, quality, and patient-satisfaction data to identify trends and develop performance-improvement strategies.
• Drive improvements in discharge planning, patient flow, transitional care, post-acute coordination, and continuity of care.
• Support escalation and resolution of complex cases involving clinical, payer, discharge, or resource barriers.
• Collaborate with the multidisciplinary team to maintain effective communication with patients and families regarding continuing-care plans and transitions.
• Support development, implementation, evaluation, and improvement of case management processes, clinical pathways, workflows, and tools.
• Lead, coach, mentor, and develop case management professionals, including orientation and support for new team members.
• Participate in hiring, performance management, staff development, competency, and other personnel functions.
• Promote effective conflict resolution, interdisciplinary collaboration, accountability, and sound clinical and operational decision-making.
• Maintain compliance with departmental policies, quality standards, service expectations, productivity goals, and budget requirements.
• Promote safe, compassionate, personalized, and efficient care for patients and families.

Required Qualifications

• Bachelor of Science in Nursing with a current and valid Texas Registered Nurse license, or a Master of Social Work degree with a current and valid Texas Licensed Master Social Worker license.
• Current Case Manager Certification.
• At least 5 years of experience in utilization management, case management, discharge planning, or a related cost and quality management program.
• At least 3 years of hospital-based nursing or social work experience.
• At least 3 years of demonstrated leadership experience.
• Strong knowledge of payer requirements, managed care, utilization management, discharge planning, case management, and clinical care practices.
• Working knowledge of inpatient, outpatient, pre-acute, post-acute, home health, and community-based care resources.
• Ability to build effective working relationships with physicians and healthcare professionals at all levels.
• Strong written, verbal, interpersonal, negotiation, conflict-resolution, organizational, and time-management skills.
• Strong analytical and data-management skills with the ability to use performance information to guide decisions and improvement efforts.

Preferred Qualifications

• Master’s degree preferred for the nursing pathway.
• Licensed Clinical Social Worker credential preferred for the social work pathway.
• Experience leading case management operations in a fast-paced adult hospital environment.
• Experience with performance improvement, change management, business planning, and targeted clinical or operational outcomes.

Skills

• Hospital case management leadership
• Utilization management and utilization review
• Discharge planning and transitions of care
• Patient flow and care progression
• Clinical resource management
• Payer and reimbursement coordination
• Performance and quality improvement
• Data-driven decision-making
• Physician and interdisciplinary collaboration
• Staff coaching, mentoring, and professional development

Work Environment

This is a full-time, on-site leadership position in an adult hospital setting. The role requires regular collaboration with physicians, clinical leaders, nursing teams, social work professionals, case management staff, ancillary departments, payers, and community resources.

Benefits

• Medical, dental, and vision insurance
• Life insurance
• Retirement benefits
• Paid time off
• Continuing education and professional-development support
• Relocation assistance

Why This Opportunity Stands Out

• Hospital leadership responsibility within an established Houston healthcare organization
• Direct impact on patient flow, care progression, resource utilization, discharge planning, and quality outcomes
• Opportunity to lead and develop an interdisciplinary case management team
• Meaningful involvement in operational and performance-improvement initiatives
• Relocation assistance for qualified candidates
• Strong continuing-education and professional-growth support

Equal Employment Opportunity

Avento Health provides equal recruiting opportunities to qualified candidates without regard to race, color, religion, sex, pregnancy, national origin, age, disability, genetic information, veteran status, sexual orientation, gender identity, or any other characteristic protected by applicable law.

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