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Manager Utilization Management Jobs in Houston, TX

HealthCare Support

Utilization Management

Houston, TX · On-site

$38 - $42/hr

RN Outpatient Utilization Review Remote Texas HealthCare Support is actively seeking multiple ... Communicates concerns that arise in these discussions to the Manager and/or Medical Director.

Medix

Utilization Management Manager

Houston, TX · On-site

$57/hr

Job Summary Our client is seeking a Utilization Management Manager to review clinical documentation, justify inpatient hospital stays, and submit reasoning to insurance companies. Key ...

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All JobsUtilization Management JobsManager Utilization Management JobsManager Utilization Management Jobs in Houston, TX

Manager Utilization Management information

See Houston, TX salary details

$37.2K

$86.9K

$160K

How much do manager utilization management jobs pay per year?

As of Aug 23, 2026, the average yearly pay for manager utilization management in Houston, TX is $86,913.00, according to ZipRecruiter salary data. Most workers in this role earn between $56,800.00 and $104,600.00 per year, depending on experience, location, and employer.

What does a manager utilization management do?

A Manager of Utilization Management oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They lead a team that reviews medical claims and care plans to ensure compliance with clinical guidelines and regulatory requirements. Their role often involves collaborating with physicians, nurses, insurance companies, and other stakeholders to optimize patient outcomes while managing healthcare costs. Additionally, they are responsible for implementing policies, training staff, and ensuring that utilization management activities align with organizational goals.

What are the key skills and qualifications needed to thrive as a manager utilization management?

To thrive as a Manager Utilization Management, you need a thorough understanding of healthcare regulations, utilization review processes, and case management, often supported by a clinical degree (such as RN) and relevant experience. Familiarity with utilization management software, claims processing systems, and potentially certifications like CCM (Certified Case Manager) or ACM (Accredited Case Manager) is important. Strong leadership, analytical thinking, and effective communication help you guide teams and collaborate with providers and payers. These skills ensure efficient resource use, compliance, and quality patient care within managed care organizations.

What are some common challenges faced by a manager utilization management, and how can they effectively address them?

Managers in Utilization Management often encounter challenges such as balancing quality patient care with cost containment, navigating evolving healthcare regulations, and managing diverse teams. To effectively address these issues, successful managers develop strong communication skills, stay updated on industry standards, and foster collaboration between clinical and administrative staff. Implementing robust training programs and utilizing data-driven decision-making can also help ensure compliance and improve overall team performance.

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

AspectManager Utilization ManagementUtilization Review Nurse
CredentialsRN, often with management or utilization review certificationsRN, with certifications in utilization review or case management
Work EnvironmentSupervises teams, manages policies, oversees utilization review processesPerforms patient chart reviews, assesses medical necessity, collaborates with providers
Employer & IndustryHospitals, insurance companies, healthcare organizationsHospitals, insurance companies, healthcare organizations
Search & Comparison IntentYesYes

While both roles focus on utilization review, the Manager Utilization Management oversees teams and policies, ensuring efficient resource use, whereas the Utilization Review Nurse conducts patient-specific reviews to determine medical necessity. The manager role involves leadership and strategic planning, while the nurse role is more clinical and review-focused.

What are the most commonly searched types of Utilization Management jobs in Houston, TX?

The most popular types of Utilization Management jobs in Houston, TX are:

What are popular job titles related to Manager Utilization Management jobs in Houston, TX?

For Manager Utilization Management jobs in Houston, TX, the most frequently searched job titles are:

What job categories do people searching Manager Utilization Management jobs in Houston, TX look for?

The top searched job categories for Manager Utilization Management jobs in Houston, TX are:

What cities near Houston, TX are hiring for Manager Utilization Management jobs?

Cities near Houston, TX with the most Manager Utilization Management job openings:

Manager Utilization Management jobs near you
Infographic showing various Manager Utilization Management job openings in Houston, TX as of August 2026, with employment types broken down into 85% Full Time, and 15% Contract. Highlights an 100% In-person job distribution, with an average salary of $86,913 per year, or $41.8 per hour.

Utilization Management Review Nurse

Harris Health System

Bellaire, TX • On-site

Other

Posted 3 days ago

New

Harris Health System rating

7.9

Company rating: 7.9 out of 10

Based on 104 frontline employees who took The Breakroom Quiz

108th of 893 rated healthcare providers

Job description

Utilization Management Review Nurse (UMRN)

The Utilization Management Review Nurse (UMRN) performs technical and administrative work required to evaluate the necessity, appropriateness, and efficiency of the utilization of medical services procedures and facilities. This role supports the health system by utilizing clinical knowledge, expertise and industry standard clinical guidelines carrying the responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity. The UMRN promotes quality care and cost-effective outcomes to enhance the physical, psychosocial and vocational health of individuals, partnering with Care Management, Physician Advisors, Finance, and 3rd party payers to deliver the best holistic outcomes for all patients. This position will work with payers to reconcile denials and reconsiderations, assist with appeals as needed and arrange peer to peer level review while collecting, analyzing and addressing variances from the plan of care/care path with physician and/or other members of the healthcare team. The UMRN participates in quality improvement activities, exemplifies professionalism, and promotes a customer-friendly environment by utilizing ServiceFIRST behaviors in interactions with Harris Health team members, payer vendors, and physicians.

Minimum Qualifications:

  • Degrees: Graduated from an accredited school of Nursing with a Bachelors in Nursing.
  • Licenses & Certifications: Registered Nurse: Licensed to practice nursing in the State of Texas. Case Management Certification (ACM or CCM) within two years of hire. Basic Life Support: American Heart Association (AHA) or Red Cross approved program.
  • Work Experience: 5 Years of Experience: Strong clinical background in a variety of acute healthcare settings including 2 years in Case Management, Quality Management, Utilization Management, or Coding.
  • Communication Skills: Above Average Verbal Communication (Heavy Public Contact) Exceptional Verbal (Public Speaking) Writing/ Correspondence Writing/ Reports
  • Language: Bilingual Skills (Preferred)
  • Proficiencies: MS Word PC MS Excel MS PowerPoint
  • Knowledge/Skills/Abilities: Analytical Mathematics Medical Terms Other: Utilization review tools: MCG and or Change healthcare (Interqual)

Work Schedule: Flexible: 8 hour shifts as per system need; variable to 10-12 as needed. Weekends: Depends on needs of system. Telecommute Holidays: Depends on needs of system. Other Special Requirements Equipment Operated: Standard office equipment, computer software, etc.

What Harris Health System employees say

Pay

Benefits

Hours and flexibility

Workplace

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About Harris Health System

Sourced by ZipRecruiter

Harris Health System is a fully integrated healthcare system that cares for all residents of Harris County, Texas. We are the first accredited healthcare institution in Harris County to be designated by the National Committee for Quality Assurance as a Patient-Centered Medical Home, and are one of the largest systems in the country to achieve the quality standard. Our system includes community health centers, same-day clinics, three multi-specialty clinic locations, a dental center, mobile health units and two full-service hospitals.

Industry

Hospitals

Company size

5,001 - 10,000 Employees

Headquarters location

Houston, TX, US

Year founded

1966

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