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Manager Utilization Management Jobs in Houston, TX

Harris Health System

BH Utilization Manager RN

Houston, TX · On-site

$67K - $85K/yr

We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of ... Behavioral Health Utilization Manager will perform concurrent and discharge reviews on assigned ...

Actalent

Concurrent Review Nurse

Houston, TX · On-site

Actalent is Hiring a Team of Concurrent Review Nurses (Utilization Management)!! This role performs concurrent reviews of inpatient acute and post-acute cases to determine medical necessity, evaluate ...

Socket.dev

RN Case Manager

Conroe, TX · On-site

$75 - $95/hr

Utilization Management * Conduct ongoing utilization reviews to ensure services remain clinically appropriate and medically necessary. * Apply InterQual, Milliman, DRG, or other nationally recognized ...

OSI Recruit

Director, Case Management

Houston, TX

Care Facilitation, Utilization Management, Case Management and Discharge Planning. \n \n \n The Director is responsible for developing systems and processes for care\/utilization management and ...

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Showing results 21-40

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 Sep 2, 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 Mgmt Clinical RN

Texas Children's Hospital

Bellaire, TX • On-site

Full-time

Posted 17 days ago

Texas Children's Hospital rating

8.3

Company rating: 8.3 out of 10

Based on 177 frontline employees who took The Breakroom Quiz

85th of 1,064 rated hospitals

Job description

We're searching for a Utilization Management Clinical Registered Nurse, someone who works well in a fast-paced setting. In this position, you'll be responsible for providing precertification of inpatient hospitalizations and all outpatient procedures and services requiring authorization, and performing telephonic and/or concurrent review of inpatient hospitalizations and extended courses of outpatient treatment.  
Think you've got what it takes?

Job Duties & Responsibilities

  • Analyzes unique situation of request, identifying appropriate guideline and regulatory requirements for each request
  • Applies clinical decision making to assessment of clinical acuity and appropriateness of suggested treatment/services
  • Creates a case summary evaluation for requests failing medical necessity criteria, and has collaborative discussion with the medical director or designee for review and disposition
  • Researches clinical guidelines for potential investigative service requests, researches weekly changes to Medicaid manual to assure coverage determinations, and maintains currency of clinical guideline elements
  • Ensures the timeliness of all denial letters within the regulations mandated
  • Creates communication pieces to providers, which meet accrediting and regulatory guidelines for clinical content and readability levels describing decision making rationale for service requests and notifies providers through written correspondence
  • Collaborates with all disciplines within the health plan to meet goals and objectives meeting with contracting and provider relations on routine basis
  • Screens, identifies, and refers potential members to case management and evaluation for programs or coverage
  • Identifies potential quality of care issues, and/or fraud and abuse, and refers to appropriate department 
     

As part of our commitment to maintaining a safe and healthy workplace, all successful candidates will be required to undergorespiratoryfit testing in compliance with occupational health and safety standards.  
Skills & Requirements 

  • Diploma in nursing required or
    • Associates degree in nursing or an associate's degree in a related field accepted by the Texas Board of Nursing for the purposes of obtaining and maintaining an RN license required or
    • Bachelor's degree in nursing preferred
  • RN - Lic-Registered Nurses by Texas Board of Nursing or Nursing Licensure Compact required
  • 3 years of nursing experience required 
Founded in 1996, Texas Children's Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.

To join our community of 15,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities.

Texas Children's is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

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