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Manager Utilization Management Jobs in Spring, TX

Memorial Hermann Health System

Case Manager

Houston, TX · On-site

$19 - $24.50/hr

The role integrates and coordinates resource utilization management, care facilitation and discharge planning functions. In addition, the Case Manager helps drive change by identifying areas where ...

Kinghaven Counseling Group, Inc.

Be Seen First

Director of Case Management & Community Partnerships

Houston, TX · On-site

$100K - $130K/yr (+ commission)

Candidate will have overall responsibility for Clinic utilization performance improvement and operational management of the Case Management Department to promote effective utilization of clinic ...

Memorial Hermann Health System

Case Manager

Houston, TX · On-site

$19 - $24.50/hr

The role integrates and coordinates resource utilization management, care facilitation and discharge planning functions. In addition, the Case Manager helps drive change by identifying areas where ...

Memorial Hermann Health System

Case Manager

Houston, TX · On-site

$19 - $24.50/hr

The role integrates and coordinates resource utilization management, care facilitation and discharge planning functions. In addition, the Case Manager helps drive change by identifying areas where ...

Aveanna Healthcare

Payor Relations Manager

Houston, TX · On-site +1

Essential Job Functions Develop and own relationships with all case management and utilization management departments within assigned payor accounts. Hold weekly or monthly meetings with MCO ...

Harris Health System

Manager, Behavioral Health

Houston, TX · On-site

$92K - $116K/yr

This role oversees implementation of case management and utilization management workflows for Behavioral Health, serves as a clinical resource for staff, supports policy and procedure implementation ...

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

Manager Utilization Management information

See Spring, TX salary details

$34.7K

$81K

$149.1K

How much do manager utilization management jobs pay per year?

As of Sep 11, 2026, the average yearly pay for manager utilization management in Spring, TX is $80,990.00, according to ZipRecruiter salary data. Most workers in this role earn between $52,900.00 and $97,400.00 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 Spring, TX?

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

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

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

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

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

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

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

Manager Utilization Management jobs near you
Infographic showing various Manager Utilization Management job openings in Spring, TX as of August 2026, with employment types broken down into 86% Full Time, and 14% Contract. Highlights an 100% In-person job distribution, with an average salary of $80,990 per year, or $38.9 per hour.

Case Manager

Houston, TX • On-site

Memorial Hermann Health System
Health Care and Social Assistance • 10K+ employees
Learn more about Memorial Hermann Health Systemexternal

$19 - $24.50/hr

Full-time

Re-posted 24 days ago

Memorial Hermann Health System rating

7.7

Company rating: 7.7 out of 10

Based on 293 frontline employees who took The Breakroom Quiz

Job description

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.
Job Summary
The purpose of the Case Manager position is to support the physician, primary medical homes, and interdisciplinary teams. Facilitates patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payors. The role integrates and coordinates resource utilization management, care facilitation and discharge planning functions. In addition, the Case Manager helps drive change by identifying areas where performance improvement is needed (e.g., day to day workflow, education, process improvements, patient satisfaction). The position is responsible for coordinating a wide range of self management support and provides information to update and maintain relevant disease registry activity. Accountable for a designated patient caseload and plans effectively in order to meet patient needs across the continuum, provide family support, manage the length of stay, and promote efficient utilization of resources.Job Description
Minimum Qualifications
Education: Graduate of an accredited school of professional nursing required; Bachelor's of Nursing preferred, or graduate of an accredited Masters of Social Work program.
Licenses/Certifications:
  • Current and valid license to practice as a Registered Nurse in the state of Texas or
  • Current and valid license as a Master Social Worker (LMSW) in the state of Texas required, LCSW preferred
  • Certification in Case Management required within two (2) years of hire into the Case Manager position.

Experience / Knowledge / Skills:
  • Three (3) years of nursing or social work experience acute hospital-based preferred, or three (3) years of experience comparable clinical setting (i.e. ambulatory surgery center, infusion/dialysis clinic, Federally Qualified Health Clinic (FQHC), skilled nursing facility, or wound clinic).
  • Experience in utilization management, case management, discharge planning or other cost/quality management program preferred.
  • Excellent interpersonal communication and negotiation skills.
  • Demonstrated leadership skills.
  • Strong analytical, data management and PC skills.
  • Current working knowledge of discharge planning, utilization management, case management, performance improvement, disease or population management and managed care reimbursement.
  • Understanding of pre-acute and post-acute venues of care and post-acute community resources, physician office routines, and transitional procedures for pre and post acute care. Demonstrated understanding of motivational interviewing and change management.
  • Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components.
  • Ability to work independently and exercise sound judgment in interactions with physicians, payors, and patients and their families.
  • Effective oral and written communication skills.

Principal Accountabilities
  • Coordinates/facilitates patient care progression throughout the continuum.
  • Works collaboratively and maintains active communication with physicians, nursing and other members of the multi-disciplinary care team to effect timely, appropriate patient care.
  • Addresses/resolves system problems impeding diagnostic or treatment progress.
  • Proactively identifies and resolves delays and obstacles to discharge.
  • Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge.
  • Utilizes advanced conflict resolution skills as necessary to ensure timely resolution of issues.
  • Collaborates with the physician and all members of the multidisciplinary team to facilitate care for designated case load. Monitors the patient's progress, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective.
  • Facilitates the following on a timely basis: Completes and reports diagnostic testing, Completes treatment plan and discharge plan, Modifies plan of care as necessary, to meet the ongoing needs of the patient, Communicates to third party payors and other relevant information to the care team.
  • Assigns appropriate levels of care.
  • Completes all required documentation in TQ screens and patient records.
  • Collaborates with medical staff, nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting.
  • Completes Utilization Management and Quality Screening for assigned patients.
  • Applies approved clinical appropriateness criteria to monitor appropriateness of admissions and continued stays, and documents findings based on department standards.
  • Identifies at-risk populations using approved screening tool and follows established reporting procedures. Monitors LOS and ancillary resource use on an ongoing basis.
  • Takes actions to achieve continuous improvement in both areas.
  • Refers cases and issues to Care Management Medical Director in compliance with Department procedures and follows up as indicated.
  • Communicates with Resource Center to facilitate covered day reimbursement certification for assigned patients.
  • Discusses payor criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payors as needed.
  • Uses quality screens to identify potential issues and forwards information to Clinical Quality Review Department.
  • Ensures that all elements critical to the plan of care have been communicated to the patient/family and members of the healthcare team and are documented as necessary to assure continuity of care.
  • Manages all aspects of discharge planning for assigned patients.
  • Meets directly with patient/family to assess needs and develop an individualized continuing care plan in collaboration with physician.
  • Collaborates and communicates with multidisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching and ongoing evaluation.
  • Ensures/maintains plan consensus from patient/family, physician and payor.
  • Refers appropriate cases for social work intervention based on department criteria.
  • Collaborates/communicates with external case managers.
  • Initiates and facilitates referrals through the Resource Center for home health care, hospice, medical equipment and supplies.
  • Documents relevant discharge planning information in the medical record according to department standards.
  • Facilitates transfer to other facilities as appropriate.
  • Actively participates in clinical performance improvement activities.
  • Assists in the collection and reporting of financial indicators including case mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials and appeals.
  • Uses data to drive decisions and plan/implement performance improvement strategies related to case management for assigned patients, including fiscal, clinical and patient satisfaction data.
  • Collects, analyzes and addresses variances from the plan of care/care path with physician and/or other members of the healthcare team.
  • Uses concurrent variance data to drive practice changes and positively impact outcomes.
  • Collects delay and other data for specific performance and/or outcome indicators as determined by Director of Outcomes Management. Documents key clinical path variances and outcomes which relate to areas of direct responsibility (e.g., discharge planning).
  • Uses pathway data in collaboration with other disciplines to ensure effective patient management concurrently.
  • Leads the development, implementation, evaluation and revision of clinical pathways and other Case management tools as a member of the clinical resource/team.
  • Assists in compilation of physician profile data regarding LOS, resource utilization, denied days, costs, case mix index, patient satisfaction and quality indicators (e.g., readmission rates, unplanned return to OR, etc.)
  • Acts as preceptor/mentor to new hires.
  • Assists in development of orientation schedule and helps identify individual needs for learning.
  • Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
  • Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.
  • Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann's service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.
  • Other duties as assigned.

What Memorial Hermann Health System employees say

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About Memorial Hermann

Sourced by ZipRecruiter

The Memorial Hermann Southwest Hospital Women's Services is a magnet hospital as well as a level 3 designated facility with a blend of high-risk and community patients. This creates a fast-paced environment and a chance to work with a diverse population. Our Labor & Delivery unit has a low c-section rate and is extremely collaborative and close-knit. We have the ability to cross-train through all areas of Women's Services. We have a family-like atmosphere with an amazing amount of comradery, and our low turnover rates attest to this. Nurses here feel like they not only have autonomy but can also be advocates for their patients. MHSW not only prides ourselves on evidenced based practice, but nurses have a strong voice.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Houston, TX, US

Year founded

1907

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