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Utilization Care Manager Jobs in Texas (NOW HIRING)

CareVitality Inc

Care Manager - Onsite

Katy, TX · On-site

Care Manager - Onsite - Houston, TX and surrounding areas Reports to: CEO/President Status ... utilization and hospital readmissions. Coordinate care with patients, caregivers, primary care ...

CareVitality Inc

Care Manager - Remote

Austin, TX · On-site

Care Manager - Remote- Texas/ Illinois/ /Arkansas/ Ohio/ Florida preferred Reports to: CEO ... utilization and hospital readmissions. Coordinate care with patients, caregivers, primary care ...

CareVitality Inc

Care Manager - Remote

El Paso, TX · Remote

Care Manager - Remote- Texas/ Illinois/ /Arkansas/ Ohio/ Florida preferred Reports to: CEO ... utilization and hospital readmissions. Coordinate care with patients, caregivers, primary care ...

CareVitality Inc

Care Manager - Remote

El Paso, TX · On-site

Care Manager - Remote- Texas/ Illinois/ /Arkansas/ Ohio/ Florida preferred Reports to: CEO ... utilization and hospital readmissions. Coordinate care with patients, caregivers, primary care ...

CareVitality Inc

Care Manager - Remote

Dallas, TX · On-site

Care Manager - Remote- Texas/ Illinois/ /Arkansas/ Ohio/ Florida preferred Reports to: CEO ... utilization and hospital readmissions. Coordinate care with patients, caregivers, primary care ...

CareVitality Inc

Care Manager - Remote

Fort Worth, TX · On-site

Care Manager - Remote- Texas/ Illinois/ /Arkansas/ Ohio/ Florida preferred Reports to: CEO ... utilization and hospital readmissions. Coordinate care with patients, caregivers, primary care ...

CareVitality Inc

Care Manager - Remote

Houston, TX · On-site

Title: Care Manager - Remote- Texas /Arkansas preferred Reports to: CEO/President Status ... utilization and hospital readmissions. Coordinate care with patients, caregivers, primary care ...

HJ Staffing

Registered Nurse Care Manager

Irving, TX · On-site

You will be the primary advocate for the patient, ensuring high-quality outcomes, managing resource utilization, and removing barriers to efficient care delivery. What You Will Do * Care Coordination:

HJ Staffing

Registered Nurse Care Manager

Irving, TX · On-site

You will be the primary advocate for the patient, ensuring high-quality outcomes, managing resource utilization, and removing barriers to efficient care delivery. What You Will Do * Care Coordination:

Medix

Utilization Management Manager

Houston, TX · On-site

$57/hr

Job Summary Our client is seeking a Utilization Management Manager to review clinical documentation ... Experience with InterQual and MCG Care Management platform. Additional Requirements * Schedule:

Suvida Healthcare

Nurse Care Manager

Dallas, TX · On-site

... utilization of resources. The Nurse Care Manager will implement Suvida's care pathways for patients ... with chronic conditions. They will also oversee transitions of care for patients to ensure safe ...

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All JobsUtilization Care JobsUtilization Care Manager JobsUtilization Care Manager Jobs in Texas

Utilization Care Manager information

What is a utilization care manager?

Utilization Care Managers are healthcare professionals responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They work to ensure that patients receive the right care at the right time, while also helping healthcare organizations manage costs and comply with regulations. Utilization Care Managers often review patient cases, coordinate with medical staff, and interact with insurance companies to authorize or deny services. Their goal is to optimize healthcare delivery, reduce unnecessary procedures, and improve patient outcomes.

How does a utilization care manager collaborate with medical and administrative teams to ensure effective patient care?

Utilization Care Managers work closely with physicians, nursing staff, and administrative teams to review patient cases, determine medical necessity, and coordinate appropriate care plans. They frequently participate in interdisciplinary meetings, communicate with insurance providers regarding authorizations, and ensure compliance with regulatory guidelines. This collaborative approach helps to optimize resource utilization, improve patient outcomes, and support smooth transitions of care. Being proactive in communication and documentation is key to success in this role.

What are the key skills and qualifications needed to thrive as a utilization care manager, and why are they important?

To thrive as a Utilization Care Manager, you need a background in healthcare, typically as a registered nurse or social worker, with expertise in care coordination and utilization review. Familiarity with utilization management software, medical necessity guidelines (such as Milliman or InterQual), and knowledge of insurance regulations are important. Strong analytical thinking, attention to detail, and effective communication skills help you advocate for patients while working with healthcare teams and payers. These skills ensure appropriate resource use, quality patient outcomes, and compliance with regulatory standards.

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

AspectUtilization Care ManagerUtilization Review Nurse
CredentialsRN, case management certificationRN, certification in utilization review
Work EnvironmentHealthcare facilities, insurance companiesHospitals, insurance companies, outpatient clinics
Primary FocusCoordinating patient care, managing resourcesReviewing medical necessity, approving treatments

Utilization Care Managers focus on coordinating patient care and managing resources, while Utilization Review Nurses primarily evaluate medical necessity for treatments. Both roles require nursing credentials and work within healthcare or insurance settings, but their core responsibilities differ in scope and focus.

What does a utilization care manager do in healthcare?

A utilization care manager in healthcare reviews patient cases to ensure appropriate use of medical services and resources, coordinating care plans to optimize patient outcomes and reduce unnecessary costs. They often work with healthcare providers, insurance companies, and patients, using data and clinical guidelines to make informed decisions about treatment and service utilization.

What are popular job titles related to Utilization Care Manager jobs in Texas?

For Utilization Care Manager jobs in Texas, the most frequently searched job titles are:

What job categories do people searching Utilization Care Manager jobs in Texas look for?

The top searched job categories for Utilization Care Manager jobs in Texas are:

What cities in Texas are hiring for Utilization Care Manager jobs?

Cities in Texas with the most Utilization Care Manager job openings:

Utilization Care Manager jobs near you
Infographic showing various Utilization Care Manager job openings in Texas as of August 2026, with employment types broken down into 2% As Needed, 74% Full Time, 18% Part Time, and 6% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution.

ED RN Care Manager - Utilization Managment

Corpus Christi, TX • On-site

CHRISTUS Health
Outpatient Health Care • 1 - 5K employees

6.7

Company rating: 6.7 out of 10

Based on 532 frontline employees who took The Breakroom Quiz

534th of 896 rated healthcare providers

People enjoy working here

Recommended by students

Recommended by parents

Learn more about CHRISTUS Healthexternal

Full-time

Re-posted 17 days ago

Job description

Summary:
The Emergency Department (ED) Care Manager is responsible for establishing, coordinating, and maintaining the process to increase patient throughput to the most appropriate level of care while facilitating interdisciplinary care across the continuum for the ED. The Care Manager collaborates with the patient and/or family, multidisciplinary team, physicians, community partners, and payers to ensure the patient's progress and level of care are appropriately determined. The Care Manager has well-developed knowledge and skill in patient status in the inpatient and outpatient settings and collaborates with other care managers, social workers, Patient Access, physicians, and administrative leadership in the ED to determine the appropriate level of care. The Care Manager also has a robust understanding of services and resources outside of the hospital that would be of benefit to the patient and initiates referrals as indicated. This work includes patient assessment and management, resource management, identifying patients appropriate for admission, observation or outpatient status, care facilitation, discharge planning with referrals to all levels of care, and other duties related to the defined population.
Responsibilities:
  • Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
  • Uses approved criteria to conduct patient assessment and admission clinical review to ensure the appropriateness of setting and timely implementation of the plan of care.
  • Performs review of anticipated admissions, placements in Observation status, and discharges using evidence-based criteria set for appropriate level of care assignment.
  • Provides identification of patients for whom standard of care treatments could be safely rendered at home.
  • Screens appropriateness of admission including observation versus inpatient status.
  • Educates ED physicians and nurses about medical necessity and admission criteria.
  • Collaborates with physicians and other members of the treatment team on documentation needs and opportunities.
  • Utilizes high-risk screening criteria to make appropriate community and post-ED referrals.
  • Initiates prior authorization process when indicated for post-ED referrals and services.
  • Escalates to physician advisor when unable to resolve discrepancies with the attending physician.
  • Manages high-use patients and works to find alternatives for care to frequent ED visits.
  • Plans for discharges from the ED for patients who do not require admission to include arranging for Home Health, DME, placement, and community resources as they relate to social determinants of health.
  • Provides patient and family education and counseling about existing health problem-related care.
  • Anticipates barriers/variances to the delivery of care and intervenes as necessary.
  • Intervenes with physicians and ancillary departments concerning clinical and utilization issues to ensure optimal patient outcomes.
  • Coordinates and facilitates patient progression throughout the continuum.
  • Collaborates with all members of the interdisciplinary team to facilitate appropriate care coordination and care delivery.
  • Able to analyze clinical information and accurately apply clinical criteria.

Job Requirements:
Education/Skills
  • Graduate of an accredited school of nursing

Experience
  • 3+ years of relevant clinical case/care management experience in the acute care setting required
  • Familiarity with evidence-based medical necessity criteria sets required
  • Competency in prior authorization functions and software, including the application of criteria and timelines required
  • Proficiency in medical and managed care terminology required

Licenses, Registrations, or Certifications
  • RN License
  • Case Manager certification preferred
  • BLS preferred

Work Schedule:
7PM - 7AM
Work Type:
Full Time
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About CHRISTUS Health

Sourced by ZipRecruiter

CHRISTUS Health is a prominent name in the healthcare industry, with its headquarters situated in Irving, TX, USA. Established in 1999, the company has since been devoted to providing comprehensive care and extending the healing ministry of Jesus Christ. This not-for-profit health system primarily operates more than 600 healthcare services and programs, including long-term care facilities, health insurance products, community clinics, and outreach services, serving both urban and rural populations.

Industry

Outpatient health care

Company size

1,001 - 5,000 Employees

Headquarters location

Irving, TX, US

Year founded

1999

View All CHRISTUS Health Jobs

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Hours and flexibility

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