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Utilization Case Manager Jobs in Texas (NOW HIRING)

Memorial Hermann Health System

Case Manager

The Woodlands, TX · On-site

$18.25 - $23.50/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 ...

Memorial Hermann Health System

Case Manager

Pearland, TX · On-site

$17.50 - $22.75/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 ...

Memorial Hermann

Case Manager

The Woodlands, TX · On-site

$17.75 - $23/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

Case Manager

Pearland, TX · On-site

$17.75 - $23/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 ...

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All JobsUtilization Case JobsUtilization Case Manager JobsUtilization Case Manager Jobs in Texas

Utilization Case Manager information

What is a utilization case manager?

A Utilization Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient cases, coordinate with healthcare providers, and ensure that treatments are in line with established guidelines and insurance requirements. Their goal is to optimize patient outcomes while managing costs and ensuring compliance with regulations. Utilization Case Managers often work in hospitals, insurance companies, or managed care organizations.

How does a utilization case manager typically collaborate with healthcare providers and insurance companies?

Utilization Case Managers play a key role in coordinating care between healthcare providers and insurance companies. They review patient cases to ensure that the recommended treatments are medically necessary and align with insurance policies. This often involves regular communication with doctors, nurses, and insurance representatives to gather information, clarify treatment plans, and advocate for appropriate patient care. Strong collaboration skills are essential, as Utilization Case Managers must balance the needs of patients with organizational guidelines while maintaining positive professional relationships.

What degree do I need for utilization review?

Utilization case managers typically need at least a bachelor's degree in healthcare, nursing, social work, or a related field. Some positions may require a master's degree or professional certification, such as a Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ), to advance in the role or handle complex cases.

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

To thrive as a Utilization Case Manager, you need a background in nursing or social work, strong analytical skills, and a solid understanding of healthcare regulations and insurance processes, often supported by RN licensure or certification in case management (e.g., CCM). Familiarity with utilization management software, electronic health records (EHRs), and payer authorization systems is essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration among patients, providers, and payers. These skills ensure appropriate care delivery, cost management, and compliance with healthcare standards.

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

AspectUtilization Case ManagerUtilization Review Nurse
CredentialsRN license, case management certificationRN license, certification in utilization review
Work EnvironmentCase management teams, hospitals, insurance companiesUtilization review departments, hospitals, insurance providers
Primary FocusCoordinating patient care, discharge planning, resource allocationAssessing medical necessity, reviewing patient records for appropriateness
Common UsageBroader case management roles, patient advocacySpecific review of medical necessity and insurance claims

While both roles require RN licensure and focus on patient care, the Utilization Case Manager primarily coordinates overall patient services and discharge planning, whereas the Utilization Review Nurse concentrates on evaluating the medical necessity of treatments for insurance purposes. Understanding these distinctions helps in choosing the right career path or job search focus.

What are popular job titles related to Utilization Case Manager jobs in Texas? For Utilization Case Manager jobs in Texas, the most frequently searched job titles are:
What job categories do people searching Utilization Case Manager jobs in Texas look for? The top searched job categories for Utilization Case Manager jobs in Texas are:
What cities in Texas are hiring for Utilization Case Manager jobs? Cities in Texas with the most Utilization Case Manager job openings:
Utilization Case Manager jobs near you
Infographic showing various Utilization Case Manager job openings in Texas as of August 2026, with employment types broken down into 86% Full Time, and 14% Contract. Highlights an 86% In-person, and 14% Remote job distribution.

Case Manager

Dallam Hartley Counties Hospital District

Dalhart, TX • On-site

$18.75 - $24/hr

Full-time

Re-posted 14 days ago

Job description

Job Description: Facilitates patient care by assessing patient needs, evaluating treatment options, creating treatment plans, coordinating care, and gauging progress. The lead case manager is responsible for overseeing the case management team and serves as the primary point of contact between the case managers and executive leadership. OSHA Bloodborne Pathogens Class I.
Essential Responsibilities:
  • Coordinates and facilitates patient care through assessment, evaluation, planning, and implementation.
  • Serves as the primary case management contact for other departments within the district.
  • Oversee and assist all members of the case management team.
  • Works closely with executive leadership to address departmental issues and concerns.
  • Consults with healthcare team to identify patients’ needs and treatment options.
  • Determines patients’ eligibility for services through multidisciplinary team members.
  • Works with physician to refer services available within the hospital district.
  • Works with patient and family regarding plan of care after services, if needed.
  • Monitors and compiles information regarding the necessity of services within the district.
  • Reviews patient records to assemble utilization review information.
  • Maintains records and supports the district in utilization matters.
  • Completes accurate, timely records for submission to business office to coordinate billing flow between the district and outside agencies.
  • Prepares and presents education sessions and materials for medical staff members and the outpatient clinic staff.
Patient Advocate Duties:
  • Identify the need for additional services for patients.
  • Build a network of federal, state and community resources.
  • Maintains records for all assistance programs used and people helped through these services.
  • Maintains confidentiality while working with confidential matters on a daily basis.
  • Interacts with patients, family members, medical staff members and other department managers on a continuous basis.
  • Conducts patient satisfaction surveys as required
  • Follows safety guidelines and infection control policies for the Hospital District.
  • Any other duties as assigned.
Job Qualifications
  • Education: High school graduate or equivalent. Associate's degree in nursing. Bachelor's degree preferred.
  • Job Related Skills: Possess reading and verbal skills necessary to understand medical records and procedures and to communicate effectively with patients and other staff. Knowledge of Medicare, Medicaid and welfare programs preferred
  • Licensure, Registry or Certification: Registered Nursing License with the availability to work in the state of Texas.
  • Experience: One year experience as a clinical case manager preferred. Prior experience in quality assurance or utilization review activities preferred.
  • Physical and Mental Requirements: This position requires moderate periods of standing and walking.

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