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Utilization Case Manager Jobs in Houston, TX (NOW HIRING)

ScionHealth

Case Manager PRN

Sugar Land, TX · On-site

Follows patients throughout the continuum of care and ensures optimum utilization of resources ... Experience in case management, utilization review, or discharge planning a plus.

GQR

RN - Case Manager

Pasadena, TX · On-site

$1.3K - $1.4K/wk

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Pasadena, Texas Start Date: August 31, 2026 Profession: Registered Nurse (RN) Facility: Short Term Acute Care ...

GQR Global Markets

RN Case Manager

Pasadena, TX · On-site

$1.3K - $1.4K/wk

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Pasadena, Texas Start Date: August 31, 2026 Profession: Registered Nurse (RN) Facility: Short Term Acute Care ...

Team Select Home Care

Case Manager

Houston, TX · On-site

$19 - $24.50/hr

The Case Manager is a qualified registered nurse with the ability to provide and oversee the care ... Participates in clinical record/utilization review of medical records and quality assurance and ...

Team Select Home Care

Case Manager

Houston, TX · On-site

$19 - $24.50/hr

The Case Manager is a qualified registered nurse with the ability to provide and oversee the care ... Participates in clinical record/utilization review of medical records and quality assurance and ...

Team Select Home Care

Case Manager

Houston, TX · On-site

$19 - $24.50/hr

The Case Manager is a qualified registered nurse with the ability to provide and oversee the care ... Participates in clinical record/utilization review of medical records and quality assurance and ...

Team Select Home Care

Case Manager

Houston, TX · On-site

$19 - $24.50/hr

The Case Manager is a qualified registered nurse with the ability to provide and oversee the care ... Participates in clinical record/utilization review of medical records and quality assurance and ...

Team Select Home Care

Case Manager

Houston, TX · On-site

$19 - $24.50/hr

The Case Manager is a qualified registered nurse with the ability to provide and oversee the care ... Participates in clinical record/utilization review of medical records and quality assurance and ...

Team Select Home Care

Case Manager

Houston, TX · On-site

$19 - $24.50/hr

The Case Manager is a qualified registered nurse with the ability to provide and oversee the care ... Participates in clinical record/utilization review of medical records and quality assurance and ...

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All JobsUtilization Case JobsUtilization Case Manager JobsUtilization Case Manager Jobs in Houston, TX

Utilization Case Manager information

See Houston, TX salary details

$15

$34

$57

How much do utilization case manager jobs pay per hour?

As of Sep 1, 2026, the average hourly pay for utilization case manager in Houston, TX is $34.84, according to ZipRecruiter salary data. Most workers in this role earn between $28.22 and $36.73 per hour, depending on experience, location, and employer.

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.

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.

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 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 degree do I need for utilization case manager?

Utilization case managers typically need at least a bachelor's degree in healthcare, social work, nursing, or a related field. Some positions may prefer or require a master's degree or relevant certifications, such as Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ).

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

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

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

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

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

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

Utilization Case Manager jobs near you
Infographic showing various Utilization Case Manager job openings in Houston, TX 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, with an average salary of $72,474 per year, or $34.8 per hour.

Lead RN Case Manager

Nexus Children's Hospital

Shenandoah, TX • On-site

Full-time

Re-posted 4 days ago

Job description

RN Case Manager
Nexus Children’s Hospital – Shenandoah
Full-Time | Monday–Friday | Day Shift

About Nexus Children’s Hospital – Shenandoah

Nexus Children’s Hospital – Shenandoah specializes in providing comprehensive, pediatric-focused care for children and adolescents with complex medical, neurological, and rehabilitative needs. Our interdisciplinary approach supports recovery, independence, and long-term quality of life through coordinated medical care, therapy services, and family engagement. We are committed to empowering patients and families throughout their healthcare journey with compassion, expertise, and a collaborative spirit.

Position Summary

The RN Case Manager is responsible for assessing patient and family psychosocial needs, planning and coordinating care, and evaluating clinical progress across the healthcare episode. This role ensures cost-effective care delivery within appropriate length of stay while preventing fragmentation of services. Working collaboratively with physicians, payors, and an interdisciplinary healthcare team, the RN Case Manager supports age-specific and patient-focused outcomes, linking resource management with quality care.

Job Responsibilities

General Responsibilities

  • Maintains PHI and HIPAA compliance according to hospital policy and federal regulations.

  • Promotes a safe working environment and safe patient care at all times.

  • Practices “minimum information necessary” when performing utilization review, case management, and discharge functions.

  • Acts as a patient advocate for all patients within the facility.

  • Adheres to all regulatory, company, and ethical standards of practice.

  • Demonstrates respect, professionalism, and confidentiality at all times.

  • Supports and models the organization’s mission, vision, and values.

Case Management & Coordination

  • Conducts initial and ongoing patient assessments, focusing on clinical needs, discharge criteria, and family support.

  • Plans, coordinates, and facilitates interdisciplinary care conferences.

  • Evaluates ongoing treatment plans and collaborates with providers for necessary adjustments.

  • Prevents service duplication and ensures appropriate use of resources.

  • Collaborates with third-party payors to provide medical information and support authorization processes.

  • Coordinates discharge planning, ensuring safe and effective transition to the next level of care.

Patient & Family Engagement

  • Serves as a primary communication point for patient families and outside agencies.

  • Provides education regarding treatment goals, discharge needs, and community resources.

  • Facilitates problem-solving and addresses barriers to discharge or care progression.

Qualifications

  • Current RN license in the State of Texas (required)

  • Bachelor of Science in Nursing preferred

  • Case Management certification (ACM or CCM) preferred

  • Prior experience in pediatrics, rehabilitation, acute care, behavioral health, or complex medical case management strongly preferred

  • Strong communication skills and ability to work effectively with families under stress

  • Experience with utilization review or managed care interaction is a plus

Why Join Nexus?

  • Mission-driven pediatric and neuro-rehabilitation environment

  • Collaborative and supportive interdisciplinary culture

  • Opportunity to impact children and families facing complex healthcare challenges

  • Competitive compensation & benefit package