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

Encompass Health Corporation

Case Manager

Dallas, TX · On-site

$18.50 - $23.75/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications • License or ...

Encompass Health

Case Manager

Bedford, TX · On-site

$17.75 - $22.75/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...

Encompass Health

Case Manager

Dallas, TX · On-site

$19.75 - $25.50/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications License or Certification:

Encompass Health

Case Manager

Dallas, TX · On-site

$19.75 - $25.50/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications License or Certification:

Valor Healthcare, Inc.

RN Case Manager

Dallas, TX · On-site

Non-Clinical case Managers coordinate all aspects of the care of individual patients ... They ensure proper utilization of services and resources and provide assistance within, between ...

ScionHealth

Case Manager II PRN

Dallas, TX · On-site

Follows patients throughout the continuum of care and ensures optimum utilization of resources ... of functions of case management, utilization review and management, and discharge planning.

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

Utilization Case Manager information

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$15

$35

$57

How much do utilization case manager jobs pay per hour?

As of Aug 21, 2026, the average hourly pay for utilization case manager in Irving, TX is $35.04, according to ZipRecruiter salary data. Most workers in this role earn between $28.41 and $36.92 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 job categories do people searching Utilization Case Manager jobs in Irving, TX look for?

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

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

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

Utilization Case Manager jobs near you

RN Case Manager

Clinical Management Consultants

Fort Worth, TX • On-site

Other

Posted 6 days ago

Job description

An exciting opportunity is available for an experienced RN Case Manager / Utilization Review Nurse to join a respected healthcare organization focused on quality, patient-centered care, and efficient care delivery. This role is ideal for a detail-oriented nursing professional who enjoys clinical review, problem-solving, and collaborating across the healthcare team.
The RN Case Manager / Utilization Review Nurse will play a key role in evaluating medical necessity and ensuring patients receive the appropriate level of care. This position will conduct prospective, concurrent, and post-discharge reviews using approved clinical criteria. The nurse will also evaluate admission status, monitor continued stays, and ensure documentation meets CMS, payer, and regulatory requirements.
The Utilization Review RN will work closely with physicians, case managers, physician advisors, and interdisciplinary teams to resolve documentation concerns and support accurate patient status determinations. A major focus of the role will be denial management. Responsibilities include identifying denials, preparing appeal letters, coordinating supporting documentation, and analyzing payer trends to help reduce future denials.
This RN Case Manager will also support discharge planning when needed. The nurse will help identify barriers to discharge and coordinate resources such as home health, durable medical equipment, medications, and therapy services. The role will also monitor avoidable days and extended lengths of stay while contributing to utilization reports, quality initiatives, regulatory reviews, and staff education.
Qualified candidates must hold an active Texas RN license and current CPR certification. A BSN is preferred along with case management certification. Candidates should have at least five years of experience in case management, discharge planning, and utilization review. Strong critical thinking, organization, communication, and attention to detail are essential for success.
The RN Case Manager / Utilization Review Nurse will have the opportunity to make a meaningful impact on patient outcomes while helping improve care coordination, resource utilization, and financial performance. Connect with a Clinical Management Consultants recruiter today to learn more about this exciting case management opportunity.

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About Clinical Management Consultants

Sourced by ZipRecruiter

Clinical Management Consultants (CMC) is a prominent organization based in San Francisco, California, that operates in the healthcare recruitment industry. Founded with the aim to bridge the gap between job seekers and employers in the healthcare sector, CMC has been successful in fulfilling its mission throughout the years. The company uses an analytical approach to facilitate the hiring process, helping healthcare organizations to find skilled candidates who can successfully fill the positions. The considerable experience CMC possesses in the recruitment industry aids them to make the recruitment process more transparent and efficient for all parties involved.

Industry

Human resource programs administration

Company size

51 - 200 Employees

Headquarters location

San Francisco, CA, US

Year founded

2010

Social media

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