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

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Utilization Case Manager information

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$12

$27

$45

How much do utilization case manager jobs pay per hour?

As of Aug 11, 2026, the average hourly pay for utilization case manager in Paris, TX is $27.76, according to ZipRecruiter salary data. Most workers in this role earn between $22.50 and $29.28 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.

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 job categories do people searching Utilization Case Manager jobs in Paris, TX look for? The top searched job categories for Utilization Case Manager jobs in Paris, TX are:
What cities near Paris, TX are hiring for Utilization Case Manager jobs? Cities near Paris, TX with the most Utilization Case Manager job openings:
Utilization Case Manager jobs near you
Infographic showing various Utilization Case Manager job openings in Paris, TX as of August 2026, with employment types broken down into 82% Full Time, and 18% Contract. Highlights an 82% In-person, and 18% Remote job distribution, with an average salary of $57,732 per year, or $27.8 per hour.

Supervisory Medical Director, National Physical Health Appeals Outpatient UM

Centene

Ladonia, TX • On-site, Remote

$236K - $449K/yr

Full-time

Medical, Retirement, PTO

Posted 4 days ago

Centene rating

8.4

Company rating: 8.4 out of 10

Based on 402 frontline employees who took The Breakroom Quiz

23rd of 887 rated healthcare providers

Job description

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: Supervisory Medical Director at Centene provides medical and leadership expertise to ensure high-quality, cost-effective care for our members. This role further assists the Senior Medical Director and Chief Medical Officer in execution of operational and strategic clinical initiatives.

  • Provides operational leadership, coaching and mentorship for a team of front-line medical directors including, but not limited to, scheduling for Utilization Management coverage, annual performance goal development, routine 1:1s, mentorship/career development, and annual evaluations.
  • Participates in creation and updates to new hire and existing medical director training, including new hire mentorship.
  • Supports Chief Medical Officer and Sr. Medical Director in the execution of strategic clinical initiatives.
  • Participates in utilization review studies, performance management and trend analysis.
  • Handles complex and high-profile utilization management cases, ensuring timely and appropriate decision-making.
  • Conducts and participates in case escalation reviews, collaborating with healthcare providers and market leadership to resolve disputes and or complaints.
  • Oversees and actively participates in the appeals process, ensuring that appeals are handled efficiently, thoroughly, and in compliance with regulatory requirements.
  • Provides clinical guidance and training to appeals medical director team around regulatory updates.
  • Collaborates closely with clinical teams, UM teams, and network providers to ensure understanding and adherence to utilization management clinical coverage criteria.
  • Performs other duties as assigned.
  • Complies with all policies and standards.

Education/Experience:

  • Medical Doctor (MD) Graduate of an accredited medical school required
  • Master's Degree MBA, MPH, or epidemiologist degree preferred
  • 5+ years Managed care/ clinical experience; experienced with commercial, Medicare and Medicaid lines of business required
  • 1+ years Supervisory/management experience preferred
  • Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association’s Department of Certifying Board Services required
  • American Board Certification in Internal or Family Medicine, preferred.
  • MD - Physician - State Licensure Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs required


Pay Range: $236,500.00 - $449,300.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.


Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

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