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

Houston Methodist

Case Manager - PRN

Sugar Land, TX · On-site

Comprehensive knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement. * Understanding of pre-acute and post-acute venues of ...

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.

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 ...

Houston Methodist

Case Manager Certified

Sugar Land, TX · On-site

Comprehensive knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement. * Understanding of pre-acute and post-acute venues of ...

Houston Methodist

Case Manager Certified

Sugar Land, TX · On-site

Comprehensive knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement. * Understanding of pre-acute and post-acute venues of ...

CommonSpirit Health

Utilization Review RN

Houston, TX · On-site

$41.14 - $61.20/hr

Utilization Review RN Inspired by faith. Driven by innovation. Powered by humankindness ... Certified Case Manager, upon hire or * Accredited Case Manager, upon hire or Baylor St. Luke ...

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

Utilization Case Manager information

See Rosenberg, TX salary details

$14

$32

$53

How much do utilization case manager jobs pay per hour?

As of Aug 12, 2026, the average hourly pay for utilization case manager in Rosenberg, TX is $32.56, according to ZipRecruiter salary data. Most workers in this role earn between $26.39 and $34.33 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 Rosenberg, TX look for? The top searched job categories for Utilization Case Manager jobs in Rosenberg, TX are:
What cities near Rosenberg, TX are hiring for Utilization Case Manager jobs? Cities near Rosenberg, TX with the most Utilization Case Manager job openings:
Utilization Case Manager jobs near you
Infographic showing various Utilization Case Manager job openings in Rosenberg, 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 $67,716 per year, or $32.6 per hour.

Case Manager - PRN

Houston Methodist

Sugar Land, TX • On-site

Part-time

Posted 8 days ago

Houston Methodist rating

8.2

Company rating: 8.2 out of 10

Based on 300 frontline employees who took The Breakroom Quiz

55th of 887 rated healthcare providers

Job description

At Houston Methodist, the Case Manager PRN (CM) position is a licensed registered nurse (RN) who comprehensively plans for case management of a target patient population on a designated unit(s). This position works with the physicians and interprofessional health care team to facilitate and maintain compassionate, efficient quality care and achievement of desired treatment outcomes. The CM PRN holds joint accountability with social worker for discharge planning and continuity of care and assures that admission and continued stay are medically necessary and communicates clinical information to payors to ensure reimbursement. The CM PRN helps drive change by identifying areas where performance improvement is needed (e.g., day-to-day workflow, education, process improvements, patient satisfaction).FLSA STATUS
Non-exempt
QUALIFICATIONS
EDUCATION
  • Graduate of education program approved by the credentialing body for the required credential(s) indicated below in the Certificates, Licenses and Registrations section.

EXPERIENCE
  • Three (3) years hospital clinical nursing experience which includes two (2) years in case management

LICENSES AND CERTIFICATIONS
Required
  • RN - Registered Nurse - Texas State Licensure - Texas Board of Nursing_PSV Compact Licensure - Must obtain permanent Texas license within 60 days (if establishing Texas residency)

SKILLS AND ABILITIES
  • Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations.
  • Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security.
  • Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles.
  • Strong assessment, organizational and problem-solving skill as evidenced by capacity to prioritize multiple tasks and role components
  • Knowledge of Medicare, Medicaid and Managed Care requirements
  • Comprehensive knowledge of community resources, health care financial and payer requirements/issues, and eligibility for state, local and federal programs
  • Comprehensive knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement.
  • Understanding of pre-acute and post-acute venues of care and post-acute community resources.
  • Ability to work independently
  • Strong assessment, organizational and problem-solving skill as evidenced by capacity to prioritize multiple tasks and role components
  • Demonstrates critical thinking and makes decisions using evidence-based analytical approach in interactions with physicians, payors, and patients and their families
  • Well versed in computer skills of the entire Microsoft Office Suite (Access, Excel, Outlook, PowerPoint and Word)

ESSENTIAL FUNCTIONS
PEOPLE ESSENTIAL FUNCTIONS
  • Collaborates with the physician and all members of the interprofessional health care team to facilitate care for designated case load; monitors the patient's progress, intervening as needed to ensure that the plan of care and services provided are patient-focused, high quality, efficient, and cost-effective; facilitates timely:
    • completion and reporting of diagnostic testing;
    • completion of treatment plan and discharge plan;
    • modification of plan of care, as necessary, to meet the ongoing needs of the patient;
    • assignment of appropriate levels of care;
    • completion of all required documentation in EPIC and MIDAS
  • Serves as a preceptor, as appropriate, and implements staff education specific to patient populations and unit processes; coaches and mentors other staff and students. Serves a resource for case management and social work resources and needs for the department and the hospital.

SERVICE ESSENTIAL FUNCTIONS
  • Performs review for medical necessity of admission, continued stay and resource use, appropriate level of care and program compliance. Identifies when services no longer meet InterQual/Millman l criteria, initiates discussion with attending physicians, coordinates with the external case manager to facilitate discharge planning, seeks assistance from the physician advisor, if needed, and informs management of the possible need for issuing Medicare Hospital Initiated Notice of Non-coverage.
  • Applies approved utilization criteria to monitor appropriateness of admissions, level of care, resource utilization, and continued stay. Reviews level of care denials to identify trends and collaborate with team to recommend opportunities for process improvement.

QUALITY/SAFETY ESSENTIAL FUNCTIONS
  • Documents assessment and interventions efficiently and effectively.
  • Plans for routine/difficult discharge and anticipates/prevents and manages emergent situations. Specific focus given to discharge plan and elimination of barriers.
  • Performs post-discharge review by analyzing the inpatient record to ensure that compliance with quality indicators are met. Intervenes and takes appropriate action to foster real-time compliance with CMS guidelines and other performance measures associated with certification programs and other regulatory, national, regional or locally- sponsored quality programs. Provides reports, as needed, to appropriate parties showing:
    • compliance with established governmental and/or institutional rules and regulations
    • analysis of problematic areas, and
    • actions taken to improve compliance
  • Conducts chart audits and performs peer-to-peer evaluations for continuous quality improvement.
  • Identifies opportunities to improve patient satisfaction with focus on discharge domain and collaborates with unit leadership to implement evidence-based patient engagement strategies.

FINANCE ESSENTIAL FUNCTIONS
  • Monitors Length of Stay (LOS) for case load on an ongoing basis. Identifies population and/or service-specific trends impacting LOS and addresses/resolves problems impeding treatment progress. Proactively takes action to achieve continuous improvement and expedite care/facilitate discharge. Contributes to meeting departmental financial target on scorecard
  • Manages all patients in Observation Status, daily, informing physicians of timely disposition options to assure maximum benefits for patients and reimbursement for the hospital.
  • Secures reimbursement for hospital services by communicating medical information required by all external review entities, managed care contracts, insurers, fiscal intermediaries, and state and federal agencies. Responds to requests for information, monitors covered days, and initiates review to assure that all days are covered and reimbursable.

GROWTH/INNOVATION ESSENTIAL FUNCTIONS
  • Provides education to unit-based physicians, nurses, and other healthcare providers on any case management topics.
  • Identifies opportunity for practice changes. Offers innovative solutions through evidence-based practice/performance improvement projects and shared governance activities.
  • Identifies and presents areas for innovation, efficiency and improvement in case management or department operations using evidence-based practice literature. Completes and updates the individual development plan (IDP) on an on-going basis.

SUPPLEMENTAL REQUIREMENTS
    WORK ATTIRE
    • Uniform: No
    • Scrubs: No
    • Business professional: Yes
    • Other (department approved): No

    ON-CALL*
    *Note that employees may be required to be on-call during emergencies (ie. Disaster, Severe Weather Events, etc) regardless of selection below.
    • On Call* Yes

    TRAVEL**
    **Travel specifications may vary by department**
    • May require travel within the Houston Metropolitan area Yes
    • May require travel outside Houston Metropolitan area No

Work Shift:
1 - Day (United States of America)
Job Category:
Non-clinicalHouston Methodist Sugar Land Hospital is committed to leading medicine by delivering the Houston Methodist standard of unparalleled quality, safety, service and innovation to patients in Fort Bend County and surrounding areas. Houston Methodist Sugar Land offers access to the most innovative care available, including comprehensive cancer care; neuroscience and spine care; orthopedics and sports medicine; heart and vascular care; women's services; childbirth center with level III NICU; bariatric and digestive care; and advanced imaging - all backed by our focus on healing people today and offering hope for tomorrow.
Houston Methodist is an Equal Opportunity Employer.

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