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

Colorwave Inc

Nurse Case Manager (RN)

Houston, TX · On-site

$59K - $100K/yr

Nurse Case Manager (RN) Hospitals on Incredible Health are actively hiring and accepting ... Clinical pathway, Navigator, or Utilization Review. Shift(s) available: day shift, night shift, and ...

Encompass Health

Certified Case Manager

Houston, TX · On-site

PRN position Full Time The Certified Case Manager (CCM) serves as a key member of the ... The CCM performs ongoing utilization review and acts as a liaison to the payor while assuring that ...

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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 11, 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.

Registered Nurse Case Manager

Houston Methodist Cypress Hospital

Cypress, TX • On-site

Full-time

This job post has expired today. Applications are no longer accepted.

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 (CM) position is a registered nurse (RN) responsible for comprehensively assessing clinical condition and planning for case management, which includes care transitions and discharge planning of a targeted patient population on a designated unit(s) and/or service lines. This position works with the physicians and multidisciplinary healthcare team to facilitate clinical care coordination and maintain compassionate, efficient, quality and safe patient care and achievement of desired treatment outcomes. The CM position holds joint accountability with the social worker for discharge planning, coordination of care, and throughput, assuring that admission and continued stay are medically necessary. This position communicates clinical information to payors and post-acute care providers to ensure safe transition and continuity of care.
FLSA STATUS
Exempt
QUALIFICATIONS
EDUCATION
  • Graduate of education program approved by the credentialing body for the required credential(s) indicated below in the Certifications, Licenses and Registrations section.
  • Bachelor’s degree preferred

EXPERIENCE
  • Three years hospital nursing clinical experience
  • Acute care case management experience preferred

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)

KNOWLEDGE AND ABILITIES
  • Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through ongoing 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
  • Knowledge of Medicare, Medicaid and Managed Care requirements
  • Progressive knowledge of community resources, healthcare financial and payor requirements/issues, and eligibility for state, local and federal programs
  • Progressive 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 and exercise sound judgment in interactions with physicians, payors, and patients and their families
  • Well versed in computer skills of the entire Microsoft Office Suite (Excel, Outlook, PowerPoint and Word)
  • Strong assessment, organizational and problem-solving skills

ESSENTIAL FUNCTIONS
PEOPLE ESSENTIAL FUNCTIONS
  • Communicates in an active, positive and effective manner to all healthcare team members and reports pertinent clinical patient care and family data in a comprehensive and unbiased manner; listens and responds to the ideas of others. Supports patients and families in preventing/resolving clinical or ethical issues.
  • Collaborates with staff from the multidisciplinary care team concerning the discharge plan to improve outcomes and the safe transition of care. Uses a structured format for regular communication with patients and families.
  • Communicates effectively with physicians, multidisciplinary care team, patients, and families to ensure safe and timely transitions of care.
  • Contributes towards improvement of employee engagement as reflected by department scores, i.e., peer-to-peer accountability.

SERVICE ESSENTIAL FUNCTIONS
  • Assesses all patients timely, per policy, and thoroughly. Reviews chart for medical necessity and facilitation of throughput and appropriate utilization of inpatient resources and services, etc. Initiates and facilitates referrals and transfers for home health care, hospice, durable medical equipment, and other post-acute services.
  • Participates and is prepared to present barriers to efficient patient throughput in daily multi-disciplinary rounds (MDRs). Escalates appropriate discharge barriers to leadership and/or physician advisor.
  • Facilitates discharge planning activities for assigned patients and collaborates with other members of the multidisciplinary care team, as well as patient and family, on clinically complex care transitions and discharges. Maintains ownership of the discharge planning process on assigned units.

QUALITY/SAFETY ESSENTIAL FUNCTIONS
  • Modifies care based on continuous evaluation of the patient’s medical condition and progression. Demonstrates clinical problem-solving and critical thinking within the scope of practice and makes decisions using an evidence-based analytical approach. Documents accurate assessment and interventions efficiently and effectively.
  • Educates patient and family appropriately on disease process that impacts their health and readmission. Connects patient and family with resources related to their disease process.
  • Proactively plans for routine discharge, elevates emergent situations, and escalates unresolved barriers. Manages usual patient assignment and other unit demands, anticipating/planning for potential problems.
  • Focuses on discharge domain by contributing to department and hospital targets for quality, patient satisfaction and safety measures.

FINANCE ESSENTIAL FUNCTIONS
  • Focuses on reducing length of stay for all levels of care, (inpatient, observation and outpatient in a bed) and avoidable days by ensuring efficient and timely use of resources in discharge planning and transitions. Reviews medical records for medical necessity for continued stay, facilitate timely discharge to reduce discharge delays.
  • Applies knowledge of payor requirements and coverage to facilitate cost-effective discharges. Contributes to meeting department and hospital financial targets. Utilizes resources with cost effectiveness and value creation in mind. Self-motivated to independently manage time effectively and prioritize daily tasks, assisting coworkers as needed.

GROWTH/INNOVATION ESSENTIAL FUNCTIONS
  • Identifies areas for process improvement based on understanding of evidence-based practice literature. Participates in evidence-based practice/performance improvement projects based on these observations and offers solutions.
  • Seeks opportunities to identify self-development needs and takes appropriate action. Ensures own career discussions occur with appropriate management. Completes and updates the My Development Plan on an ongoing 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
QUALIFICATIONS
EDUCATION
  • Graduate of education program approved by the credentialing body for the required credential(s) indicated below in the Certifications, Licenses and Registrations section.
  • Bachelor’s degree preferred

EXPERIENCE
  • Three years hospital nursing clinical experience
  • Acute care case management experience preferred

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)

Company Profile:

Houston Methodist Cypress Hospital, Houston Methodist's eighth hospital, opened in the first quarter of 2025 in a prime location in the heart of the rapidly growing U.S. 290 corridor. It incorporates the most advanced technology available, featuring innovations designed to enhance communication between patients, physicians, staff and families. The facility combines state-of-the-art technology with world-class clinicians, creating an unparalleled experience for patients, employees and physicians.

Houston Methodist is an Equal Opportunity Employer.

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