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Utilization Management Associate Jobs in Texas (NOW HIRING)

UHS

Case Management Associate PT McAllen

Mcallen, TX · On-site

The Case Management Associate (CMA) assists in development and maintenance of systems to support ... or utilization management is strongly preferred. 3. Bilingual preferred (Spanish). 4. Must ...

New

Ascension

Registered Nurse Utilization Review

Austin, TX · Remote

$84K/yr

Utilization Management Schedule: Days l Full-Time Salary range: $78,561.60 - $110,905.60 per year ... We empower our 97,000+ associates to bring their skills and expertise every day to reimagining ...

New

Ascension

Registered Nurse Utilization Review

Austin, TX · Remote

$78K - $110K/yr

Utilization Management Schedule: Days l Full-Time Salary range: $78,561.60 - $110,905.60 per year ... We empower our 97,000+ associates to bring their skills and expertise every day to reimagining ...

UHS

Case Management Associate PT McAllen

Mcallen, TX · On-site

The Case Management Associate (CMA) assists in development and maintenance of systems to support ... or utilization management is strongly preferred. 3. Bilingual preferred (Spanish). 4. Must ...

New

UHS

Case Management Associate PT McAllen

Mcallen, TX · On-site

The Case Management Associate (CMA) assists in development and maintenance of systems to support ... or utilization management is strongly preferred. 3. Bilingual preferred (Spanish). 4. Must ...

New

Ascension

RN-Utilization Review

Austin, TX · Remote

$84K/yr

Utilization Management Schedule: Days l Part-Time Salary range: $84,060.91 - $118,668.99per year ... We empower our 97,000+ associates to bring their skills and expertise every day to reimagining ...

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Utilization Management Associate information

What does a utilization management associate do?

A Utilization Management Associate is responsible for reviewing healthcare services and determining whether they are medically necessary, appropriate, and efficient. They work with healthcare providers, insurance companies, and patients to ensure that treatments comply with established guidelines and policies. Their role often includes reviewing medical records, processing authorizations, and assisting in the coordination of care to optimize the use of healthcare resources. This position helps control costs while ensuring that patients receive the appropriate level of care.

What skills and qualifications are needed to thrive as a utilization management associate?

A Utilization Management Associate typically needs a background in healthcare administration or a related field, strong analytical skills, and knowledge of medical terminology and insurance guidelines. Familiarity with utilization review software, electronic health records (EHRs), and regulatory compliance systems is important, and certifications like Certified Professional in Healthcare Management (CPHM) can be advantageous. Attention to detail, effective communication, and strong organizational skills help associates excel in evaluating medical necessity and collaborating with care teams. These competencies ensure accurate, efficient review processes that support quality patient care and compliance with payer requirements.

What are the typical daily responsibilities of a utilization management associate?

Utilization Management Associates typically review medical records, verify insurance coverage, and coordinate with healthcare providers to ensure that treatments and services meet established guidelines and payer requirements. They also communicate with physicians and patients to gather necessary information for authorization requests. By ensuring appropriate utilization of healthcare resources, they help support patient care while managing costs and compliance for their organization. Collaboration with clinical staff and insurance representatives is a key part of the role, contributing to effective case management.

What is the difference between Utilization Management Associate vs Utilization Review Coordinator?

AspectUtilization Management AssociateUtilization Review Coordinator
CertificationsTypically requires a healthcare-related certification or licenseOften requires similar certifications, such as CCM or RHIA
Work EnvironmentWorks in insurance companies, healthcare providers, or managed care organizationsWorks in hospitals, insurance companies, or healthcare facilities
Job FocusAssists in reviewing medical necessity and authorization processesCoordinates and conducts utilization reviews and approvals
Common UsageUsed interchangeably in healthcare and insurance settingsOften used in hospital and insurance contexts

The Utilization Management Associate and Utilization Review Coordinator roles share similarities in certifications and work environments, focusing on reviewing medical necessity and authorization. The main difference lies in their specific responsibilities, with associates assisting in the process and coordinators actively conducting reviews and approvals.

What are the most commonly searched types of Utilization Management jobs in Texas?

The most popular types of Utilization Management jobs in Texas are:

What cities in Texas are hiring for Utilization Management Associate jobs?

Cities in Texas with the most Utilization Management Associate job openings:

Infographic showing various Utilization Management Associate job openings in Texas as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 13% Part Time, 3% Contract, and 1% Nights. Highlights an 82% Physical, 3% Hybrid, and 15% Remote job distribution.

Utilization Management Director, El Paso Health

El Paso, TX

University Medical Center of El Paso
Health Care and Social Assistance • 1 - 5K employees
Learn more about University Medical Center of El Pasoexternal

Full-time

Re-posted 10 days ago

University Medical Center Of El Paso rating

6.7

Company rating: 6.7 out of 10

Based on 36 frontline employees who took The Breakroom Quiz

Job description

Job Summary

Provides strategic leadership and oversight of El Paso Health’s Utilization Management (UM) program, including planning, development, implementation, and continuous quality improvement of integrated UM services across all lines of business. Ensures compliance with all contractual, regulatory, and accreditation requirements established by HHSC, TDI, CMS, URAC, and other governing bodies.

Partners with healthcare providers to ensure appropriate and consistent administration of plan benefits through clinical review processes, including prior authorization, medical necessity determinations, out-of-network requests, and appropriate level-of-care decisions. Applies medical policies, clinical guidelines, benefit structures, and standardized decision-support tools within scope of licensure. Develops and maintains utilization management protocols supporting Medicaid, CHIP, Medicare Advantage, and Third-Party Administrator products. Maintains an effective and informed relationship with health plan Medical Director(s).

Minimum Job Requirements:

            Work Experience:

Five years of experience in a management/supervisory capacity required. Strong background in managed care environment with Medicaid and/or other government programs is optimal.  Experience with utilization review, clinic operations, and data collection and analysis preferred. Familiarity with third party insurance and other forms of reimbursement preferred.

            License/Registration/Certification:

             Current and active license to practice as a Registered Nurse in the state of Texas required.

            Education and Training:

            Bachelor degree in Nursing required.

     

            Skills:

  1. Proven leadership, communication, and interpersonal skills necessary to interact effectively with physicians, management, associates, and external agencies/customers.
  2. Solid organization and contract management skills.
  3. Excellent analytical and negotiation skills.
  4. Excellent oral and written communication, interpersonal and time management skills.
  5. Ability to execute and be a self-starter and follow through on projects.
  6. Possess expertise in Microsoft Excel, Power Point and Microsoft Word.
  7. Strong computer skills, including familiarity with database systems.

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