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Utilization Management Jobs in Texas (NOW HIRING)

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

Provides information regarding utilization management requirements and operational procedures to ... members, providers, and facilities. JOB QUALIFICATIONS (Required): * Registered Nurse (RN) with a ...

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Utilization Management information

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$36.3K

$83.4K

$151.9K

How much do utilization management jobs pay per year?

As of Aug 2, 2026, the average yearly pay for utilization management in Texas is $83,367.00, according to ZipRecruiter salary data. Most workers in this role earn between $60,100.00 and $97,400.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in the Utilization Management position, and why are they important?

To thrive in Utilization Management, you need a strong understanding of healthcare procedures, insurance guidelines, and case review processes, usually backed by a clinical background such as RN, LPN, or allied health certification. Familiarity with medical management software, electronic health records (EHR), and utilization review tools like InterQual or MCG is often required. Excellent analytical thinking, attention to detail, and effective communication skills greatly enhance performance in this role. These competencies enable accurate assessment of medical necessity, ensure regulatory compliance, and support efficient, collaborative workflows between providers, insurers, and patients.

What is a Utilization Management job?

A Utilization Management (UM) job involves evaluating medical services to ensure they are necessary, cost-effective, and compliant with healthcare guidelines. Professionals in this field review patient care plans, authorize treatments, and collaborate with healthcare providers to optimize resource use. They work for insurance companies, hospitals, or healthcare organizations to balance quality care with cost control. Strong analytical skills and knowledge of medical policies are essential in this role.

What are the typical daily responsibilities of a Utilization Management professional?

As a Utilization Management professional, your day-to-day duties typically include reviewing patient admissions, authorizing ongoing treatment or procedures, assessing medical necessity, and ensuring services comply with insurance policies and industry guidelines. You will frequently collaborate with physicians, nurses, and insurance representatives to facilitate timely and appropriate care decisions while managing cost and quality. Documentation and communication play key roles as you help bridge the gap between clinical teams and payers. This role is often fast-paced, requires decisive action, and provides opportunities to have a direct impact on patient outcomes and organizational efficiency.

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 are popular job titles related to Utilization Management jobs in Texas? For Utilization Management jobs in Texas, the most frequently searched job titles are:
What job categories do people searching Utilization Management jobs in Texas look for? The top searched job categories for Utilization Management jobs in Texas are:
What cities in Texas are hiring for Utilization Management jobs? Cities in Texas with the most Utilization Management job openings:
Utilization Management jobs near you
Infographic showing various Utilization Management job openings in Texas as of July 2026, with employment types broken down into 82% Full Time, 15% Part Time, 1% Temporary, and 2% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution, with an average salary of $83,367 per year, or $40.1 per hour.

Utilization Management Nurse II - Case Management - Full Time

CHRISTUS Health

Beaumont, TX • On-site

Full-time

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

CHRISTUS Health rating

6.7

Company rating: 6.7 out of 10

Based on 526 frontline employees who took The Breakroom Quiz

530th of 887 rated healthcare providers

Job description

Summary:
The Utilization Management Nurse II is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services. This Nurse is responsible for performing a variety of pre-admission, concurrent, and retrospective UM related reviews and functions. They must competently and accurately utilize approved screening criteria (InterQual/MCG/Centers for Medicare and Medicaid Services "CMS" Inpatient List). They effectively and efficiently manage a diverse workload in a fast-paced, rapidly changing regulatory environment and are responsible for maintaining current and accurate knowledge regarding commercial and government payors and Joint Commission regulations and guidelines related to UM. This Nurse effectively communicates with internal and external clinical professionals, efficiently organizes the financial insurance care of the patients, and relays clinical data to insurance providers and vendors to obtain approved certification for services. The Utilization Management Nurse collaborates as necessary with other members of the health care team to ensure the above according to the mission of CHRISTUS.
Responsibilities:
  • Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
  • Applies demonstrated clinical competency and judgment in order to perform comprehensive assessments of clinical information and treatment plans and apply medical necessity criteria in order to determine the appropriate level of care.
  • Resource/Utilization Management appropriateness: Assess assigned patient population for medical necessity, level of care, and appropriateness of setting and services. Utilizes MCG/InterQual Care Guidelines and/or health system-approved tools to track impact and variance.
  • Uses appropriate criteria sets for admission reviews, continued stay reviews, outlier reviews, and clinical appropriateness recommendations.
  • Coordinate and facilitate correct identification of patient status.
  • Analyze the quality and comprehensiveness of documentation and collaborate with the physician and treatment team to obtain documentation needed to support the level of care.
  • Facilitates joint decision-making with the interdisciplinary team regarding any changes in the patient status and/or negative outcomes in patient responses.
  • Demonstrates, maintains, and applies current knowledge of regulatory requirements relative to the work process in order to ensure compliance, i.e. IMM, Code 44.
  • Demonstrate adherence to the CORE values of CHRISTUS.
  • Utilize independent scope of practice to identify, evaluate and provide utilization review services for patients and analyze information supplied by physicians (or other clinical staff) to make timely review determinations, based on appropriate criteria and standards.
  • Take appropriate follow-up action when established criteria for utilization of services are not met.
  • Proactively refer cases to the physician advisor for medical necessity reviews, peer-to-peer reviews, and denial avoidance.
  • Effectively collaborate with the Interdisciplinary team including the Physician Advisor for secondary reviews.
  • Proactively review patients at the point of entry, prior to admission, to determine the medical necessity of a requested hospitalization and the appropriate level of care or placement for the patient.
  • Review surgery schedule to ensure planned surgeries are ordered in the appropriate status and that necessary authorization has been obtained as required by the payor or regulatory guidance (i.e., CMS Inpatient Only List, Payor Prior Authorization matrix, etc.)
  • Regularly review patients who are in the hospital in Observation status to determine if the patient is appropriate for discharge or if conversion to inpatient status is appropriate.
  • Proactively identify and resolve issues regarding clinical appropriateness recommendations, coverage, and potential or actual payor denials.
  • Maintain consistent communication and exchange of information with payors as per payor or regulatory requirements to coordinate certification of hospital services.
  • Coordinate and facilitate patient care progression throughout the continuum and communicate and document to support medical necessity at each level of care.
  • Evaluate care administered by the interdisciplinary health care team and advocate for standards of practice.
  • Analyze assessment data to identify potential problems and formulate goals/outcomes.
  • Follows the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability ACT (HIPPA) designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI).
  • Attend scheduled department staff meetings and/or interdepartmental meetings as appropriate.
  • Possesses and demonstrates technology literacy and the ability to work in multiple technology systems.
  • Act as a catalyst for change in the organization; respond to change with flexibility and adaptability; demonstrate the ability to work together for change.
  • Translate strategies into action steps; monitor progress and achieve results.
  • Demonstrate the confidence, drive, and ability to face and overcome challenges and obstacles to achieve organizational goals.
  • Demonstrate competence to perform assigned responsibilities in a manner that meets the population-specific and developmental needs of patients served by the department.
  • Possess negotiating skills that support the ability to interact with physicians, nursing staff, administrative staff, discharge planners, and payers.
  • Excellent verbal and written communication skills, knowledge of clinical protocol, normative data, and health benefit plans, particularly coverage and limitation clauses.
  • Must adjust to frequently changing workloads and frequent interruptions.
  • May be asked to work overtime or take calls.
  • May be asked to travel to other facilities to assist as needed.
  • Actively participates in Multidisciplinary/Patient Care Progression Rounds.
  • Escalates cases as appropriate and per policy to Physician Advisors and/or CM Director.
  • Documents in the medical record per regulatory and department guidelines.
  • May be asked to assist with special projects.
  • May serve as a preceptor or orienter to new associates.
  • Assumes responsibility for professional growth and development.
  • Familiarity with criteria sets including InterQual and MCG preferred.
  • Must have excellent verbal and written communication and ability to interact with diverse populations.
  • Must have critical and analytical thinking skills.
  • Must have demonstrated clinical competency.
  • Must have the ability to Multitask and to function in a stressful and fast-paced environment.
  • Must have working knowledge of discharge planning, utilization management, case management, performance improvement, and managed care reimbursement.
  • Must have an understanding of pre-acute and post-acute levels of care and community resources.
  • Must have the ability to work independently and exercise sound judgment in interactions with physicians, payors, patients, and their families.
  • Must have an understanding of internal and external resources and knowledge of available community resources.
  • Other duties as assigned.

Job Requirements:
Education/Skills
  • Graduate of an accredited School of Nursing OR demonstrated success in the Utilization Management Nurse I role for at least five years at CHRISTUS Health on top of required experience in lieu of education required.

Experience
  • Two or more years of clinical experience with at least one year in the acute care setting OR demonstrated success as Utilization Management Nurse I role at CHRISTUS Health required.

Licenses, Registrations, or Certifications
  • RN License in state of employment or compact required.
  • LPN or LVN license accepted for associates with 5+ years of demonstrated success and experience in the Utilization Management Nurse I role at CHRISTUS Health.
  • Certification in Case Management preferred.
  • BLS preferred.

Work Schedule:
8AM - 5PM Monday-Friday
Work Type:
Full Time

What CHRISTUS Health employees say

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Hours and flexibility

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About CHRISTUS Health

Sourced by ZipRecruiter

CHRISTUS Health is a prominent name in the healthcare industry, with its headquarters situated in Irving, TX, USA. Established in 1999, the company has since been devoted to providing comprehensive care and extending the healing ministry of Jesus Christ. This not-for-profit health system primarily operates more than 600 healthcare services and programs, including long-term care facilities, health insurance products, community clinics, and outreach services, serving both urban and rural populations.

Industry

Outpatient health care

Company size

1,001 - 5,000 Employees

Headquarters location

Irving, TX, US

Year founded

1999

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