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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

See Texas salary details

$36.3K

$83.4K

$151.9K

How much do utilization management jobs pay per year?

As of Aug 19, 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 is utilization management?

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 key skills and qualifications needed to thrive in utilization management, 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 degree is needed for utilization management?

Utilization management professionals typically need at least a bachelor's degree in healthcare, nursing, health administration, or a related field. Some roles may require a master's degree or professional certifications such as Certified Professional in Healthcare Quality (CPHQ) or Certified Case Manager (CCM). Experience in healthcare settings and knowledge of medical terminology and insurance processes are also important.

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 August 2026, with employment types broken down into 1% As Needed, 85% Full Time, 12% Part Time, and 2% Contract. Highlights an 84% Physical, 3% Hybrid, and 13% Remote job distribution, with an average salary of $83,367 per year, or $40.1 per hour.

Director, Utilization Management - CMC - Clear Lake Center

UTMB Health

Galveston, TX • On-site

Full-time

Posted 6 days ago

UTMB Health rating

7.3

Company rating: 7.3 out of 10

Based on 168 frontline employees who took The Breakroom Quiz

268th of 888 rated healthcare providers

Job description

Summary:

The Director is responsible for the coordination and management of a full-service Utilization Management program to service the TDCJ, TJJD and other contracted inmate populations.

The mission of Correctional Managed Care is to address the healthcare needs of underserved patient populations within the Texas Department of Criminal Justice (TDCJ) and the Texas Juvenile Justice Department (TJJD).

Scope:

Contribute to the success of UTMB and the (CMC) Correctional Managed Care Organization through the effective management of the CMC Utilization Management Program. May be required to work within the confines of a prison, jail, or juvenile detention center.

Responsibilities:

  • Organize a staff of professionals to perform all aspects of both Utilization Review and Case Management in the Utilization Management Program.
  • Oversee the orientation program of staff to the Utilization Management methods, review, and the documentation process.
  • Acts as a resource to medical and security personnel at the prison level to the managed care process.
  • Oversee an ongoing quality assurance/ quality improvement program for the Utilization Management Department.
  • Responsible for the development of all the reporting and documentation needs for the Utilization Management Program.
  • Develop and maintain an ongoing process to evaluate and modify the Utilization Management program.
  • Continuous monitoring and improvement of reporting and documents to reflect the department's productivity, patient population and opportunities for improvement and predictive analysis.
  • Responsible for the twenty-four-hour operation of the department to provide services to the CMC patient population.
  • Ensure effective fiscal responsible use of resources.
  • Adheres to internal controls and reporting structure established for department.
  • Performs other related duties as required.

Knowledge, Skills & Abilities:

  • Strong data analysis skills
  • Performance Improvement expertise
  • Flexible and adept at managing a changing work environment
  • Superior people skills to interact with varied agencies, departments, and healthcare providers
  • Outstanding prioritization and organizational skills

Minimum Qualifications:

  • Master's Degree in related field plus five (5) years of progressive leadership and clinical experience in a healthcare environment to include four (4) years of utilization management experience.
  • Graduate of accredited Registered Nursing program with current unrestricted Texas RN License.

Preferred Qualifications:

  • Master's degree in Nursing, Healthcare Administration, Business Administration, Public Health, or related field plus five (5) or more years of progressive leadership experience in utilization management, case management, managed care, or healthcare operations in a correctional healthcare, academic medical center or large integrated healthcare system environment.
  • Current CCM, ACM, CPHQ, or equivalent utilization management/quality certification.
  • Advanced experience with InterQual and healthcare analytics platforms.
  • Demonstrated expertise in performance improvement, physician engagement, and utilization optimization initiatives.
  • Lean Six Sigma certification.
  • Proven success leading large multidisciplinary teams and complex healthcare operations.
  • Certification for performance improvement.

Equal Employment Opportunity

UTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. As a Federal Contractor, UTMB Health takes affirmative action to hire and advance protected veterans and individuals with disabilities.

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