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Utilization Management Jobs in Houston, TX (NOW HIRING)

HealthCare Support

Utilization Management

Houston, TX · On-site

$38 - $42/hr

Accurately enters the required information into the managed care platform, adhering to UM policies and procedures. * . Assists in discharge planning especially Home Health Nursing requests and DME ...

Harris Health System

BH Utilization Manager RN

Houston, TX · On-site

$67K - $85K/yr

We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of ... Behavioral Health Utilization Manager will perform concurrent and discharge reviews on assigned ...

St. Luke's Health

Utilization Review RN

Houston, TX · On-site

Job Summary and Responsibilities As our Utilization Management Professional, you will be a critical guardian of healthcare efficiency and quality, ensuring integrity in clinical decision-making ...

St. Luke's Health

Utilization Review RN

Houston, TX · On-site

$41.14 - $61.20/hr

Job Summary and Responsibilities As our Utilization Management Professional, you will be a critical guardian of healthcare efficiency and quality, ensuring integrity in clinical decision-making ...

St Luke's Health

Utilization Review RN

Houston, TX

$41.14 - $61.20/hr

Job Summary and Responsibilities As our Utilization Management Professional, you will be a critical guardian of healthcare efficiency and quality, ensuring integrity in clinical decision-making ...

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All JobsUtilization Management JobsUtilization Management Jobs in Houston, TX

Utilization Management information

See Houston, TX salary details

$37.2K

$85.5K

$155.7K

How much do utilization management jobs pay per year?

As of Aug 7, 2026, the average yearly pay for utilization management in Houston, TX is $85,453.00, according to ZipRecruiter salary data. Most workers in this role earn between $61,600.00 and $99,800.00 per year, depending on experience, location, and employer.

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 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 most commonly searched types of Utilization Management jobs in Houston, TX? The most popular types of Utilization Management jobs in Houston, TX are:
What are popular job titles related to Utilization Management jobs in Houston, TX? For Utilization Management jobs in Houston, TX, the most frequently searched job titles are:
What job categories do people searching Utilization Management jobs in Houston, TX look for? The top searched job categories for Utilization Management jobs in Houston, TX are:
What cities near Houston, TX are hiring for Utilization Management jobs? Cities near Houston, TX with the most Utilization Management job openings:
Utilization Management jobs near you
Infographic showing various Utilization Management job openings in Houston, TX as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $85,453 per year, or $41.1 per hour.

Utilization Management Rep

Allmed Staffing Inc

Pearland, TX • Remote

Full-time

Medical, Dental, Vision, Retirement

Re-posted 10 days ago

Job description

Job Title: Utilization Management Representative (UMR)

Work Location: 11511 Shadow Creek Parkway
Schedule: Monday – Friday | 8:00 AM – 5:00 PM | 24–40 hours per week
Interview Process: Virtual interview via camera
Dress Code: Business Casual
Pay Rate: 13/hr (Paid Weekly)
Allmed Benefits: Vision, Health, Dental Insurance & 401(k)

Position Overview

The Utilization Management Representative (UMR) plays a critical role in supporting Utilization Management operations by ensuring the timely and accurate processing of authorization requests and communicating authorization determinations to providers and members. This role directly supports regulatory compliance, operational efficiency, and quality patient care by facilitating appropriate utilization of healthcare services.

The UMR serves as a key point of contact between providers, members, and the clinical review team while supporting overall care management strategies through efficient workflow management and effective communication.

Team Environment

The selected candidate will join a collaborative Utilization Management team consisting of approximately 20 Utilization Management Representatives (UMRs) working alongside clinical reviewers, including Registered Nurses (RNs), LVNs, and Medical Directors.

The team operates in a fast-paced, production-driven environment where accuracy, efficiency, and teamwork are critical to success. Team culture emphasizes:

  • Collaboration and strong communication
  • Accountability for productivity and quality metrics
  • Continuous learning and process improvement
  • Supportive teamwork across clinical and operational departments
  • Commitment to regulatory compliance and quality member care

Team members regularly collaborate with internal departments including clinical review teams, provider relations, claims, and appeals teams.

Key Responsibilities

  • Answer inbound calls from providers, members, and healthcare facilities regarding authorization requests, status updates, and coverage questions
  • Create authorization cases by reviewing and processing clinical requests received through fax, electronic submissions, or phone communication
  • Accurately document authorization requests within utilization management systems and/or electronic medical record systems
  • Coordinate with clinical review staff, including RNs, LVNs, and Medical Directors, to appropriately route cases requiring medical necessity review
  • Communicate authorization determinations verbally to providers and members in compliance with regulatory guidelines and organizational requirements
  • Maintain accurate records and ensure documentation standards are consistently met
  • Support workflow efficiency while managing multiple priorities in a high-volume environment
  • Provide exceptional customer service while maintaining confidentiality and professionalism

Required Qualifications

  • 1–3 years of healthcare experience, preferably within:
    • Utilization Management
    • Insurance operations
    • Medical office environments
    • Managed care settings
  • Experience handling high-volume calls in a professional and efficient manner
  • Strong data entry and documentation skills with high attention to detail
  • Ability to effectively manage multiple tasks simultaneously in a fast-paced environment
  • Strong verbal and written communication skills when interacting with providers, members, and internal teams
  • Basic understanding of healthcare authorization processes and insurance workflows
  • Experience using EMR/EHR platforms, case management systems, or related healthcare systems
  • Strong organizational and time-management skills

Preferred Qualifications

  • Experience supporting authorization processes within healthcare operations or managed care settings
  • Previous experience in health plans, hospitals, medical offices, or healthcare call center environments
  • Experience working with provider communication and care coordination activities
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