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Utilization Management Jobs in Spring, TX (NOW HIRING)

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Director, Case Management

Houston, TX

Care Facilitation, Utilization Management, Case Management and Discharge Planning. \n \n \n The Director is responsible for developing systems and processes for care\/utilization management and ...

Memorial Hermann Health System

Case Manager

Houston, TX · On-site

$19 - $24.50/hr

The role integrates and coordinates resource utilization management, care facilitation and discharge planning functions. In addition, the Case Manager helps drive change by identifying areas where ...

Memorial Hermann Health System

Case Manager

Houston, TX · On-site

$19 - $24.50/hr

The role integrates and coordinates resource utilization management, care facilitation and discharge planning functions. In addition, the Case Manager helps drive change by identifying areas where ...

Memorial Hermann Health System

Case Manager

The Woodlands, TX · On-site

$18.25 - $23.50/hr

The role integrates and coordinates resource utilization management, care facilitation and discharge planning functions. In addition, the Case Manager helps drive change by identifying areas where ...

Pharmacy Careers

Appeals Pharmacist (Remote)

Katy, TX · On-site +1

$49.50 - $60.25/hr

Experience: Prior managed care or utilization management experience preferred - retail and hospital pharmacists with strong clinical and documentation skills are encouraged to apply. * Skills:

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$34.7K

$79.6K

$145.1K

How much do utilization management jobs pay per year?

As of May 30, 2026, the average yearly pay for utilization management in Spring, TX is $79,630.00, according to ZipRecruiter salary data. Most workers in this role earn between $57,400.00 and $93,000.00 per year, depending on experience, location, and employer.

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 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 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.
More about Utilization Management jobs
What are the most commonly searched types of Utilization Management jobs in Spring, TX? The most popular types of Utilization Management jobs in Spring, TX are:
What are popular job titles related to Utilization Management jobs in Spring, TX? For Utilization Management jobs in Spring, TX, the most frequently searched job titles are:
What job categories do people searching Utilization Management jobs in Spring, TX look for? The top searched job categories for Utilization Management jobs in Spring, TX are:
What cities near Spring, TX are hiring for Utilization Management jobs? Cities near Spring, TX with the most Utilization Management job openings:
Utilization Management jobs near you
Manager, Case Management

Manager, Case Management

Memorial Hermann Health System

Houston, TX • On-site

$19 - $24.50/hr

Full-time

Posted 8 days ago

Memorial Hermann Health System rating

7.7

Company rating: 7.7 out of 10

Based on 278 frontline employees who took The Breakroom Quiz

158th of 864 rated healthcare providers

Job description

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.
Job Summary
The Manager of Case Management is responsible and accountable to assist the Director of Case Management in the implementation of the case management program at the local level. The components/roles of the inpatient case management program consist of the following: Care Facilitation, Utilization Management, Case Management and Discharge Planning.
The Manager is responsible for coordinating the use systems and processes for care/utilization management at the hospital level. In addition, the Manager is responsible for to assist the Director in managing the department's activities related to discharge planning and clinical quality improvement. The Manager coordinates day to day departmental operations and the use of hospital resources appropriately and effectively. The Manager participates in the collection, analysis and reporting of financial and quality data related to utilization management, quality improvement and performance improvement.Job Description
Minimum Qualifications
Education: Bachelors of Science in Nursing OR Social Work (BSW). Master's degree preferred*
*Note: effective March 1, 2019 and going forward, these are the minimum qualifications for this role; incumbents hired before March 1, 2019 may have commensurate experience in lieu of BSN.
Licenses/Certifications:
  • Current and valid license to practice as a Registered Nurse in the state of Texas or
  • Licensed Master Social Worker (LMSW) required, LCSW preferred
  • Case Manager Certification required

Experience/ Knowledge/ Skills:
  • Minimum five (5) years experience in utilization management, case management, discharge planning or other cost/quality management program
  • Three (3) years of experience in hospital-based nursing or social work
  • Three (3) years of demonstrated leadership experience
  • Knowledge of leading practice in clinical care and payor requirements
  • Self-motivated, proven communication skills, assertive
  • Background in business planning, and targeted outcomes
  • Working knowledge of managed care, inpatient, outpatient, and the home health continuum, as well as utilization management and case management
  • Working knowledge of the concepts associated with Performance Improvement
  • Demonstrated effective working relationship with physicians
  • Ability to work collaboratively with health care professionals at all levels to achieve established goals and improve quality outcomes
  • Effective oral and written communication skills

Principal Accountabilities
  • Assists in supervising and managing all aspects of the local level program.
  • Supports growth and development of the case management program consistent with enterprise wide philosophy and in response to the dynamic nature of the health care environment through benchmarking for best practices, networking, quality management, and other activities as needed.
  • Responsible for coordinating day to day operations of the program at the unit level.
  • Assists in identifying and achieving optimal targeted financial outcomes via the inpatient case management process.
  • Participates in departmental personnel functions (hiring, firing, etc.) in conjunction with the Director of Case Management.
  • Provides input to annual and interim performance appraisal reviews for the professional and non-professional staff in department.
  • Acts as liaison to facilitate communication and collaboration between all care partners (physicians, hospitalists, community care managers, nurses, community resources, etc.)
  • Responsible for leading a high performance team of "system thinkers" who incorporate leadership principles and vision in performing the functions of case management.
  • Uses data to drive decisions, plan, and implement performance improvement strategies for case management.
  • Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
  • Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.
  • Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann's service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.
  • Other duties as assigned.

What Memorial Hermann Health System employees say

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About Memorial Hermann

Sourced by ZipRecruiter

The Memorial Hermann Southwest Hospital Women's Services is a magnet hospital as well as a level 3 designated facility with a blend of high-risk and community patients. This creates a fast-paced environment and a chance to work with a diverse population. Our Labor & Delivery unit has a low c-section rate and is extremely collaborative and close-knit. We have the ability to cross-train through all areas of Women's Services. We have a family-like atmosphere with an amazing amount of comradery, and our low turnover rates attest to this. Nurses here feel like they not only have autonomy but can also be advocates for their patients. MHSW not only prides ourselves on evidenced based practice, but nurses have a strong voice.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Houston, TX, US

Year founded

1907

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