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Utilization Review Case Manager Jobs in Texas (NOW HIRING)

St Luke's Health

Utilization Review RN

Houston, TX

$41.14 - $61.20/hr

Conducts admission and continued stay reviews per the Care Coordination Utilization Review ... Certified Case Manager, upon hire or * Accredited Case Manager, upon hire or Where You'll Work ...

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All JobsUtilization Review Case JobsUtilization Review Case Manager JobsUtilization Review Case Manager Jobs in Texas

Utilization Review Case Manager information

See Texas salary details

$15

$33

$55

How much do utilization review case manager jobs pay per hour?

As of Aug 9, 2026, the average hourly pay for utilization review case manager in Texas is $33.99, according to ZipRecruiter salary data. Most workers in this role earn between $27.55 and $35.82 per hour, depending on experience, location, and employer.

What are some common challenges utilization review case managers face when coordinating care across multiple departments?

Utilization Review Case Managers often navigate complex communication between physicians, nursing staff, insurance providers, and patients to ensure appropriate care and resource use. Balancing timely authorizations with evolving patient needs and varying documentation standards can be challenging. Additionally, staying current with changing regulations and payer requirements requires ongoing learning and adaptability. Building strong collaborative relationships and maintaining clear, concise documentation are key strategies for overcoming these hurdles.

What is a utilization review case manager?

A Utilization Review Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical treatments and services provided to patients. They review clinical information, coordinate with providers and insurance companies, and ensure that patient care aligns with established guidelines and policies. Their goal is to optimize patient outcomes while managing healthcare costs and ensuring compliance with regulations.

What is the difference between Utilization Review Case Manager vs Utilization Review Nurse?

AspectUtilization Review Case ManagerUtilization Review Nurse
CredentialsTypically requires a nursing license or relevant healthcare certificationRegistered Nurse (RN) license is required
Work EnvironmentOffice-based, insurance companies, healthcare organizationsHospital, clinic, insurance review departments
Primary FocusReviewing medical necessity, coordinating care, managing casesAssessing medical records, clinical review, patient care evaluation

Both roles involve healthcare review and require nursing credentials, but the Utilization Review Case Manager often focuses on coordinating care and managing cases, while the Utilization Review Nurse emphasizes clinical assessment and review of medical records. Understanding these differences helps in choosing the right career path or job search focus.

What are the key skills and qualifications needed to thrive as a utilization review case manager, and why are they important?

To thrive as a Utilization Review Case Manager, you need a clinical background such as an RN or LCSW license, strong knowledge of medical necessity criteria, and experience with case management. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of regulatory guidelines like Medicare and Medicaid are essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration between patients, providers, and payers. These skills ensure appropriate resource use, compliance with regulations, and high-quality patient care.
What are popular job titles related to Utilization Review Case Manager jobs in Texas? For Utilization Review Case Manager jobs in Texas, the most frequently searched job titles are:
What job categories do people searching Utilization Review Case Manager jobs in Texas look for? The top searched job categories for Utilization Review Case Manager jobs in Texas are:
What cities in Texas are hiring for Utilization Review Case Manager jobs? Cities in Texas with the most Utilization Review Case Manager job openings:
Utilization Review Case Manager jobs near you
Infographic showing various Utilization Review Case Manager job openings in Texas as of August 2026, with employment types broken down into 88% Full Time, 11% Part Time, and 1% Contract. Highlights an 84% Physical, 3% Hybrid, and 13% Remote job distribution, with an average salary of $70,704 per year, or $34 per hour.

AUSTIN TX Utilization Review RN

Bracane Company

Austin, TX • On-site

$35 - $40/hr

Full-time

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

Job description

About the Role:
Bracane Company is seeking a dedicated and detail-oriented Utilization Review RN to join our team in Austin, TX. This is an exciting opportunity for a clinical professional to make a meaningful impact by ensuring patients receive the right care at the right time. If you're passionate about healthcare quality and patient advocacy, we want to hear from you!
Responsibilities:
  • Conduct utilization review assessments to evaluate medical necessity and appropriateness of care
  • Perform concurrent, prospective, and retrospective reviews of patient cases
  • Collaborate with physicians, case managers, and healthcare teams to coordinate patient care plans
  • Apply evidence-based clinical criteria (e.g., InterQual, Milliman) to support review decisions
  • Document and communicate review findings accurately and in a timely manner
  • Identify opportunities for care improvement and ensure compliance with payer guidelines
  • Support denial management and appeals processes as needed
Requirements:
  • Active and unrestricted RN license in the state of Texas
  • Minimum 2-3 years of clinical nursing experience required
  • Prior utilization review, case management, or managed care experience strongly preferred
  • Familiarity with InterQual or Milliman clinical criteria
  • Strong knowledge of medical terminology, coding, and payer guidelines
  • Excellent analytical, communication, and critical thinking skills
  • Ability to work independently and manage a high-volume caseload efficiently
About Us:
Bracane Company is a trusted name in healthcare staffing and management solutions, committed to connecting top clinical talent with organizations that need them most. Our clients rely on us for our expertise, integrity, and dedication to quality care outcomes. At Bracane Company, employees thrive in a supportive environment that values their skills and invests in their professional growth.