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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 ...

Nexus Children's Hospital

RN Case Manager

Conroe, TX · On-site

Practices "minimum information necessary" when performing utilization review, case management, and discharge functions. * Acts as a patient advocate for all patients within the facility. * Adheres to ...

Nexus Health Systems

RN Case Manager

Conroe, TX · On-site

Practices "minimum information necessary" when performing utilization review, case management, and discharge functions. * Acts as a patient advocate for all patients within the facility. * Adheres to ...

Nexus Health Systems

RN Case Manager

Shenandoah, TX · On-site

Practices "minimum information necessary" when performing utilization review, case management, and discharge functions. * Acts as a patient advocate for all patients within the facility. * Adheres to ...

CommonSpirit Health

Utilization Review RN

Houston, TX · On-site

$41.14 - $61.20/hr

Utilization Review RN Inspired by faith. Driven by innovation. Powered by humankindness ... Certified Case Manager, upon hire or * Accredited Case Manager, upon hire or Baylor St. Luke ...

Oscar Health

Utilization Review Nurse

Dallas, TX · Remote

$35 - $45.94/hr

You will perform frequent case reviews, check medical records and speak with care providers ... Previous experience conducting concurrent or inpatient reviews for a managed care plan This is an ...

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

Utilization Review Case Manager information

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$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.

Utilization Review RN

St. Luke's Health

Houston, TX • On-site

$41.14 - $61.20/hr

Other

Posted 13 days ago

St. Luke's Health (Texas) rating

7.2

Company rating: 7.2 out of 10

Based on 41 frontline employees who took The Breakroom Quiz

347th of 887 rated healthcare providers

Job description

Where You'll Work
Baylor St. Luke's Medical Center is an 881-bed quaternary care academic medical center that is a joint venture between Baylor College of Medicine and CHI St. Luke's Health. Located in the Texas Medical Center, the hospital is the home of the Texas Heart® Institute, a cardiovascular research and education institution founded in 1962 by Denton A. Cooley, MD. The hospital was the first facility in Texas and the Southwest designated a Magnet® hospital for Nursing Excellence by the American Nurses Credentialing Center, receiving the award five consecutive times. Baylor St. Luke's also has three community emergency centers offering adult and pediatric care for the Greater Houston area.
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, regulatory compliance, and responsible resource utilization.
Every day, you will meticulously review medical records, authorize services, and prepare cases for physician review in partnership with UM teams. You'll monitor patient care for appropriateness, quality, and cost-effectiveness, aligning decisions with established criteria.
To be successful in this role, you will possess a strong clinical background, deep UM/regulatory knowledge, and exceptional analytical/organizational skills. Your ability to manage charts, apply criteria precisely, and communicate effectively with enthusiasm, efficiency, and empathy is paramount for optimal patient care and operational flow.
  • Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted based on established criteria and critical thinking.
  • Reviews include admission, concurrent and post discharge for appropriate status determination.
  • Ensures compliance with principles of utilization review, hospital policies and external regulatory agencies, Peer Review Organization (PRO), Joint Commission, and payer defined criteria for eligibility.
  • Reviews the records for the presence of accurate patient status orders and addresses deficiencies with providers.
  • Ensures timely communication and follow up with physicians, payers, Care Coordinators and other stakeholders regarding review outcomes.
  • Collaborates with facility RN Care Coordinators to ensure progression of care.

Job Requirements
Required
  • Diploma Of Nursing Graduate of an accredited school of nursing, upon hire and
  • Minimum two (2) years of acute hospital clinical experience , upon hire or
  • Registered Nurse: TX, upon hire and

Preferred
  • Bachelors Of Nursing Bachelor's Degree in Nursing (BSN) or related healthcare field. , upon hire
  • At least five (5) years of nursing experience., upon hire
  • Certified Case Manager, upon hire or
  • Accredited Case Manager, upon hire or

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