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Utilization Review Case Manager Jobs in Texas (NOW HIRING)

Houston Methodist

At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse ... This position collaborates with case management in the development and implementation of the plan ...

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

This position is responsible for performing initial, concurrent review activities; discharge care ... Provides information regarding utilization management requirements and operational procedures to ...

Corvel

Utilization Review Intake Specialist

Dallas, TX · Remote

$16.74 - $26.92/hr

... Review / Case Management department, and of CorVel. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Takes calls relating to precertification requests * Verifies that all patient, provider and facility ...

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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.

Utilization Review Nurse (55697)

EL PASO CHILDRENS HOSPITAL CORPORATION

El Paso, TX

Full-time

Re-posted 19 days ago

El Paso Children's Hospital rating

7.5

Company rating: 7.5 out of 10

Based on 12 frontline employees who took The Breakroom Quiz

299th of 1,055 rated hospitals

Job description

To monitor adherence to the hospital's utilization review plan to ensure the effective and efficient use of hospital services. Responsible for ensuring the appropriateness of hospital admissions and extended hospital stays. An understanding of the severity of an array of illnesses, intensity of service, and care coordination needs are the key, as the nurse must integrate clinical knowledge with billing knowledge to review, evaluate and arrange peer to peers when clinical denials related to medical necessity of the patient while hospitalized. UM nurse will work closely in collaboration with physician advisers to support policy development, and process improvement.

Work Experience:

  • Two (2) years prior experience with Utilization Management.
  • Previous training and demonstrated competence in negotiations, quality assurance, case management outcomes, and keyboarding/computer use.
  • Experience with InterQual and/or Milliman Care Guidelines. Strong organizational and time management skills.
  • Ability to work on extremely complex problems where analysis of situation or data requires an evaluation of intangible variance factors.

License/Registration/Certification:

  • Current RN License to practice in the State of Texas.

Education and Training:

  • Associate's Degree in Nursing, BSN preferred.

Skills:

  • Ability to utilize proficient verbal, written and interpersonal communication skills.
  • Ability to work on extremely complete problems where analysis of situations or data requires an evaluation of intangible variance factors.
  • Knowledge of managed care, reimbursement and utilization management.
  • Knowledge of current International Classification of Disease (ICD-10), Diagnostic Related Groups (DRGs), and medical necessity criteria.
  • Knowledge of claims denials and appeals processing
  • Ability to coordinate and manage multiple priorities, projects simultaneously, reprioritizing as necessary
  • Ability to self-motivate, multi-task and prioritize in a fast paced environment.
  • Ability to use analytical and problem solving skills.
  • Knowledge of HIPAA standards.
  • Knowledge of various insurance plan coverages for Home Health, DME, SNF, LTAC agencies.
  • Works well with people of all social, economic, and cultural backgrounds.
  • Strong customer service orientation.
  • Knowledgeable regarding community resources.
  • Knowledge of basic computer, word-processing, and spreadsheet skills, Microsoft.
  • Ability to operate standard office equipment.
  • Knowledge of English grammar, punctuation and spelling.

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