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Utilization Review Jobs in Spring, TX (NOW HIRING)

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 ...

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 ...

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 ...

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Utilization Review information

See Spring, TX salary details

$19

$37

$61

How much do utilization review jobs pay per hour?

As of Jul 13, 2026, the average hourly pay for utilization review in Spring, TX is $37.63, according to ZipRecruiter salary data. Most workers in this role earn between $29.71 and $43.22 per hour, depending on experience, location, and employer.

What jobs make $3,000 a day?

High-paying jobs that can reach $3,000 a day include specialized roles such as senior physicians, anesthesiologists, or surgeons, often requiring advanced certifications and extensive experience. Certain executive positions, like CEOs or investment bankers, may also earn this level of daily income, especially through bonuses or profit sharing. These roles typically involve high responsibility, expertise, and demanding schedules.

What jobs pay 4000 a week without a degree?

Utilization Review specialists typically do not earn $4,000 per week without a degree; most roles in this field require healthcare-related certifications or experience. High-paying jobs that can reach this level without a degree include certain sales positions, real estate brokers, or specialized trades like commercial pilots or skilled trades, which often rely on experience, licensing, or certifications rather than formal degrees. These roles may involve commission, bonuses, or overtime to achieve such weekly earnings.

What does a typical day look like for someone working in Utilization Review?

A typical day in Utilization Review involves reviewing patient medical records, evaluating the necessity and appropriateness of proposed treatments or services, and documenting recommendations based on clinical criteria and insurance policies. Utilization Review specialists often collaborate closely with physicians, nurses, and insurance representatives to gather additional information and clarify cases. While much of the role is desk-based and may include remote work options, it requires regular communication with both clinical and administrative teams. This position offers variety and challenge, as no two cases are exactly alike, and there are often opportunities to advance into supervisory or quality improvement roles within the department.

What skills do you need for utilization review?

Utilization review professionals need strong analytical skills to assess medical necessity and appropriateness of care, attention to detail, and knowledge of healthcare regulations and insurance policies. Good communication skills are essential for coordinating with healthcare providers and explaining decisions. Familiarity with electronic health records (EHR) systems and relevant certifications, such as Certified Professional in Healthcare Quality (CPHQ), can also be beneficial.

What is a Utilization Review job?

A Utilization Review (UR) job involves assessing the medical necessity, efficiency, and appropriateness of healthcare services. UR professionals, often nurses or healthcare specialists, review patient records, insurance claims, and treatment plans to ensure they meet industry standards and payer requirements. They work with healthcare providers, insurance companies, and regulatory agencies to optimize care while controlling costs. Their goal is to balance quality patient care with cost-effective resource utilization.

What are the key skills and qualifications needed to thrive in the Utilization Review position, and why are they important?

To thrive in Utilization Review, professionals typically need a background in nursing or healthcare, strong clinical assessment capabilities, and a thorough understanding of medical guidelines and insurance regulations. Familiarity with electronic medical records (EMR) systems and utilization management software, and often certification such as Certified Utilization Review Specialist (CURN), are important. Excellent critical thinking, attention to detail, and strong communication skills enable effective case evaluation and collaboration with healthcare teams. These skills and qualifications ensure objective, accurate decisions that support cost-effective, quality patient care within compliance standards.

How do I get into a utilization review?

To become a utilization review specialist, typically a healthcare professional such as a registered nurse, licensed social worker, or physician completes relevant education and gains experience in healthcare or insurance. Certification in utilization review or case management, such as the Certified Professional in Healthcare Quality (CPHQ), can improve job prospects. Strong analytical skills and knowledge of medical coding and insurance policies are also important.
What are the most commonly searched types of Utilization Review jobs in Spring, TX? The most popular types of Utilization Review jobs in Spring, TX are:
What are popular job titles related to Utilization Review jobs in Spring, TX? For Utilization Review jobs in Spring, TX, the most frequently searched job titles are:
What job categories do people searching Utilization Review jobs in Spring, TX look for? The top searched job categories for Utilization Review jobs in Spring, TX are:
What cities near Spring, TX are hiring for Utilization Review jobs? Cities near Spring, TX with the most Utilization Review job openings:
Infographic showing various Utilization Review job openings in Spring, TX as of July 2026, with employment types broken down into 1% As Needed, 79% Full Time, 17% Part Time, 1% Temporary, and 2% Contract. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $78,263 per year, or $37.6 per hour.
Corporate Director of Care Management

Corporate Director of Care Management

Nexus Health Systems Ltd

Houston, TX • On-site

Full-time

Re-posted 2 days ago


Nexus Health Systems rating

6.3

Company rating: 6.3 out of 10

Based on 5 frontline employees who took The Breakroom Quiz


Job description

Corporate Director of Care ManagementNexus Health Systems

Nexus Health Systems is seeking an experienced and strategic healthcare leader to serve as the Corporate Director of Care Management. This role provides operational and clinical oversight for all case management, utilization review, discharge planning, and care coordination functions across multiple Nexus facilities. The Corporate Director will partner closely with executive leadership, physicians, nursing teams, and interdisciplinary departments to drive exceptional patient outcomes, regulatory compliance, patient throughput, and financial performance.

This position plays a critical role in supporting patients with neurodevelopmental disorders and co-occurring complex behavioral and medical conditions across the continuum of care.

About Nexus Health Systems

Nexus Health Systems is a multi-facility healthcare organization specializing in complex medical, neurobehavioral, rehabilitation, and behavioral healthcare services for pediatric and adult populations. Our mission-driven team is committed to delivering compassionate, evidence-based care while improving quality of life for patients and families.

Position Summary

The Corporate Director of Care Management will lead system-wide care management operations including utilization review, discharge planning, transition of care initiatives, and interdisciplinary care coordination. This leader will standardize workflows, optimize length of stay, strengthen payer relationships, and ensure compliance with CMS Conditions of Participation, accreditation standards, and organizational policies.

Key ResponsibilitiesOperational & Clinical Leadership
  • Lead and standardize care management operations across assigned facilities
  • Oversee utilization review, discharge planning, care coordination, and transition of care processes
  • Ensure compliance with CMS Conditions of Participation, Joint Commission/DNV standards, and URAC principles
  • Establish and oversee Utilization Management Committee operations
  • Collaborate with physician advisors regarding medical necessity determinations and documentation quality
  • Implement InterQual® criteria for admission status, continued stay reviews, and discharge readiness
  • Promote Neurodevelopmental Disabilities (NDD)-informed care practices throughout care management workflows
  • Support interdisciplinary collaboration to improve patient throughput and continuity of care
Quality & Compliance
  • Monitor regulatory compliance related to utilization review and discharge planning
  • Lead performance improvement initiatives and accreditation readiness efforts
  • Conduct audits related to documentation, appeals, timeliness, and care coordination practices
  • Promote patient safety and continuous quality improvement across facilities
  • Ensure accurate documentation supporting medical necessity and fiscal reimbursement
Patient Advocacy & Experience
  • Champion person-centered discharge planning and patient advocacy initiatives
  • Support sensory-friendly environments and communication accommodations for neurodiverse patients
  • Assist patients and families with community resources, financial assistance, and care transitions
  • Collaborate with patients, caregivers, and healthcare teams to prevent fragmentation of services
Leadership & Staff Development
  • Provide mentorship, coaching, and operational guidance to care management teams
  • Oversee recruitment, onboarding, and professional development for department staff
  • Develop competency pathways and leadership development programs
  • Encourage professional certification attainment including CCM, ACM-RN, ACM-SW, and CPHQ
  • Facilitate annual education and training related to InterQual®, CMS regulations, and best practices
Financial & Strategic Oversight
  • Optimize length of stay and reduce avoidable days through proactive utilization management
  • Monitor throughput, payer denials, appeals, case mix, and departmental performance metrics
  • Develop and manage departmental budgets and resource allocation
  • Collaborate with payers and physician advisors to support efficient, cost-effective care delivery
  • Ensure equitable care management services regardless of payer source
QualificationsEducation
  • Bachelor of Science in Nursing (BSN) required
  • Master of Science in Nursing (MSN) required
Experience
  • Minimum 7 years of progressive leadership experience in hospital case management
  • Multi-site leadership experience required
  • Strong background in utilization review, discharge planning, and care coordination
  • Experience working with neurodevelopmental, behavioral health, and medically complex populations strongly preferred
  • Knowledge of CMS regulations, Joint Commission/DNV standards, and utilization management practices
Licensure & Certifications
  • Current and valid Texas Registered Nurse (RN) license required
  • Case Management Certification required (ACM, CCM, CMGT, FAACM, or equivalent)
  • Certification must be obtained within two years of hire if not currently held
Preferred Skills
  • Expert knowledge of CMS Conditions of Participation and utilization management principles
  • Proficiency with InterQual® criteria and medical necessity determinations
  • Strong leadership, communication, and interdisciplinary collaboration skills
  • Experience with EHR systems and healthcare analytics
  • Exceptional organizational, strategic planning, and operational management abilities
  • Compassionate, patient-centered leadership style with strong advocacy skills
Why Join Nexus Health Systems?
  • Mission-driven healthcare organization focused on improving lives
  • Collaborative executive leadership environment
  • Opportunity to shape and standardize care management across multiple facilities
  • Meaningful work supporting medically and behaviorally complex patient populations
  • Competitive compensation and comprehensive benefits package
  • Professional growth and leadership development opportunities

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