Top 9 Utilization specialist hybrid Jobs in Tomball, Tx

Utilization Specialist - Hybrid
Eduvention Mentoring & Consulting —Houston, TX
- Monday to Friday
- HIPAA
- Mid-level
- Master's degree
- Paid time off
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PTSD Foundation of Americ —Houston, TX
- $52,000 - $68,000 a year
- Full-time
- Hybrid work
- HIPAA
- Mid-level
- Office
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2d
Care Manager - RN (Bilingual Spanish Preferred)
Astrana Health, Inc. —Houston, TX
- $80,000 - $94,000 a year
- Email
- Hybrid work
- Spanish
- Nursing
- RN License
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Nurse Care Manager (Contract)
Suvida Healthcare —Houston, TX
- Contract
- Hybrid work
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- RN License
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Bilingual Nurse Case Manager
Suvida Healthcare —Houston, TX
- Full-time
- Hybrid work
- Spanish
- Nursing
- RN License
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Marketing Cloud Specialist
Stallion Infrastructure Services —Houston, TX
- System design
- Mid-level
- Office
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Area Loss Prevention Manager (ALPM) - dd's
Ross Stores —Katy, TX
- Hybrid work
- Microsoft Excel
- Microsoft Outlook
- 5 years

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utilization specialist hybrid jobs near tomball, tx

Utilization Specialist - Hybrid

Eduvention Mentoring & Consulting
Houston, TX

Apply Now

Job Details

Temp-to-hire
11 days ago

Benefits

Paid time off

Qualifications

Collaborate with healthcare professionals
Client assessment in therapy
QMHP Certification
Medicaid health insurance
Clinical assessment documentation
Medicaid regulations
Medicaid
Clinical documentation standards
Managing patient records

Full Job Description

At EMC Behavioral Health, we believe mental health begins with passionate care, intentional connection and the power of evidence-based practice. Guided by our mission to deliver the highest quality, client-centered care and our vision to equip individuals with innovative tools for lasting mental wellness, we serve as a trusted partner to clients, families, and communities seeking meaningful change. If your driven by purpose, energized by advocacy, and committed to ensuring that care is both clinically sound and deeply human, you will find your calling here at EMC.

Position Summary:
The Utilization Specialist is a key driver of EMC's clinical excellence, ensuring each client receives timely, appropriate, and medically necessary care. This role seamlessly integrates care coordination, clinical assessment, and utilization management to support strong recovery outcomes, uphold regulatory and payer requirements, and strengthen overall operational efficiency. We're seeking a clinically grounded professional with sharp analytical insight, exceptional communication skills, and a genuine commitment to serving diverse populations within a dynamic behavioral health setting.

What You'll Do:
In this high-impact role, you will help ensure clients receive the right care at the right time while supporting EMC's commitment to clinical excellence. Your responsibilities will include:

Care Coordination & Client Support:

Coordinate appointments, therapy sessions, referrals, and supportive services
Monitor client progress, medication adherence, and engagement in programming
Partner with families, caregivers, and interdisciplinary teams to ensure continuity of care

Clinical Assessment & Treatment Planning:

Conduct comprehensive initial and ongoing assessments
Support clients with the individualized recovery plans and evidence-based coping strategies
Serve as an internal resource on medical necessity, utilization workflows, and clinical best practices

Utilization Review & Case Management:

Lead prior authorizations, concurrent reviews, and discharge planning
Ensure full compliance with payer guidelines, authorization limits, Medicaid/Medicare rules, and regulatory requirements
Coach and train team members on documentation, compliance standards, and evolving regulations
Review utilization trends and recommend process improvements or efficiencies

Documentation, Reporting & Compliance:

Maintain accurate, timely documentation in the EHR and complete required assessments (CANS/ANSA)
Prepare and submit monthly utilization and outcomes reports
Participate in monthly UM meetings, audits, and continuous quality improvement initiatives
Consistently uphold HIPAA and all state/federal behavioral health regulations

Additional Responsibilities:

Respond to call-outs, client emergencies and inquiries in alignment with protocols, including occasional after-hours support
Support clinic outreach through community engagement, referral coordination, and collaboration with external partners
Perform other duties as assigned

Minimum Qualifications:

Bachelor’s degree in psychology, sociology, criminal justice, education or other related field (Master’s degree preferred)
Active QMHP certification and HIPAA training
CANS/ANSA certification (or willing to obtain)
At least one year experience in behavioral health, case management or a clinical support role (2-3 years in a utilization management role preferred)
Strong understanding of managed care, medical necessity criteria, and Medicaid authorizations
Excellent documentation, assessment and critical-thinking skills
Ability to collaborate effectively across clinical and administrative teams

Who Thrives in This Role:
You'll be a strong fit for EMC if you are:

Mission-driven and committed to compassionate, high-quality care
A confident communicator who builds rapport easily
Detail-oriented, organized, and comfortable balancing multiple priorities
Skilled at blending clinical judgment and operational decision-making
Dedicated to ethical practice and ongoing professional development

Why Join EMC Behavioral Health:

Make a meaningful difference in clients' lives every day
Join a collaborative, supportive clinical team
Access opportunities for professional growth, mentorship, and certification
Be a part of a mission-driven organization that truly values quality, compassion, and innovation

Schedule & Work Environment:

Contract to Hire
This position begins as a full-time contract role through our company. Based on performance, business needs, and mutual fit, the role is intended to convert into a permanent, full-time position with comprehensive benefits.
Monday-Friday with limited on-call responsibilities
Hybrid clinical/administrative position in an outpatient behavioral health setting
2 days onsite in our Northwest Houston office, Tuesdays and Thursdays
Requires regular use of EHR systems, reporting tools, and standard office equipment

Employee Benefits:

Group Health insurance options for full time employees, both employee and employer paid
Paid Time Off
Retirement Savings

Equal Opportunity Employer:
EMC Behavioral Health is an Equal Opportunity Employer and is committed to fostering a diverse, inclusive, and equitable work environment. We welcome applicants of all backgrounds, identities, and experiences.

Apply Now

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utilization specialist hybrid jobs in tomball, tx

Utilization Specialist - Hybrid

FEMALE VETERAN SERVICES MANAGER

Care Manager - RN (Bilingual Spanish Preferred)

Nurse Care Manager (Contract)

Bilingual Nurse Case Manager

Marketing Cloud Specialist

Area Loss Prevention Manager (ALPM) - dd's

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