Top 76 Pediatric utilization review Jobs in Houston, Tx

Manager, Case Management
United Pro Search Inc —Houston, TX
- $110,000 - $135,000 a year
- Full-time
- Nursing
- Anatomy knowledge
- Addiction Medicine
- Relocation assistance
- Health insurance
Quick Apply
7d
Nurse Practitioner
Houston HouseCalls —Houston, TX
- $114,378.00 - $137,745.55 a year
- Full-time
- Background check
- Skilled nursing facility
- Vital signs
- Flexible schedule
Quick Apply
6d
Corporate Director of Care Management
Stark Lane, Inc. —Houston, TX
- Nursing
- 7 years
- RN License
- Health insurance
- Dental insurance
Quick Apply
14d
Supplemental Case Manager (on the adult side)
Memorial Hermann Health System —Houston, TX
- Full-time
- Master of Social Work
- Nursing
- RN License
7d
Clinical Nurse, Outpatient - Head & Neck
MD Anderson —Houston, TX
- $32.69 - $68.26 an hour
- Overtime
- CPR Certification
- Nursing
- RN License
- Health savings account
- AD&D insurance
4d
Care Coordinator- Acute Care
Texas Children's Hospital —Houston, TX
- Full-time
- Acute care
- Nursing
- RN License
Nurse Manager of NICU RN - Sign On Bonus: $20k
All Med Search —Houston, TX
- $45.79 - $60.09 an hour
- Full-time
- Background check
- Working with individuals with developmental disabilities
- Nursing
Quick Apply
Labor and Delivery Nurse Manager
The Woman's Hospital of Texas —Houston, TX
- Full-time
- Mid-level
- 3 years
- Leadership
- Employee stock purchase plan
- Disability insurance
Quick Apply
Physical Therapist
St Luke's Health - The Woodlands Campus —Spring, TX
- $40.16 - $59.74 an hour
- Full-time
- Physical & Rehabilitation Medicine
- Mid-level
- Outpatient experience
Charge RN II Emergency Department
Houston Methodist Clear Lake Hospital —Houston, TX
- Full-time
- Nursing
- RN License
- PALS Certification
6d
Lead Respiratory Care Practitioner
Houston Methodist Continuing Care Hospital —Houston, TX
- Full-time
- PALS Certification
- Writing skills
- BLS Certification
Charge Nurse (RN) II - Emergency Dept
Houston Methodist Sugar Land Hospital —Sugar Land, TX
- Full-time
- Nursing
- RN License
- PALS Certification
1d
Charge Nurse (RN) II - Emergency Dept
Houston Methodist Sugar Land Hospital —Sugar Land, TX
- Full-time
- Nursing
- RN License
- PALS Certification
1d
Charge Nurse (RN) II - Emergency Dept
Houston Methodist Sugar Land Hospital —Sugar Land, TX
- Full-time
- Nursing
- RN License
- PALS Certification
1d
Pharmacy Clinical Specialist PRN
Houston Methodist Willowbrook Hospital —Houston, TX
- Weekends as needed
- PALS Certification
- BLS Certification
- English
Charge Registered Nurse II Emergency Department
Houston Methodist Willowbrook Hospital —Houston, TX
- Full-time
- Nursing
- RN License
- PALS Certification
1d
Charge Registered Nurse (RN) II Perioperative Services - AOD
Houston Methodist Willowbrook Hospital —Houston, TX
- Full-time
- Nursing
- RN License
- PALS Certification
Oncology Clinical Specialist-Pharmacist
Houston Methodist Baytown Hospital —Baytown, TX
- Full-time
- PALS Certification
- Hospital
- BLS Certification
1d
Staff Pharmacist PRN
Houston Methodist Clear Lake Hospital —Houston, TX
- PRN
- Hospital
- Writing skills
- BLS Certification
6d
Corporate Director of Care Management
Nexus Health Systems Ltd —Houston, TX
- Full-time
- Nursing
- 7 years
- RN License
Quick Apply

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pediatric utilization review jobs near houston, tx

Manager, Case Management

United Pro Search Inc
Houston, TX

Quick Apply

Job Details

Full-time
$110,000 - $135,000 a year
7 days ago

Benefits

Relocation assistance
Health insurance
Dental insurance
401(k)
Tuition reimbursement
Parental leave
Employee assistance program
Vision insurance
401(k) matching
Flexible schedule
Life insurance
Retirement plan

Qualifications

Supervisory support in social service case management
Utilization review
Electronic health records (EHR) management
RN License
Team leadership
Clinical case management
Acute care facility experience
Supervising experience
Utilization management
Resource utilization in healthcare
Leading team collaboration initiatives
Clinical team leadership
Managing patient records

Full Job Description

We are in search of a Manager, Case Management for Trauma, ED and OBS floors in a leading hospital located in Houston TX.

Bonus Description: Management Incentive Plan (MIP) payout at a target of 10% of your base salary with a maximum payout of 15%.

Full Relocation

Qualifications must-Haves

Case Manager Certification required

Current and valid license to practice as a Registered Nurse in the state of Texas or Licensed Master Social Worker (LMSW) required, LCSW preferred

Minimum five (5) years' experience in utilization management, case management, discharge planning, or other cost/quality management program

Three (3) years of experience in hospital-based nursing or social work

Three (3) years of demonstrated leadership experience

Minimum five (5) years’ experience in utilization management, case management, discharge planning

Three (3) years of demonstrated leadership experience; Three (3) years of experience in hospital-based nursing or social work

Overview

We are seeking a highly skilled and motivated Manager of Case Management to lead our clinical and operational case management team. This pivotal role involves overseeing the coordination and delivery of comprehensive patient care across diverse healthcare settings, including hospitals, emergency departments, and outpatient services. The ideal candidate will possess extensive experience in hospital environments, nursing, and case management, with a strong understanding of healthcare policies, medical terminology, and patient advocacy. As a leader in our organization, you will drive quality improvement initiatives, ensure compliance with regulatory standards such as NCQA and HIPAA, and foster a collaborative environment focused on delivering exceptional patient care. This position offers an excellent opportunity to influence patient outcomes positively while advancing your leadership career in healthcare.

Duties

Lead and supervise the case management team to ensure effective coordination of patient care plans across hospital units, including ICU, pediatrics, behavioral health, and trauma centers.
Oversee discharge planning processes to facilitate timely and appropriate patient transitions to home health, hospice care, or other community resources.
Manage utilization review activities to ensure appropriate hospital admissions and length of stay in accordance with Medicare and managed care policies.
Conduct comprehensive patient assessments utilizing medical terminology knowledge, physiology, and anatomy expertise to develop individualized care plans.
Ensure compliance with healthcare regulations such as HIPAA, NCQA standards, and state-specific health policies through regular documentation review and data collection.
Collaborate with multidisciplinary teams—including nursing staff, social workers, addiction counselors, behavioral health specialists, and physicians—to optimize patient outcomes.
Monitor case management performance metrics; analyze data related to patient care quality, documentation accuracy, and regulatory adherence.
Provide leadership in managing complex cases involving Level I Trauma Center experience or Level II trauma center scenarios; oversee behavioral health interventions as needed.
Facilitate staff training on topics such as medical records management, discharge procedures, behavioral therapy techniques, and managed care protocols.
Promote continuous improvement initiatives aimed at enhancing patient care quality while maintaining compliance with NCQA standards.

Qualifications

Bachelor's degree in Nursing (BSN), Social Work, or related healthcare field; advanced certifications in case management preferred.
Minimum of five years’ hospital experience with exposure to ICU, emergency medicine, pediatrics (including PICU), or trauma centers.
Proven supervisory or managerial experience within a healthcare setting managing multidisciplinary teams.
Extensive knowledge of healthcare regulations including HIPAA privacy rules and Medicare policies.
Strong understanding of medical terminology, anatomy, physiology, and behavioral health concepts.
Experience with discharge planning processes and utilization review procedures.
Familiarity with managed care operations and NCQA accreditation standards.
Excellent leadership skills combined with effective communication abilities across diverse professional groups.
Demonstrated ability to manage complex cases involving behavioral health or addiction counseling components.
Proficiency in data collection tools and electronic medical records systems; attention to detail in documentation review.
Ability to adapt to fast-paced environments while maintaining high standards for patient safety and compliance.

If you are committed to advancing patient-centered care through effective leadership and possess the qualifications outlined above, we welcome your application. Join our team dedicated to excellence in healthcare delivery.

"CCM, Case Manager, Case Management, Care Management, Care Manager, Utilization Management,Patient Safety,

Pay: $110,000.00 - $135,000.00 per year

Benefits:

401(k)
401(k) matching
Dental insurance
Employee assistance program
Flexible schedule
Health insurance
Life insurance
Parental leave
Relocation assistance
Retirement plan
Tuition reimbursement
Vision insurance

Experience:

Acute Care Hospital Case Management: 1 year (Required)
Licensed Master Social Worker (LMSW) , LCSW : 1 year (Required)

License/Certification:

Certification in Case Management (Required)
TX RN License (Preferred)

Work Location: In person

Quick Apply

Refine Your Search

pediatric utilization review jobs in houston, tx

Manager, Case Management

Nurse Practitioner

Corporate Director of Care Management

Supplemental Case Manager (on the adult side)

Clinical Nurse, Outpatient - Head & Neck

Care Coordinator- Acute Care

Nurse Manager of NICU RN - Sign On Bonus: $20k

Labor and Delivery Nurse Manager

Physical Therapist

Charge RN II Emergency Department

Lead Respiratory Care Practitioner

Charge Nurse (RN) II - Emergency Dept

Charge Nurse (RN) II - Emergency Dept

Charge Nurse (RN) II - Emergency Dept

Pharmacy Clinical Specialist PRN

Charge Registered Nurse II Emergency Department

Charge Registered Nurse (RN) II Perioperative Services - AOD

Oncology Clinical Specialist-Pharmacist

Staff Pharmacist PRN

Corporate Director of Care Management

I want to receive the latest job alert for pediatric utilization review in houston, tx

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