Texas Children's Hospital

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Manager-Utilization Management

at Texas Children's Hospital

Posted: 7/31/2019
Job Reference #: 17508

Job Description

  • Requisition ID
    Utilization Management
    Talent Area
    Registered Nurse
    Full/Part Time
    Shift Description
  • Job Summary

    We are searching for a Manager of Utilization Management — someone who works well in a fast-paced setting. In this position, you will supervise staff and develop all of the processes and procedures for intake, concurrent reviews, and the processing of denial and appeals. You will assess the quality of services of Utilization Management, as well as all programs and processes.

    Think you’ve got what it takes?


    • Oversee the development of processes and procedures for Utilization Management unit of the health plan and monitor and audit turnaround times, review weekly statistics, and ensure quarterly audit activity is complete
    • Support the Assistant Director and UM Medical Director in the planning and implementation process to support the adherence of regulatory guidelines, TDI regulations, federal and legislative obligations, as well as contractual agreements
    • Collaborate with the Chief Medical Officers and the Medical Directors in the appeals process, including investigating the initial review and documentation for decision making as indicated by policy and procedures
    • Evaluate trends for future opportunities for improvement in Utilization Management
    • Identify areas of inefficiency and facilitate/coordinate resolutions inter/intra departmentally by acting as a liaison between departments across the organizations


    • Bachelor’s degree in nursing
    • Licensed Registered Nurse from the Texas Board of Nursing
    • Minimum of 5 years’ clinical and/or managed care experience
    • Pediatrics experience preferred
    • Managed care experience preferred
    • StarKids experience preferred

    Company Profile

    Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.

    To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.

    Not ready to apply? Connect with us for general consideration.