Houston Methodist · 1 week ago
Centralized Utilization Review Manager
Houston, TX
Full-time
Onsite
Senior Level
5+ years expHouston Methodist is a leading healthcare organization, and they are seeking a Centralized Utilization Review Manager to lead the daily operations of the Utilization Review department. This role is responsible for ensuring efficient, high-quality, and compliant utilization management practices across the organization, while also guiding staff and collaborating with various teams to support organizational goals.
Health CareMedical
Responsibilities
Managing the daily work activities of the work unit/department staff
Ensuring quality, productivity, functional excellence and efficiency while assisting management in accomplishing strategic and operational objectives
Providing guidance to staff and being responsible for staffing, budget compliance, contributing to staffing decisions such as hiring and terminating employment, coaching and counseling employees on work-related performance, and assisting in the development and implementation of policies and procedures to ensure a safe and effective work environment
Implementing training, monitoring and operations initiatives that secure compliance with ethical and legal business practices and accreditation/regulatory/government regulations
Facilitating and promoting effective team dynamics and teambuilding strategies within and between departments; participating and/or leading and facilitating department process improvements as needed
Ensuring a safe and effective working environment; monitoring and/or revising the department safety plan and/or any specific accreditation/regulatory required safety guidelines, including infection control principles
Using and optimizing information systems to enhance operations; supporting entity-specific performance improvement and data management/analysis functions
Qualification
Required
Bachelor's degree or higher from an accredited school of Nursing
Five years' experience in inpatient case management, social work or utilization management or in the managed care/payer environment, of which one year must have been in a people management role in healthcare; for HM candidates, four years' experience in case management or social work, which includes HM performance that demonstrates progressive leadership abilities
RN - Registered Nurse - Texas State Licensure - Texas Board of Nursing_PSV Compact Licensure – Must obtain permanent Texas license within 60 days (if establishing Texas residency)
Magnet ANCC-recognized Case Management Certification: ACHPN-HPCC or ACM-NBCM or CCM-CCMC or CDCES-CBDCE or CHPN-HPCC or CMC-NACCM or CMCN-ABMCN or CMGT-BC-ANCC or COHN-ABOHN or COHN/CM-ABOHN or CPHRM-AHA-CC or RN-BC-ANCC
Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through ongoing skills, competency assessments, and performance evaluations
Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security
Ability to effectively communicate through a variety of channels with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles; engages the recipient(s) and helps them understand and retain the message
Demonstrates the ability to interact with others in a way that gives them confidence in one's intentions and those of the organization
Ability to use appropriate interpersonal styles and techniques to gain acceptance of ideas or plans; modifying one's own behavior to accommodate tasks, situations and individuals involved
Demonstrates leadership qualities and critical thinking through self-direction initiative and effective interpersonal skills and oral/written communication skills
Ability to identify and understand issues, problems and opportunities, comparing data from different sources to draw conclusions; using effective approaches for choosing a course of action or developing appropriate solutions; taking action that is consistent with available facts, constraints and probable consequences
Ability to work effectively in a fast paced environment
Demonstrates flexibility and adaptability in the workplace
Excellent analytical skills
Advanced negotiation and mediation skills
Advanced time management and prioritization skills
Expert collaboration skills
Advanced electronic medical record skills and data reporting skills
MCG certification within one year of hire/transfer
Preferred
Master's degree in nursing
Company
Houston Methodist
Houston Methodist is one of the nation’s leading health systems and academic medical centers.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Brooke Graham
CEO Project Director
David P. Bernard
Chief Executive Officer & Senior Vice President
Recent News
2025-12-07
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