Quality Utilization & Case Review Specialist

Texas Family Care Network; Dallas (TX); On-site; USD 65,000 - 95,000; Full time

Job summary

Texas Family Care Network is seeking an Utilization Management & Case Review Specialist to conduct utilization reviews, case record reviews, and quality assessments supporting compliance and service quality. You will analyze utilization patterns, review documentation for accuracy, identify risks, and collaborate with providers to drive continuous improvement.

Responsibilities include monitoring service trends, ensuring alignment with contracts, applying review tools, and supporting audits.

Qualifications

• Bachelor’s degree required in health, human services, or related field.
• Three years of professional experience in quality assurance, utilization management, compliance, auditing, case review, or related field.
• Texas child welfare system experience preferred.

Responsibilities

• Conduct utilization reviews to assess appropriateness, necessity, frequency, and duration of services.
• Monitor utilization trends and identify over/underutilization or gaps.
• Evaluate cases for alignment with contracts, policies, and guidelines.
• Develop review summaries and corrective action recommendations.
• Collaborate with Data Outcome team to communicate findings and improvements.
• Prepare for external audits and accreditation reviews.

Skills

Collaboration

Communication

Computer Literacy

Complexity and Judgement

Creativity and Foresight

Serves All

Leadership

Planning, Organizing, and Time

Professionalism

Risk Management and Safety

Education

Bachelor’s Degree in Healthcare Administration

Bachelor’s Degree in Human Services

Bachelor’s Degree in Social Work

Job description

Texas Family Care Network is seeking an Utilization Management & Case Review Specialist to conduct utilization reviews, case record reviews, and quality assessments supporting compliance and service quality. You will analyze utilization patterns, review documentation for accuracy, identify risks, and collaborate with providers to drive continuous improvement.

Responsibilities include monitoring service trends, ensuring alignment with contracts, applying review tools, and supporting audits.