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Case Manager Utilization Review Nurse Jobs in Puerto Rico

Boston Scientific

$41K - $78K/yr

Provide in-person clinical case support in cath labs and hospitals, ensuring proper use of Boston ... utilization, and clinical excellence. Educate physicians, fellows, nurses, and staff through ...

BDO

Manager, Program Management

San Juan, PR

This position supports clients with procurement documentation, environmental review coordination ... May oversee case management and other production staff Qualifications, Knowledge, Skills, and ...

BDO USA

Manager, Program Management

San Juan, PR · On-site

This position supports clients with procurement documentation, environmental review coordination ... May oversee case management and other production staff Qualifications, Knowledge, Skills, and ...

BDO

Manager, Program Management

San Juan, PR · On-site

$75 - $130/hr

This position supports clients with procurement documentation, environmental review coordination ... May oversee case management and other production staff Qualifications, Knowledge, Skills, and ...

DJC Law

Attorney

San Juan, PR · On-site

$60K - $80K/yr

Collaborate closely with case managers, investigators, and medical professionals to strengthen claims. * Draft demand letters, review medical records, and prepare case files for potential litigation.

US Department of the Treasury

Program Manager

Ponce, PR · On-site

$125K/yr

LBI - Strategic Programs REVIEW THE ADDITIONAL INFORMATION BELOW FOR FURTHER DETAILS Qualifications ... utilization, operational risks, and program outcomes; identifying issues and developing ...

Jobtailor

V2500 PSA Program Lead

Aguadilla, PR · On-site

$120 - $180/hr

... review, and validate PSA analyses and models, leveraging Subject Matter Experts (SMEs) when appropriate. Coordinate test cell performance trend monitoring, correlation, EagleNet case management, and ...

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All JobsCase Utilization Review Nurse JobsCase Manager Utilization Review Nurse JobsCase Manager Utilization Review Nurse Jobs in Puerto Rico

Case Manager Utilization Review Nurse information

What is a case manager utilization review nurse?

A Case Manager Utilization Review Nurse is a registered nurse who evaluates the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, coordinate with healthcare providers, and ensure that treatments meet established guidelines and insurance requirements. Their goal is to optimize patient outcomes while controlling healthcare costs and ensuring compliance with regulations. These nurses also help facilitate communication between patients, providers, and payers to support effective care management.

How does a case manager utilization review nurse typically collaborate with physicians and other healthcare providers?

Case Manager Utilization Review Nurses regularly work with physicians, social workers, and other healthcare professionals to ensure patients receive appropriate care while managing resource utilization. They often participate in interdisciplinary team meetings to discuss care plans, review patient progress, and address any barriers to discharge. Building strong communication channels and maintaining up-to-date clinical knowledge are essential, as nurses must advocate for patients while also supporting evidence-based practices and regulatory compliance. This collaborative environment helps streamline patient care and optimize outcomes.

What are the key skills and qualifications needed to thrive as a case manager utilization review nurse, and why are they important?

To excel as a Case Manager Utilization Review Nurse, you need a solid background in nursing, strong clinical assessment skills, and a valid RN license, often with case management certification. Familiarity with utilization review software, electronic health record (EHR) systems, and knowledge of insurance and regulatory guidelines is essential. Exceptional communication, critical thinking, and negotiation abilities set top performers apart in this role. These qualifications ensure effective patient advocacy, cost-effective care, and compliance with healthcare standards.

What is the difference between Case Manager Utilization Review Nurse vs Case Manager?

AspectCase Manager Utilization Review NurseCase Manager
CredentialsRN license, certification in utilization review (e.g., URAC)RN license, case management certification (e.g., CCM)
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community health, insurance providers
Primary FocusReviewing medical necessity and appropriateness of careCoordinating patient care and discharge planning

While both roles involve patient care coordination, the Case Manager Utilization Review Nurse primarily focuses on reviewing medical necessity and insurance approvals, whereas the Case Manager handles broader patient care coordination and discharge planning. Both roles require nursing credentials and are vital in healthcare settings, but their specific responsibilities differ.

What are popular job titles related to Case Manager Utilization Review Nurse jobs in Puerto Rico?

For Case Manager Utilization Review Nurse jobs in Puerto Rico, the most frequently searched job titles are:

What job categories do people searching Case Manager Utilization Review Nurse jobs in Puerto Rico look for?

The top searched job categories for Case Manager Utilization Review Nurse jobs in Puerto Rico are:

What cities in Puerto Rico are hiring for Case Manager Utilization Review Nurse jobs?

Cities in Puerto Rico with the most Case Manager Utilization Review Nurse job openings:

Case Manager Utilization Review Nurse jobs near you
Infographic showing various Case Manager Utilization Review Nurse job openings in Puerto Rico as of August 2026, with employment types broken down into 76% Full Time, 13% Part Time, and 11% Contract. Highlights an 86% In-person, and 14% Remote job distribution.

Medical Administrative Provider (NP/PA/MD/DO)

Anonymous

Salinas, PR • On-site

Part-time

Re-posted 28 days ago

Job description

Job Title: Medical Administrative Provider (NP/PA/MD/DO) - PART TIME 850 Hours annually on site
Location: Salinas, Puerto Rico
We are seeking a qualified Medical Administrative Provider (NP/PA/MD/DO) to deliver non-clinical, administrative medical support services to the Puerto Rico Army National Guard (PRARNG)
Key Responsibilities:
• Conduct comprehensive reviews of Service Member health and dental records, interpret clinical findings (e.g., labs, imaging), and issue formal deployability/readiness determinations in accordance with Army Regulations (AR 40-501 and AR 40-502).
• Manage medical case files for Service Members who are not Fully Medically Ready (FMR), including updating e-Profiles and documenting all clinical considerations in military medical data systems (MODS, MHS Genesis, and MEDCHART).
• Deliver comprehensive, accurate monthly Medical Non-Deployable (MND)/e-Profile Case Reports to the State Surgeon, detailing the status of all medical actions, return-to-duty timelines, and required waivers.
• Coordinate and verify Service Member treatment plans, referrals, and pre-authorizations with Military Treatment Facilities (MTF), VA, and TRICARE networks to facilitate timely return to duty.
• Serve as the medical records custodian, ensuring the preparation, safeguarding, and maintenance of all hard-copy and electronic medical and dental records in strict compliance with HIPAA, the Privacy Act, and AR 40-66.
• Ensure all administrative and clinical data is entered into required military medical data systems within 72 hours of service or encounter.
• Maintain strict compliance with all applicable Army regulations and privacy requirements.
Minimum Qualifications:
• Must possess one of the following (as required by the contract):
- Current, active, valid, and unrestricted license to practice as a Nurse Practitioner (NP), Physician Assistant (PA), Medical Doctor (MD), or Doctor of Osteopathic Medicine (DO) in Puerto Rico.
• Minimum two (2) years of post-licensure clinical or medical administrative experience.
• Demonstrated knowledge of military medical regulations, including AR 40-501 and AR 40-502.
• Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook) and ability to rapidly learn and utilize military medical data systems (MODS, MHS Genesis, MEDCHART).
• Ability to work on-site at Camp Santiago, Salinas, PR, during standard business hours, with occasional weekend work to support readiness events.
• U.S. citizenship and ability to pass background checks for access to military installations and systems.
Additional Requirements:
• Must complete required DoD training (Information Assurance, OPSEC, etc.) as specified by the contract.
• Must maintain all required licenses and credentials throughout employment.
• Strong organizational, communication, and documentation skills.
ADB Pros, Inc. (ADB) Overview:
ABD affords equal employment opportunity to all individuals, regardless of race, creed, color, religion, gender, national origin, ancestry, age, marital status, veteran status, disability, medical condition, gender identity, or sexual orientation. Our employees, as well as applicants and others with whom we do business, will not be subjected to sexual, racial, religious, ethnic, or any other form of unlawful harassment and/or discrimination. In addition, ADB adheres to the equal employment opportunity requirements of all states and localities in which it does business.
ADB's commitment to equal opportunity is applied through every aspect of the employment relationship, including, but not limited to, recruitment, selection, placement, training, compensation, promotion, transfer, termination, and all other matters of employment.
Applicants may be required to complete online test(s) to determine qualification for positions requiring specific skills.

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