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Pediatric Utilization Management Jobs in Nebraska

CommonSpirit Health

Care Coordinator RN

Lincoln, NE · On-site

The role integrates and coordinates utilization management, care facilitation and discharge ... St. Elizabeth specializes in the treatment areas of newborn and pediatric care, women's health ...

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Pediatric Utilization Management information

What is pediatric utilization management?

Pediatric Utilization Management (UM) is a healthcare process that reviews and evaluates the medical necessity, efficiency, and appropriateness of healthcare services provided to children. Professionals in this field assess treatment plans, hospital stays, procedures, and medications to ensure they align with evidence-based guidelines and are truly needed for a pediatric patient's care. The goal is to optimize health outcomes for children while managing healthcare costs and resources efficiently. Pediatric UM often involves collaboration between healthcare providers, insurance companies, and families to make informed decisions about a child's medical care.

What are some common challenges faced by professionals in pediatric utilization management, and how can they be addressed?

Professionals in Pediatric Utilization Management often encounter challenges such as balancing cost-effective care with the unique needs of pediatric patients, staying updated with evolving clinical guidelines, and communicating effectively with both providers and families. Navigating insurance requirements while advocating for appropriate treatments requires strong clinical knowledge and negotiation skills. Building collaborative relationships with multidisciplinary teams and ongoing professional development can help address these challenges and ensure the best outcomes for young patients.

What are the key skills and qualifications needed to thrive as a pediatric utilization management nurse, and why are they important?

To thrive in Pediatric Utilization Management, you need a solid background in pediatric nursing, critical thinking, and knowledge of healthcare regulations, generally supported by an RN license and experience in pediatrics. Familiarity with utilization review software, electronic medical records (EMRs), and certification such as Certified Case Manager (CCM) or Utilization Review Accreditation Commission (URAC) is often required. Excellent communication, attention to detail, and strong organizational skills are crucial for collaborating with medical teams and advocating for appropriate patient care. These competencies ensure effective care coordination, regulatory compliance, and optimal outcomes for pediatric patients.

What is the difference between Pediatric Utilization Management vs Pediatric Case Management?

AspectPediatric Utilization ManagementPediatric Case Management
CredentialsRN, licensed healthcare professionals, certifications in utilization reviewRN, social worker, case management certification
Work EnvironmentInsurance companies, healthcare organizations, utilization review departmentsHospitals, clinics, community health settings
Employer & Industry UsageInsurance providers, managed care organizationsHospitals, outpatient clinics, social services
FocusReviewing medical necessity, approving services, optimizing resource useCoordinating care, supporting patient needs, discharge planning

While both roles involve working with pediatric patients, Pediatric Utilization Management primarily focuses on reviewing and approving healthcare services for medical necessity within insurance or managed care settings. Pediatric Case Management emphasizes coordinating ongoing patient care and support services across healthcare providers and community resources.

What are popular job titles related to Pediatric Utilization Management jobs in Nebraska?

For Pediatric Utilization Management jobs in Nebraska, the most frequently searched job titles are:

What job categories do people searching Pediatric Utilization Management jobs in Nebraska look for?

The top searched job categories for Pediatric Utilization Management jobs in Nebraska are:

What cities in Nebraska are hiring for Pediatric Utilization Management jobs?

Cities in Nebraska with the most Pediatric Utilization Management job openings:

Pediatric Utilization Management jobs near you
Infographic showing various Pediatric Utilization Management job openings in Nebraska as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution.

Care Coordinator RN / Social Worker

CommonSpirit Health

Lincoln, NE • On-site

Full-time

Posted 3 days ago

New

CommonSpirit Health rating

6.9

Company rating: 6.9 out of 10

Based on 537 frontline employees who took The Breakroom Quiz

456th of 891 rated healthcare providers

Job description

CHI Health St. Elizabeth founded by the Sisters of St. Francis of Perpetual Adoration in 1889 is a full-service 260-bed nonprofit regional medical center in Lincoln, Nebraska. St. Elizabeth specializes in the treatment areas of newborn and pediatric care, women’s health, burn and wound, cardiology, oncology, emergency medicine, orthopedics, and neuroscience.


As a Case Manager, you will be a pivotal healthcare professional, delivering compassionate, high-quality care that truly impacts our patients' well-being and recovery.

The purpose of the Case Manager position is to support the physician and interdisciplinary team in facilitating patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payors.  The role integrates and coordinates utilization management, care facilitation and discharge planning functions.

    • Collaborates with and supports the Care Coordination team, including, but not limited to the RNCC and Social Worker.
    • Manage timely post-acute care referrals, to assist with length of stay management and mitigation of denials.
    • Communicate and collaborate with interdisciplinary teams, patients, and family to facilitate care progression.
    • Ensure post-acute follow-up appointments for identified patients to assist with readmission prevention and ensuring continuity of care. 
    • Deliver required patient notifications and letters, and obtain patient or family signatures on required documentation as needed to meet regulatory compliance.
    • Manage transportation referrals as requested.

Graduate of an accredited Nursing program.

RN License valid in the state of Nebraska
Three to five years clinical experience in clinical practice area to which assigned - Preferred

Basic Life Support - American Heart Association

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