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Utilization Care Manager Jobs in Alaska (NOW HIRING)

CVS Health

Utilization Management Nurse Consultant

Homer, AK · Remote

$26.01 - $68.55/hr

At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose ... Position Summary As a Utilization Management Nurse Consultant, you will utilize clinical skills to ...

Front Street Clinic Inc

RN - Urgent Care

Juneau, AK · On-site

Provide clinical services in collaboration with healthcare providers, staff, and management to ensure high-quality care, efficient resource utilization, and compliance with organizational standards.

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Utilization Care Manager information

What is a utilization care manager?

Utilization Care Managers are healthcare professionals responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They work to ensure that patients receive the right care at the right time, while also helping healthcare organizations manage costs and comply with regulations. Utilization Care Managers often review patient cases, coordinate with medical staff, and interact with insurance companies to authorize or deny services. Their goal is to optimize healthcare delivery, reduce unnecessary procedures, and improve patient outcomes.

How does a utilization care manager collaborate with medical and administrative teams to ensure effective patient care?

Utilization Care Managers work closely with physicians, nursing staff, and administrative teams to review patient cases, determine medical necessity, and coordinate appropriate care plans. They frequently participate in interdisciplinary meetings, communicate with insurance providers regarding authorizations, and ensure compliance with regulatory guidelines. This collaborative approach helps to optimize resource utilization, improve patient outcomes, and support smooth transitions of care. Being proactive in communication and documentation is key to success in this role.

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

To thrive as a Utilization Care Manager, you need a background in healthcare, typically as a registered nurse or social worker, with expertise in care coordination and utilization review. Familiarity with utilization management software, medical necessity guidelines (such as Milliman or InterQual), and knowledge of insurance regulations are important. Strong analytical thinking, attention to detail, and effective communication skills help you advocate for patients while working with healthcare teams and payers. These skills ensure appropriate resource use, quality patient outcomes, and compliance with regulatory standards.

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

AspectUtilization Care ManagerUtilization Review Nurse
CredentialsRN, case management certificationRN, certification in utilization review
Work EnvironmentHealthcare facilities, insurance companiesHospitals, insurance companies, outpatient clinics
Primary FocusCoordinating patient care, managing resourcesReviewing medical necessity, approving treatments

Utilization Care Managers focus on coordinating patient care and managing resources, while Utilization Review Nurses primarily evaluate medical necessity for treatments. Both roles require nursing credentials and work within healthcare or insurance settings, but their core responsibilities differ in scope and focus.

What does a utilization care manager do in healthcare?

A utilization care manager in healthcare reviews patient cases to ensure appropriate use of medical services and resources, coordinating care plans to optimize patient outcomes and reduce unnecessary costs. They often work with healthcare providers, insurance companies, and patients, using data and clinical guidelines to make informed decisions about treatment and service utilization.

What are popular job titles related to Utilization Care Manager jobs in Alaska?

For Utilization Care Manager jobs in Alaska, the most frequently searched job titles are:

What job categories do people searching Utilization Care Manager jobs in Alaska look for?

The top searched job categories for Utilization Care Manager jobs in Alaska are:

What cities in Alaska are hiring for Utilization Care Manager jobs?

Cities in Alaska with the most Utilization Care Manager job openings:

Utilization Care Manager jobs near you

RN - Care Coordinator

Mt. Edgecumbe Medical Center - MS

Sitka, AK • On-site

Other

Medical, Dental, Vision, Life, Retirement

Posted 18 days ago

Job description

Care Manager

Job Title: Care Manager

Profession: Nursing

Specialty: Care Manager

Duration: 13 weeks

Shift: Will discuss at interview

Hours per Shift: 40

Experience: Minimum 8 years clinical care or nursing experience, including 3 years in chart review, risk management, or related quality service

License: Active nursing license required

Certifications: Case Management certification preferred

Must-Have: Active nursing license Flu vaccine required

Description: Must have active license at the time of submission. Experience required includes 8 years of clinical care or nursing experience, with 3 years specifically in chart review, risk management, or related quality services. Preferred qualifications include Case Management certification by a recognized certifying organization. Manages patient progression of care and promotes evidence-based protocols. Ensures the appropriateness of interventions and expedites care delivery for admitted patients. Directs patient care services to ensure timely and appropriate patient discharge. Reviews patients' records and evaluates patient progress. Performs continuing reviews of hospitalizations to monitor necessity and appropriateness of care. Provides utilization management and review functions for beneficiary patients admitted to other facilities. Obtains and reviews necessary medical reports and treatment plans as requested by regulatory agencies or payers. Reviews and validates physician orders and reports progress and unusual occurrences in patients. Works with leadership, clinical care teams, and physicians to ensure healthcare services are appropriate and cost-effective. Collaborates with physicians and clinical care teams to ensure adherence to utilization management, case management, and discharge planning. Reviews new hospital admissions to assess patient conditions and needs to develop personalized treatment plans. Provides appropriate information to patients and their families regarding healthcare benefits. Participates in interdisciplinary collaboration with professional staff. Ensures maintenance of the utilization review plan in collaboration with designated providers. Facilitates educational programs and advises on regulations affecting utilization management and case management. Directs the coordination of patient care departments to ensure treatment plans meet patient needs and criteria approved by regulatory or payer requirements. Ensures documentation supports utilization management functions and communicates with payers within required timeframes. Reviews information and communicates results to claims adjusters. Prepares information for notification letters to providers and staff. Processes requests for appeal of denials. Responds to complaints per utilization management review guidelines. Maintains utilization review and appeal logs. Supports clinical improvement activities by providing quality review. Performs additional duties as assigned. This position does not require supervisory responsibilities. Education requirement includes a Bachelor's Degree in Nursing. Knowledge of conducting medical record reviews for medical necessity and compliance. Proficient in medical terminology, anatomy, physiology, and concepts of disease. Strong organizational skills and the ability to communicate effectively with providers, staff, and patients are essential.

We offer competitive benefits, including:

  • Medical, dental & vision insurance
  • Free and unlimited continuing education units (CEUs)
  • 24/7 dedicated Care Line and clinical liaison support
  • Personalized career consultant and "single point of contact" service
  • Industry‑leading pay rates, loyalty rewards & referral bonuses
  • Free tax return assistance for travelers
  • 401(k) Retirement Plan
  • Health Savings Account (HSA)
  • Disability Insurance (Short-Term and Long-Term)
  • Life and AD&D Insurance
  • Paid Sick Leave (where required by applicable state or local law)
  • Supplemental Insurance Plans
  • Identity Theft Protection
  • Pet Insurance
  • Employee Wellness Programs
  • Employee Assistance Program (EAP)
  • Career Growth and Professional Development Opportunities

Disclaimer: Benefits eligibility, accrual rates, and usage limits may vary based on employment status, length of service, and work location. Paid Sick Leave is provided in strict accordance with applicable state and municipal mandates. Cynet Health reserves the right to modify, amend, or terminate any benefit plans at any time in accordance with applicable laws.

About Cynet Health: Cynet Health is a Joint Commission-accredited, Minority-Owned healthcare staffing agency headquartered in Sterling, Virginia, proudly serving healthcare facilities across the United States since its founding in 2010. As one of the nation's largest and fastest‑growing healthcare staffing firms in the nation, we staff thousands of nursing, allied health, locum tenens, pharmacy, therapy, direct‑hire, and non‑clinical professionals across hospitals, clinics, long‑term care facilities, labs and more. We're one of the most decorated staffing agencies in America-ranked a Top Travel Nursing Company by BluePipes, recognized among the fastest‑growing and most diverse staffing firms by Inc. 5000, Staffing Industry, WBJ and USPAACC-and remain deeply committed to excellence, inclusion, and community impact.

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