Care Management Daily Work Times: 0800-1600 Shift : Days Scheduled Bi-Weekly Hours: 80 Benefits ... resource utilization, preventing readmissions and unnecessary emergency room visits. Works ...
Care Management Daily Work Times: 0800-1600 Shift : Days Scheduled Bi-Weekly Hours: 80 Benefits ... resource utilization, preventing readmissions and unnecessary emergency room visits. Works ...
Care Manager
Kingsford, MI · On-site
The goal of the Care Manager is to help individuals achieve maximum independence through person ... the utilization of diagnostic, evaluative, and progress reports. * Assists the individual in ...
Care Manager
Kingsford, MI · On-site
The goal of the Care Manager is to help individuals achieve maximum independence through person ... the utilization of diagnostic, evaluative, and progress reports. * Assists the individual in ...
Care Management Daily Work Times: 0800-1600 Shift : Days Scheduled Bi-Weekly Hours: 80 Benefits ... resource utilization, preventing readmissions and unnecessary emergency room visits. Works ...
Care Management Daily Work Times: 0800-1600 Shift : Days Scheduled Bi-Weekly Hours: 80 Benefits ... resource utilization, preventing readmissions and unnecessary emergency room visits. Works ...
Care Manager
$49K - $68K/yr
The goal of the Care Manager is to help individuals achieve maximum independence through person ... the utilization of diagnostic, evaluative, and progress reports. * Assists the individual in ...
Care Manager
$49K - $68K/yr
The goal of the Care Manager is to help individuals achieve maximum independence through person ... the utilization of diagnostic, evaluative, and progress reports. * Assists the individual in ...
... resource utilization, preventing readmissions and unnecessary emergency room visits. Works ... Experience in utilization management/case management, critical care, or patient outcomes/quality ...
... resource utilization, preventing readmissions and unnecessary emergency room visits. Works ... Experience in utilization management/case management, critical care, or patient outcomes/quality ...
Care Manager
Kingsford, MI · On-site
$49K - $68K/yr
The goal of the Care Manager is to help individuals achieve maximum independence through person ... the utilization of diagnostic, evaluative, and progress reports. * Assists the individual in ...
Care Manager
Kingsford, MI · On-site
$49K - $68K/yr
The goal of the Care Manager is to help individuals achieve maximum independence through person ... the utilization of diagnostic, evaluative, and progress reports. * Assists the individual in ...
... resource utilization, preventing readmissions and unnecessary emergency room visits. Works ... Experience in utilization management/case management, critical care, or patient outcomes/quality ...
... resource utilization, preventing readmissions and unnecessary emergency room visits. Works ... Experience in utilization management/case management, critical care, or patient outcomes/quality ...
Care Management Daily Work Times: 0800-1600 Shift : Day Scheduled Bi-Weekly Hours: 80 Benefits: • ... resource utilization, preventing readmissions and unnecessary emergency room visits. Works ...
Care Management Daily Work Times: 0800-1600 Shift : Day Scheduled Bi-Weekly Hours: 80 Benefits: • ... resource utilization, preventing readmissions and unnecessary emergency room visits. Works ...
Care Management Daily Work Times: 0800-1600 Shift : Day Scheduled Bi-Weekly Hours: 80 Benefits: • ... resource utilization, preventing readmissions and unnecessary emergency room visits. Works ...
Care Management Daily Work Times: 0800-1600 Shift : Day Scheduled Bi-Weekly Hours: 80 Benefits: • ... resource utilization, preventing readmissions and unnecessary emergency room visits. Works ...
... resource utilization, preventing readmissions and unnecessary emergency room visits. Works ... Three years of acute hospital care experience • American Case Management Certification (ACM) or ...
... resource utilization, preventing readmissions and unnecessary emergency room visits. Works ... Three years of acute hospital care experience • American Case Management Certification (ACM) or ...
... resource utilization, preventing readmissions and unnecessary emergency room visits. Works ... Experience in utilization management/case management, critical care, or patient outcomes/quality ...
... resource utilization, preventing readmissions and unnecessary emergency room visits. Works ... Experience in utilization management/case management, critical care, or patient outcomes/quality ...
Identifies unsigned level of care (LOC) orders; communicates with utilization management nurse and ... obtains orders from providers. * Reviews current DRG/LOS identified within Cerner to assess ...
Identifies unsigned level of care (LOC) orders; communicates with utilization management nurse and ... obtains orders from providers. * Reviews current DRG/LOS identified within Cerner to assess ...
Care Management Daily Work Times: 0800-1600 Shift : Days Scheduled Bi-Weekly Hours: 80 Benefits ... resource utilization, preventing readmissions and unnecessary emergency room visits. Works ...
Care Management Daily Work Times: 0800-1600 Shift : Days Scheduled Bi-Weekly Hours: 80 Benefits ... resource utilization, preventing readmissions and unnecessary emergency room visits. Works ...
... resource utilization, preventing readmissions and unnecessary emergency room visits. Works ... Experience in utilization management/case management, critical care, or patient outcomes/quality ...
... resource utilization, preventing readmissions and unnecessary emergency room visits. Works ... Experience in utilization management/case management, critical care, or patient outcomes/quality ...
Care Management Daily Work Times: 0800-1600 Shift : Days Scheduled Bi-Weekly Hours: 80 Benefits ... resource utilization, preventing readmissions and unnecessary emergency room visits. Works ...
Care Management Daily Work Times: 0800-1600 Shift : Days Scheduled Bi-Weekly Hours: 80 Benefits ... resource utilization, preventing readmissions and unnecessary emergency room visits. Works ...
... resource utilization, preventing readmissions and unnecessary emergency room visits. Works ... Three years of acute hospital care experience • American Case Management Certification (ACM) or ...
... resource utilization, preventing readmissions and unnecessary emergency room visits. Works ... Three years of acute hospital care experience • American Case Management Certification (ACM) or ...
Identifies unsigned level of care (LOC) orders; communicates with utilization management nurse and ... obtains orders from providers. * Reviews current DRG/LOS identified within Cerner to assess ...
Identifies unsigned level of care (LOC) orders; communicates with utilization management nurse and ... obtains orders from providers. * Reviews current DRG/LOS identified within Cerner to assess ...
... resource utilization, preventing readmissions and unnecessary emergency room visits. Works ... Experience in utilization management/case management, critical care, or patient outcomes/quality ...
... resource utilization, preventing readmissions and unnecessary emergency room visits. Works ... Experience in utilization management/case management, critical care, or patient outcomes/quality ...
... resource utilization, preventing readmissions and unnecessary emergency room visits. Works ... Experience in utilization management/case management, critical care, or patient outcomes/quality ...
... resource utilization, preventing readmissions and unnecessary emergency room visits. Works ... Experience in utilization management/case management, critical care, or patient outcomes/quality ...
The Local Care Management Lead is responsible for managing the Local Care Management (LCM) Team and overseeing utilization management activities that support the delivery of medically necessary ...
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The Local Care Management Lead is responsible for managing the Local Care Management (LCM) Team and overseeing utilization management activities that support the delivery of medically necessary ...
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?
| Aspect | Utilization Care Manager | Utilization Review Nurse |
|---|---|---|
| Credentials | RN, case management certification | RN, certification in utilization review |
| Work Environment | Healthcare facilities, insurance companies | Hospitals, insurance companies, outpatient clinics |
| Primary Focus | Coordinating patient care, managing resources | Reviewing 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 Michigan?
For Utilization Care Manager jobs in Michigan, the most frequently searched job titles are:
- Remote Utilization Review Social Worker
- Temporary Utilization Review Nurse
- Remote Insurance Nurse
- No Experience Utilization Review Nurse
- Full Time Physician Advisor Utilization Review
- Registered Nurse Utilization Review
- Night Shift Remote Utilization Review Nurse
- Case Management Supervisor
- Remote Utilization Management
- No Experience Utilization Management Nurse
What job categories do people searching Utilization Care Manager jobs in Michigan look for?
The top searched job categories for Utilization Care Manager jobs in Michigan are:
- Director Of Utilization Review
- Integrated Healthcare
- Behavioral Case Manager Nurse
- Behavioral Utilization Review
- Utilization Review Coordinator Remote
- Freelance International Utilization Review Nurse
- Commission Anthem Utilization Review
- Insurance Utilization Review
- Flex Schedule Utilization Review
- Evening Optum Utilization Review
What cities in Michigan are hiring for Utilization Care Manager jobs?
Cities in Michigan with the most Utilization Care Manager job openings:
Registered Nurse Care Manager
Mount Clemens, MI • On-site
McLaren Health Care •
Health Care and Social Assistance • 1 - 5K employees1,001 - 5,000 employees
6.7
Based on 221 frontline employees who took The Breakroom Quiz
534th of 896 rated healthcare providers
People enjoy working here
Recommended by students
Recommended by parents
Respectful managers
Good training
Other
Medical, Dental, Vision, Retirement, PTO
Posted 5 days ago
Job description
Department: Care Management
Daily Work Times: 0800-1600
Shift: Days
Scheduled Bi-Weekly Hours: 80
Benefits:
• 403(b)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance
Position Summary: Accountable for proactive coordination and timely transition of assigned patients to the most appropriate level of care along the continuum. Impacts key results such as achieving top decile performance in length of stay, cost efficient resource utilization, preventing readmissions and unnecessary emergency room visits. Works collaboratively with physicians, nursing, members of the multidisciplinary team (such as Home Care and PCP offices), as well as other resources internal and external to the organization.
Essential Functions and Responsibilities as Assigned:
1. Performs care coordination assessments for initial assessment of patients with 24 hrs. of admission. assessments for readmission and transition planning.
2. Works collaboratively with the social worker and other disciplines to ensure a safe, appropriate, and timely transition to the next level of care, taking into consideration the patient's available resources.
3. Assesses patient/family needs to reduce barriers and formulate discharge plans (e.g., LOS barriers to D/C).
4. Identifies unsigned level of care (LOC) orders; communicates with utilization management nurse and obtains orders from providers.
5. Reviews current DRG/LOS identified within Cerner to assess discharge planning needs with providers and identifies which family member is the point of contact.
6. Assesses risk of readmission for specified patient populations and initiates assigned interventions that will enhance the patient's ability to successfully transition along the care continuum.
7. Performs discharge planning coordination/referral by making appropriate referrals to social services, ancillary departments, outpatient case management, DME, post-acute placement, and other outside agencies per Standard Operating Procedure (SOP).
Qualifications:
Required
Daily Work Times: 0800-1600
Shift: Days
Scheduled Bi-Weekly Hours: 80
Benefits:
• 403(b)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance
Position Summary: Accountable for proactive coordination and timely transition of assigned patients to the most appropriate level of care along the continuum. Impacts key results such as achieving top decile performance in length of stay, cost efficient resource utilization, preventing readmissions and unnecessary emergency room visits. Works collaboratively with physicians, nursing, members of the multidisciplinary team (such as Home Care and PCP offices), as well as other resources internal and external to the organization.
Essential Functions and Responsibilities as Assigned:
1. Performs care coordination assessments for initial assessment of patients with 24 hrs. of admission. assessments for readmission and transition planning.
2. Works collaboratively with the social worker and other disciplines to ensure a safe, appropriate, and timely transition to the next level of care, taking into consideration the patient's available resources.
3. Assesses patient/family needs to reduce barriers and formulate discharge plans (e.g., LOS barriers to D/C).
4. Identifies unsigned level of care (LOC) orders; communicates with utilization management nurse and obtains orders from providers.
5. Reviews current DRG/LOS identified within Cerner to assess discharge planning needs with providers and identifies which family member is the point of contact.
6. Assesses risk of readmission for specified patient populations and initiates assigned interventions that will enhance the patient's ability to successfully transition along the care continuum.
7. Performs discharge planning coordination/referral by making appropriate referrals to social services, ancillary departments, outpatient case management, DME, post-acute placement, and other outside agencies per Standard Operating Procedure (SOP).
Qualifications:
Required
- State licensure as a Registered Nurse (RN)
- Bachelor's degree in nursing from accredited educational institution, or actively pursuing degree and to be obtained within five years of accepting position.
- Three years of acute hospital care experience
- Experience in utilization management/case management, critical care, or patient outcomes/quality management
- Certification in Case Management Certification (ACM or CCM)
- Basic Life Support (BLS) certification as a Healthcare Provider by the American Heart Association, American Red Cross or equivalent through the Military Training network (MTN)
About McLaren Port Huron
Sourced by ZipRecruiter
Industry
Health care and social assistance
Company size
1,001 - 5,000 Employees
Headquarters location
Port Huron, MI, US
Website
What McLaren Health Care employees say
Pay
Benefits
Hours and flexibility
Workplace
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