Care Manager
Saint Joseph, MO · On-site
The Care Manager works under the supervision of leadership providing coordination of care for ... Utilization data, Quality data, Clinical indicators, etc) utilizing electronic tools, reports, and ...
Care Manager
Saint Joseph, MO · On-site
The Care Manager works under the supervision of leadership providing coordination of care for ... Utilization data, Quality data, Clinical indicators, etc) utilizing electronic tools, reports, and ...
Care Manager
Hannibal, MO · On-site
... Care Management or Utilization Management experience preferred - BLS (CPR) required or obtained within 90 days of hire - Certification in Case Management preferred - Strong verbal and written ...
Care Manager
Hannibal, MO · On-site
... Care Management or Utilization Management experience preferred - BLS (CPR) required or obtained within 90 days of hire - Certification in Case Management preferred - Strong verbal and written ...
Care Manager
Hannibal, MO · On-site
... Care Management or Utilization Management experience preferred - BLS (CPR) required or obtained within 90 days of hire - Certification in Case Management preferred - Strong verbal and written ...
Care Manager
Hannibal, MO · On-site
... Care Management or Utilization Management experience preferred - BLS (CPR) required or obtained within 90 days of hire - Certification in Case Management preferred - Strong verbal and written ...
Care Manager
Saint Joseph, MO · On-site
The Care Manager works under the supervision of leadership providing coordination of care for ... Utilization data, Quality data, Clinical indicators, etc) utilizing electronic tools, reports, and ...
Care Manager
Saint Joseph, MO · On-site
The Care Manager works under the supervision of leadership providing coordination of care for ... Utilization data, Quality data, Clinical indicators, etc) utilizing electronic tools, reports, and ...
Value Based Care Nurse Care Manager
Rolla, MO · On-site
$21/hr
... utilization. This position uses population health data and EHR information to guide patient ... management, and patient engagement.●Coordinate care transitions and follow-up following ...
Value Based Care Nurse Care Manager
Rolla, MO · On-site
$21/hr
... utilization. This position uses population health data and EHR information to guide patient ... management, and patient engagement.●Coordinate care transitions and follow-up following ...
Manage an assigned Medicare population using data-driven approaches to identify high-risk patients, care gaps, and opportunities to improve quality, outcomes, and appropriate utilization. Conduct ...
Manage an assigned Medicare population using data-driven approaches to identify high-risk patients, care gaps, and opportunities to improve quality, outcomes, and appropriate utilization. Conduct ...
Value Based Care Nurse Care Manager
Rolla, MO · On-site
$21/hr
The Value-Based Care Nurse Care Manager primarily supports Medicare patients and organizational ... utilization. This position uses population health data and EHR information to guide patient ...
Value Based Care Nurse Care Manager
Rolla, MO · On-site
$21/hr
The Value-Based Care Nurse Care Manager primarily supports Medicare patients and organizational ... utilization. This position uses population health data and EHR information to guide patient ...
... utilization. This position uses population health data and EHR information to guide patient ... management, and patient engagement. ●Coordinate care transitions and follow-up following ...
... utilization. This position uses population health data and EHR information to guide patient ... management, and patient engagement. ●Coordinate care transitions and follow-up following ...
Work closely with utilization review staff, care managers and social workers to assist with any administrative responsibilities or needs. * Documentation entry * Phone and Voicemail retrieval * Mail ...
Work closely with utilization review staff, care managers and social workers to assist with any administrative responsibilities or needs. * Documentation entry * Phone and Voicemail retrieval * Mail ...
Work closely with utilization review staff, care managers and social workers to assist with any administrative responsibilities or needs. * Documentation entry * Phone and Voicemail retrieval * Mail ...
Work closely with utilization review staff, care managers and social workers to assist with any administrative responsibilities or needs. * Documentation entry * Phone and Voicemail retrieval * Mail ...
Work closely with utilization review staff, care managers and social workers to assist with any administrative responsibilities or needs. * Documentation entry * Phone and Voicemail retrieval * Mail ...
Work closely with utilization review staff, care managers and social workers to assist with any administrative responsibilities or needs. * Documentation entry * Phone and Voicemail retrieval * Mail ...
Care Manager RN
Poplar Bluff, MO · On-site
$75 - $105/hr
Job Summary The Care Manager - RN is responsible for coordinating and overseeing discharge planning ... continued hospital stay, and utilization of diagnostic services. * Collaborates with ...
Care Manager RN
Poplar Bluff, MO · On-site
$75 - $105/hr
Job Summary The Care Manager - RN is responsible for coordinating and overseeing discharge planning ... continued hospital stay, and utilization of diagnostic services. * Collaborates with ...
Care Manager RN
Poplar Bluff, MO · On-site
Job Summary The Care Manager - RN is responsible for coordinating and overseeing discharge planning ... continued hospital stay, and utilization of diagnostic services. * Collaborates with ...
Care Manager RN
Poplar Bluff, MO · On-site
Job Summary The Care Manager - RN is responsible for coordinating and overseeing discharge planning ... continued hospital stay, and utilization of diagnostic services. * Collaborates with ...
Required Education: • Graduate of an accredited School of Nursing, required Experience: • 2-3 years acute care hospital setting, preferred. • Care Management or Utilization Management ...
Required Education: • Graduate of an accredited School of Nursing, required Experience: • 2-3 years acute care hospital setting, preferred. • Care Management or Utilization Management ...
RN Care Manager in Joplin, MO
Joplin, MO · On-site
... Care Management or Utilization Management experience, preferred Certification/Registration BLS (CPR) at hire date, Minimum Required, or within 90 days of hire Certification in Case Management ...
RN Care Manager in Joplin, MO
Joplin, MO · On-site
... Care Management or Utilization Management experience, preferred Certification/Registration BLS (CPR) at hire date, Minimum Required, or within 90 days of hire Certification in Case Management ...
Chief Medical Officer
California, MO · On-site
$294.52 - $385.56/hr
This physician is chosen based upon knowledge of medical practice, experience in Managed Care, Utilization, Management/Quality Management programs and an ability to obtain mutual respect from and ...
Chief Medical Officer
California, MO · On-site
$294.52 - $385.56/hr
This physician is chosen based upon knowledge of medical practice, experience in Managed Care, Utilization, Management/Quality Management programs and an ability to obtain mutual respect from and ...
RN Care Manager I-IPCM
Saint Louis, MO · On-site
Care Management or Utilization Management experience, preferred Licensure: * Current License in the state of employment, required Certifications: * BLS (CPR) at hire date, required, or within 90 days ...
RN Care Manager I-IPCM
Saint Louis, MO · On-site
Care Management or Utilization Management experience, preferred Licensure: * Current License in the state of employment, required Certifications: * BLS (CPR) at hire date, required, or within 90 days ...
Care Management or Utilization Management experience, preferred Licensure: * Current License in the state of employment, required Certifications: * BLS (CPR) at hire date, required, or within 90 days ...
Care Management or Utilization Management experience, preferred Licensure: * Current License in the state of employment, required Certifications: * BLS (CPR) at hire date, required, or within 90 days ...
Supervisor, Utilization Management (RN)
Jefferson City, MO · On-site +1
$75K - $135K/yr
Collaborates with utilization management team to resolve complex care member issues * Maintains knowledge of regulations, accreditation standards, and industry best practices related to utilization ...
Supervisor, Utilization Management (RN)
Jefferson City, MO · On-site +1
$75K - $135K/yr
Collaborates with utilization management team to resolve complex care member issues * Maintains knowledge of regulations, accreditation standards, and industry best practices related to utilization ...
Supervisor, Utilization Management (RN)
Kansas City, MO · On-site +1
$75K - $135K/yr
Collaborates with utilization management team to resolve complex care member issues * Maintains knowledge of regulations, accreditation standards, and industry best practices related to utilization ...
Supervisor, Utilization Management (RN)
Kansas City, MO · On-site +1
$75K - $135K/yr
Collaborates with utilization management team to resolve complex care member issues * Maintains knowledge of regulations, accreditation standards, and industry best practices related to utilization ...
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 Missouri?
For Utilization Care Manager jobs in Missouri, the most frequently searched job titles are:
- No Experience Utilization Management Nurse
- Remote Utilization Review Social Worker
- Evening Optum Health Utilization Review
- Full Time Remote Utilization Review Nurse
- Home Based Utilization Review Nurse
- Per Diem Remote Chart Review Nurse
- Oasis Review Nurse
- Per Diem Utilization Review Nurse
- Independent Contractor Remote Utilization Management Nurse
What job categories do people searching Utilization Care Manager jobs in Missouri look for?
The top searched job categories for Utilization Care Manager jobs in Missouri are:
- Online Utilization Review
- Full Time Behavioral Health Case Manager Remote
- Therapy Utilization Review
- From Home Anthem Utilization Review Nurse
- Er Case Manager
- Utilization Review Case Manager
- Utilization Review
- Freelance International Utilization Review Nurse
- Temporary Aetna Utilization Review Nurse
- Supervisor Utilization Review Remote
What cities in Missouri are hiring for Utilization Care Manager jobs?
Cities in Missouri with the most Utilization Care Manager job openings:
Full-time
Medical, Vision, Life
This job post has expired 1 day ago. Applications are no longer accepted.
Mosaic Life Care rating
6.6
Based on 63 frontline employees who took The Breakroom Quiz
570th of 893 rated healthcare providers
Job description
The Care Manager works under the supervision of leadership providing coordination of care for patients in Mosaic Life Care and the organization's service area in such a manner as to use the right resources, at the right time and at the right level of care. Utilizing a collaborative process, the Care Manager will assess, plan, implement and evaluate the options and services required to meet an individual's health and health related needs. Strong communication skills are necessary to access available resources and communicate with providers and other members of the interdisciplinary team. The Care Manager serves as an advocate for the patient, family and the organization to promote quality, cost effective outcomes. Active participation in program development and process improvement efforts is an expectation of the role of Care Manager.
Responsibilities
- Proactively identifies patients/individuals appropriate for CM service based upon indicators of each program (i.e. Utilization data, Quality data, Clinical indicators, etc) utilizing electronic tools, reports, and interview techniques effectively/efficiently to gather information about assigned populations and prioritizes workload appropriately to meet desired outcomes.
- Responds to referral requests in a timely manner and offers possible alternatives for assistance if referral is not appropriate for CM intervention.
- Collects and reviews information to determine strengths and barriers of the patient in 6 key areas: access to care, current problems/treatment plans (medical/mental health), psychosocial/support system (formal and informal resources), functional status/safety, financial/benefits available, lifestyle/behavior (risk factors).
- Develops a plan to address identified barriers to care collaboratively with the patient/family, provider and interdisciplinary team. Prioritizes the plan appropriately to achieve optimal outcomes (Quality, Cost, Experience) avoiding a focus on task accomplishment.
- Coordinates/facilitates implementation of plan demonstrating problem solving skills, effective communication and appropriate sense of urgency in providing service to avoid delays in progression of care, and over, under, or inappropriate utilization of resources (include but not limited to unnecessary ED/IP visits, greater than expected LOS, unplanned readmissions, unnecessary testing/treatment, etc.).
- Monitors effectiveness of CM services through patient reassessment and outcome analysis and revises plan as necessary. Compiles tracking reports/summaries as requested for measure and/or productivity purposes.
- Effectively communicates the goals and processes of assigned program to various audiences. Communicates effectively with internal and external customers the benefits of Care management service, programs, and process for referral.
- Develops and maintains knowledge of Medicare, Medicaid and key payer benefits/reimbursement methodologies necessary to procure services for patients and serve as a resource to the IDT on quality, cost effective care.
- Maintains understanding of, and articulates the Regulatory requirements (CMS, TJC, etc) regarding Discharge Planning/Utilization Review and/or Care Management services.
- Maintains a patient centered approach through ongoing communication with patient/family seeking their input and participation at all times.
- Bed Side rounding with inter disciplinary team
- Other duties as assigned
Education
- Graduate from school of nursing. - Required
- BSN - Preferred
Work Experience
- 3 Years - Clinical experience, Care Management - Preferred
- 3 Years - Clinical experience in a Behavioral Health related field for Behavioral health care manager - Preferred
- 3 Years - Clinical experience in clinical field (obstetrical nursing) for Pregnancy Care Manager - Preferred
- 3 Years - Experience navigating resources and computer systems to access information. - Required
Licenses and Certifications
- Registered Nurse (RN) - State Licensure/Or Compact State Licensure - Licensed in State of Missouri and Kansas (as needed for job assignment) - Required Upon Hire
- Basic Life Support (BLS) - Required within 90 Days
Travel Requirements
- Must be able to travel between various system facilities and off-site locations as needed. - No
Qualifications
Skills and Abilities
Essential Technical/Motor Skills
- Hand/eye coordination; good hearing; computer skills/telephone skills, ability to read, write, and speak clearly.
Interpersonal Skills
- Must be able to teach, provide accurate and concise information, answer questions, demonstrate excellent leadership skills, maintain positive relationships with multiple customers, motivate and persuade others.
- Excellent verbal and written communication skills including sensitivity to other cultures, ethnicities and diverse backgrounds.
Essential Physical Requirements
- Physical requirements include standing, walking, and fine motor skills; reach for items; bend, squat, sit, and climb stairs.
- Sufficient strength and mobility to sit for long periods of time (depending on assignment).
- Ability to drive to various locations in and around the service area.
Essential Mental Abilities
- Critical thinking skills, problem-solving skills, negotiating abilities.
- Capable of determining appropriate response to emergency situations.
- Ability to focus and concentrate in order to correctly perform tasks despite numerous distractions and interruptions.
- Ability to maintain professional demeanor to communicate and interact with patients, customers and team members.
Essential Sensory Requirements
- Appropriate functional vision, hearing acuity, and smell.
Exposure to Hazards
- Driving to and from various locations for the purpose of coordinating patient care/collaboration and outreach.
- Respiratory exposures for airborne pathogens.
- Exposure to infectious pathogens.
- Exposure to physical hazards.
- Frequent contact with water/soap/detergents.
- 1. Excellent skills in conceptual thinking, listening, problem resolution and planning2. Demonstrated leadership skills3. Excellent organizational skills.4. Proficient computer skills including Office applications and electronic medical records.5. Knowledgeable about issues related to chronic illness.6. Must have access to transportation, which will allow for timely scheduled visits.
Other Skills and Abilities
- Excellent skills in conceptual thinking, listening, problem resolution and planning
- Demonstrated leadership skills
- Excellent organizational skills.
- Proficient computer skills including Office applications and electronic medical records.
- Knowledgeable about issues related to chronic illness.
- Must have access to transportation, which will allow for timely scheduled visits.
About Us
Mosaic Life Care is a health care system in northwest Missouri. With a vision of transforming community health by being a life-care innovator, Mosaic places the holistic needs of patients first by providing the right care at the right time and place, offering high value and quality health care.
Mosaic has a wide array of benefits to meet each employee's individual needs. Our benefits were designed by listening to people just like you. Mosaic also offers several perks with a focus on ensuring our employees feel valued, including concierge services, employee lounge, wellness programs, free covered parking, free on-site and virtual health clinics and many more. When paired with compensation and recognition, it is what continues to make us the employer of choice for employees at any stage of their journey.
What Mosaic Life Care employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About Mosaic Life Care
Sourced by ZipRecruiter
Industry
Health care and social assistance
Company size
1,001 - 5,000 Employees
Headquarters location
Saint Joseph, MO, US
Year founded
2012