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Utilization Care Manager Jobs (NOW HIRING)

Mosaic Life Care

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 ...

Willis Knighton Health

Care Manager

Shreveport, LA · On-site

The role of the Care Manager is to coordinate and manage care throughout the patient's acute inpatient illness; ensure continuity of services and appropriate utilization and management of resources.

Willis Knighton Health

Care Manager

Shreveport, LA · On-site

The role of the Care Manager is to coordinate and manage care throughout the patient's acute inpatient illness; ensure continuity of services and appropriate utilization and management of resources.

Crouse Hospital

Care Manager

Syracuse, NY · On-site

The Care Manager actively participates in the utilization management process using standards of care to determine the most appropriate level of care, managing care across the continuum to ensure a ...

Crouse Hospital

Care Manager

Syracuse, NY · On-site

The Care Manager actively participates in the utilization management process using standards of care to determine the most appropriate level of care, managing care across the continuum to ensure a ...

Crouse Hospital

Care Manager

Syracuse, NY · On-site

The Care Manager actively participates in the utilization management process using standards of care to determine the most appropriate level of care, managing care across the continuum to ensure a ...

AHMC Healthcare

CARE MANAGER

Daly City, CA · On-site

$68 - $72/hr

The Case Manager RN is responsible for ensuring effective and efficient utilization of hospital resources and assisting patients in receiving appropriate, high quality post hospital care and service.

AHMC Healthcare

CARE MANAGER

Daly City, CA

Overview The Case Manager RN is responsible for ensuring effective and efficient utilization of hospital resources and assisting patients in receiving appropriate, high quality post hospital care and ...

AHMC Healthcare

CARE MANAGER

Daly City, CA · On-site

$68/hr

Overview The Case Manager RN is responsible for ensuring effective and efficient utilization of hospital resources and assisting patients in receiving appropriate, high quality post hospital care and ...

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Utilization Care Manager information

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$39K

$91K

$167.5K

How much do utilization care manager jobs pay per year?

As of Jun 20, 2026, the average yearly pay for utilization care manager in the United States is $91,011.00, according to ZipRecruiter salary data. Most workers in this role earn between $59,500.00 and $109,500.00 per year, depending on experience, location, and employer.

How does a Utilization Care Manager typically 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 Utilization Care Managers?

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.

What jobs pay 2000 a day?

Jobs that can pay $2,000 a day typically include specialized roles such as senior management, high-level consultants, certain medical professionals like surgeons, and experienced freelance contractors in fields like software development or engineering. These positions often require advanced skills, extensive experience, or professional certifications, and may involve project-based or contract work with high hourly or daily rates.

What does a utilization manager do in healthcare?

A utilization care manager in healthcare evaluates the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient cases, coordinate with healthcare providers, and ensure that care plans align with insurance policies and clinical guidelines to optimize resource use and control costs.

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 highest paying job with a BSW?

The highest paying jobs with a Bachelor of Social Work (BSW) degree typically include roles such as clinical social worker, healthcare administrator, or mental health director, with salaries often exceeding $70,000 annually. Advancement to supervisory or administrative positions, along with additional certifications or experience, can lead to higher compensation in social services and healthcare settings.

What job makes $10,000 a month without a degree?

A Utilization Care Manager typically does not earn $10,000 a month without a degree, as this role usually requires healthcare or administrative certifications and experience. High-paying jobs that can reach this level without a degree often include specialized sales, real estate brokers, or skilled trades like certain construction or technical roles, but these usually require relevant skills, licenses, or extensive experience.

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.

More about Utilization Care Manager jobs
What cities are hiring for Utilization Care Manager jobs? Cities with the most Utilization Care Manager job openings:
What states have the most Utilization Care Manager jobs? States with the most job openings for Utilization Care Manager jobs include:
What job categories do people searching Utilization Care Manager jobs look for? The top searched job categories for Utilization Care Manager jobs are:
Utilization Care Manager jobs near you
Care Manager (RN) - $12,000 sign on bonus

Care Manager (RN) - $12,000 sign on bonus

DCH Health System

Tuscaloosa, AL • On-site

Full-time

Posted 25 days ago

DCH Health System rating

6.9

Company rating: 6.9 out of 10

Based on 18 frontline employees who took The Breakroom Quiz

Job description

Overview
The Care Manager works collaboratively with interdisciplinary and healthcare team members, both internal and external to the organization to facilitate patient care through effective utilization and monitoring of healthcare resources and assumes a leadership role to achieve safe discharge planning along with desired clinical and financial outcomes. The Care Manager coordinates care and services through the acute care episode and across the continuum.
Responsibilities
Assessment
  1. Completes a face to face assessment of all new patients in caseload within 24 hours or next business day to identify appropriateness for acute care, level of care and to anticipate high level care planning needs. Screens high risk patients with lace score greater than or equal to 10 to reduce 30 day readmissions. Consults with attending physicians regarding potential care transition barriers identified as a result of this process.
  2. Assumes transition process in collaboration with the multidisciplinary team and patient/family and assists with executing the plans and interventions to facilitate the stay and manage the length of stay.
  3. Facilitates patient care conferences/complex case conferences proactively as needs are identified to reduce avoidable readmissions.

Utilization Management
  1. Provides an Important Message notice and choice on Medicare patients as appropriate.
  2. Identifies and reports process improvement opportunities by capturing delays in care by documenting avoidable days in MIDAS per guidelines.
  3. Monitors and facilitates appropriateness of tests/procedures, consultation, treatment plans and resource utilization.

Care Coordination, Collaboration, and Transition Planning
  1. Collaborates with social workers for patients with complex, clinical, financial and psycho-social needs.
  2. Reviews physician orders and patient progression on a daily basis and intervenes with care coordination as needed. Collaborates with other departments to eliminate barriers, as necessary.
  3. Actively participates in multi-disciplinary rounds, long stay rounds and meetings that promote comprehensive and coordinated care plans and monitors progress against goals
  4. Provides clear and timely information on the patients plan of care to the next provider
  5. Builds trusting relationships with attending physician, patient and/or family and other members of the healthcare team. Maintains contact with the patient, family, physician, and team members to ensure the most cost effective plan of care is being carried out and appropriate in network providers are being utilized.
  6. Establishes a caring relationship with patients and their caregivers, promotes patient engagement and guides patients/families through the transition phase
  7. In accordance with established clinical guidelines/standards of care establishes a comprehensive care transition plan and will organize, secure, integrate and modify resources necessary to meet the goals stated in the assessment plan.
  8. Documents plan of care and updates /changes in plan of care in the electronic medical record.
  9. In collaboration with the appropriate services, arranges home care, DME and infusion and/or post acute services in partnership with the social worker. Maintains good working relationships with community providers
  10. Assists with medication issues for patients on an as needed basis.
  11. Serves in obtaining legal guardianship, competency determinations, adoption related situations and all cases where Adult or Child abuse is a concern. Is responsible for making sure all legal documents are completed. Collaborates with the Corporate Director and Manager of Case Management as needed.
  12. Provides counseling and support as needed. Identifies cases which would benefit from palliative care and elicits palliative consults as needed.

Education and Professionalism
  1. Serves as a resource to patients, physicians, Administration, and other disciplines regarding care management functions and expertise.
  2. Participates in defining, maintaining and interpreting care management standards of practice
  3. Assesses and educates patients and families on community agencies and resources
  4. Educates and reinforces the early identification of changes in patient condition and changes in care transition plans
  5. Assumes responsibility for own professional growth and is willing to share knowledge with coworkers and other health care providers.
  6. Performs assigned work safely, adhering to established departmental safety standards rules and practices; reports to supervisor, in a timely manner, any unsafe activities, conditions, hazards, or safety violations that may cause injury to oneself, other employees, patients, and visitors

DCH Standards:
  • Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation.
  • Performs compliance requirements as outlined in the Employee Handbook
  • Must adhere to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.
  • Performs essential job functions in a manner that ensures the safety of patients, visitors and employees.
  • Identifies and reduces unsafe practices that may result in harm to patients, visitors and employees.
  • Recognizes and takes appropriate action to reduce risks and hazards to promote safety for patients, visitors and employees.
  • Requires use of electronic mail, time and attendance software, learning management software and intranet.
  • Must adhere to all DCH Health System policies and procedures.
  • All other duties as assigned.

Qualifications
  1. RN with 2 years' experience required, BSN and or related bachelor's degree in a healthcare field preferred any relevant experience in utilization and/or case management.
  2. Current Alabama RN Licensure.
  3. Knowledge of managed care, governmental payers, and third party reimbursement.
  4. Skill in using Microsoft office applications, and Information systems including but not limited to MIDAS.
  5. Demonstrated critical thinking skills and ability to prioritize work load.
  6. Ability to exercise clinical judgment and autonomous decision making.
  7. Strong interpersonal skills relative to both professional and lay interactions.
  8. Strong organizational skills.
  9. Demonstrated working knowledge of performance improvement activities.
  10. Demonstrated working knowledge of data management/reporting practices.
  11. Strong communication skills.

WORK CONTEXT
  • Ability to form positive, collaborative relationships with physicians, colleagues, hospital staff, patients, families, and external contacts
  • Ability to provide guidance and direction to subordinates, including performance standards and monitoring performance
  • Ability to encourage and build mutual trust, respect, and cooperation among team members
  • Ability to communicate with people outside the organization and represent the organization to the public, government, and other external sources
  • Ability to work independently or within a team structure
  • Must be able to read, legibly write, speak, and comprehend English
  • Must be able to operate a telephone and computer
  • May be exposed to environmental cleaning chemicals

PHYSICAL FACTORS
  • Requires Light work. Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects. If the use of arm and/or leg controls requires exertion of forces greater than that for sedentary work and the worker sits most of the time, the job is rated for light work
  • Ability to tolerate prolonged periods of sitting, standing, and/or walking
  • Ability to reach reasonable distances to handle equipment
  • Good manual and finger dexterity
  • Must be able to perform the duties with or without reasonable accommodation
  • Hearing and vision must be normal or corrected to within normal range
  • Physical presence onsite is essential

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