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Utilization Case Manager Jobs (NOW HIRING)

Project Hospitality

Case Manager

Staten Island, NY · On-site

$22/hr

SUMMARY: The Case Manager will work in our Transitional Independent Living Program (TIL) and be ... Care Coordination includes making referrals for services, monitoring service utilization, case ...

Project Hospitality

Case Manager

Staten Island, NY · On-site

$20.25 - $26.25/hr

SUMMARY: The Case Manager will work in our Transitional Independent Living Program (TIL) and be ... Care Coordination includes making referrals for services, monitoring service utilization, case ...

Baptist Health

Clinical Case Coordinator I

Malvern, AR · On-site

Utilization /Case Management Shift: Day Working Hours: 8:30-4:30pm Summary: The Clinical Case Coordinator I is accountable for the clinical and financial outcome of care for an assigned case load. He ...

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How much do utilization case manager jobs pay per hour?

As of Jul 11, 2026, the average hourly pay for utilization case manager in the United States is $36.49, according to ZipRecruiter salary data. Most workers in this role earn between $29.57 and $38.46 per hour, depending on experience, location, and employer.

What is a Utilization Case Manager?

A Utilization Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient cases, coordinate with healthcare providers, and ensure that treatments are in line with established guidelines and insurance requirements. Their goal is to optimize patient outcomes while managing costs and ensuring compliance with regulations. Utilization Case Managers often work in hospitals, insurance companies, or managed care organizations.

What does a utilization case manager do?

A utilization case manager reviews and authorizes healthcare services to ensure they are necessary and appropriate, often working with insurance companies and healthcare providers. They analyze patient records, coordinate care plans, and ensure compliance with policies, typically using case management software and requiring strong communication skills.

How does a Utilization Case Manager typically collaborate with healthcare providers and insurance companies?

Utilization Case Managers play a key role in coordinating care between healthcare providers and insurance companies. They review patient cases to ensure that the recommended treatments are medically necessary and align with insurance policies. This often involves regular communication with doctors, nurses, and insurance representatives to gather information, clarify treatment plans, and advocate for appropriate patient care. Strong collaboration skills are essential, as Utilization Case Managers must balance the needs of patients with organizational guidelines while maintaining positive professional relationships.

What jobs pay 4000 a week without a degree?

Utilization Case Managers typically do not earn $4,000 weekly without relevant experience or certifications; most roles in healthcare or social services pay less. High-paying jobs that can reach this level without a degree are rare and often involve specialized skills, sales, or entrepreneurship. Generally, achieving such income without a degree requires significant experience, licensing, or working in high-demand fields like real estate or certain trades.

What is the highest paid case manager?

The highest paid case managers are often those with advanced certifications, specialized skills, or experience in high-demand fields such as healthcare or insurance. Senior or managerial roles, such as Utilization Review Managers, can earn salaries exceeding $80,000 to $100,000 annually. Compensation varies based on location, industry, and level of responsibility.

Is being a MOA a good entry level job?

A Medical Office Assistant (MOA) role is often considered an entry-level position in healthcare, requiring basic administrative and clinical skills. It provides experience with medical records, patient communication, and office procedures, which can serve as a foundation for advancing in healthcare careers. However, the job's suitability depends on individual career goals and the specific workplace environment.

What are the key skills and qualifications needed to thrive as a Utilization Case Manager, and why are they important?

To thrive as a Utilization Case Manager, you need a background in nursing or social work, strong analytical skills, and a solid understanding of healthcare regulations and insurance processes, often supported by RN licensure or certification in case management (e.g., CCM). Familiarity with utilization management software, electronic health records (EHRs), and payer authorization systems is essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration among patients, providers, and payers. These skills ensure appropriate care delivery, cost management, and compliance with healthcare standards.

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

AspectUtilization Case ManagerUtilization Review Nurse
CredentialsRN license, case management certificationRN license, certification in utilization review
Work EnvironmentCase management teams, hospitals, insurance companiesUtilization review departments, hospitals, insurance providers
Primary FocusCoordinating patient care, discharge planning, resource allocationAssessing medical necessity, reviewing patient records for appropriateness
Common UsageBroader case management roles, patient advocacySpecific review of medical necessity and insurance claims

While both roles require RN licensure and focus on patient care, the Utilization Case Manager primarily coordinates overall patient services and discharge planning, whereas the Utilization Review Nurse concentrates on evaluating the medical necessity of treatments for insurance purposes. Understanding these distinctions helps in choosing the right career path or job search focus.

More about Utilization Case Manager jobs
What cities are hiring for Utilization Case Manager jobs? Cities with the most Utilization Case Manager job openings:
What states have the most Utilization Case Manager jobs? States with the most job openings for Utilization Case Manager jobs include:
What job categories do people searching Utilization Case Manager jobs look for? The top searched job categories for Utilization Case Manager jobs are:
Utilization Case Manager jobs near you
Infographic showing various Utilization Case Manager job openings in the United States as of July 2026, with employment types broken down into 2% As Needed, 78% Full Time, 17% Part Time, and 3% Contract. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $75,891 per year, or $36.5 per hour.
Pharmacist, Utilization Case Manager - Archimedes

Pharmacist, Utilization Case Manager - Archimedes

Navitus Health Solutions

Remote

Other

Medical, Dental, Vision, Retirement, PTO

Posted 24 days ago

Job description

Pharmacist, Utilization Case Manager

The Pharmacist, Utilization Case Manager will coordinate care between physicians, patients, and pharmacies, facilitating access to specialty medications for patients with complex disease states

How do I make an impact on my team?

  • Review chart notes and perform utilization management on patient/drug specific case basis.
  • Coordinate facilitation of patients' specialty drug treatment, ensuring timely delivery to the appropriate site of care.
  • Handle case assignments, review case progress, properly document case notes, and determine case closure.
  • Provide clinical expertise to prescribers around preferred therapy and be a guide for prescribing offices through the prior authorization process.
  • Follow established procedures, processes, and standards for production, productivity, quality, and customer service. Meet performance targets for speed, efficiency, and quality.
  • Complete care management clinical escalations. Escalate to account management as appropriate.
  • Ensure all external and internal customers receive the level of customer service required by Archimedes and serve as a representative of Archimedes to all external customers.
  • Participate in, adhere to, and support compliance, people and culture, and learning programs.
  • Perform other duties as assigned.

What our team expects from you?

  • Education: PharmD required.
  • Certification/Licenses: Current, unrestricted licensure as a Registered Pharmacist in the state of residence, or the ability to gain reciprocity within 4 months, may be required based on state of residence laws or client contracts. Refer to the Licensure and Credentialing Verification P&P for current detail.
  • Experience: Retail, hospital, or specialty pharmacy experience required. Utilization and Case management experience preferred. Experience in an infusion setting, physician office, or pharmacy preferred. Experience with managing specialty medications for patients with chronic illness preferred. Expert in Microsoft Office Suite.

What can you expect from Archimedes?

  • Top of the industry benefits for Health, Dental, and Vision insurance
  • 20 days paid time off
  • 4 weeks paid parental leave
  • 9 paid holidays
  • 401K company match of up to 5% - No vesting requirement
  • Adoption Assistance Program
  • Flexible Spending Account
  • Educational Assistance Plan and Professional Membership assistance

Location: Remote

Location: US

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