American Traveler is seeking an experienced RN Case Manager with inpatient case management ... utilization review, prior authorizations, care coordination, admission criteria evaluation, and ...
American Traveler is seeking an experienced RN Case Manager with inpatient case management ... utilization review, prior authorizations, care coordination, admission criteria evaluation, and ...
RN-CASE MGR | CASE MANAGEMENT
Mccalla, AL · On-site
The RN-Case Manager plays a critical role in coordinating and managing patient care to ensure ... Familiarity with chronic disease management and utilization review processes. * Master's degree in ...
RN-CASE MGR | CASE MANAGEMENT
Mccalla, AL · On-site
The RN-Case Manager plays a critical role in coordinating and managing patient care to ensure ... Familiarity with chronic disease management and utilization review processes. * Master's degree in ...
Case Manager
Pelham, AL · On-site
$18.25 - $23.75/hr
Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications License or Certification:
Case Manager
Pelham, AL · On-site
$18.25 - $23.75/hr
Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications License or Certification:
Shift: 8:00AM - 5:00PM ET Position Goal The Case Manager is responsible for performing care coordination, utilization review support, and discharge planning. This includes assessment, identification ...
Shift: 8:00AM - 5:00PM ET Position Goal The Case Manager is responsible for performing care coordination, utilization review support, and discharge planning. This includes assessment, identification ...
Case Manager
$19.75 - $25.50/hr
Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...
Case Manager
$19.75 - $25.50/hr
Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...
Case Manager
$18.75 - $24.25/hr
Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * Must be qualified to ...
Case Manager
$18.75 - $24.25/hr
Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * Must be qualified to ...
Case Manager
$18 - $23.25/hr
Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...
Case Manager
$18 - $23.25/hr
Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...
Case Manager Full Time
Phenix City, AL · On-site
Shift: 8:00AM - 5:00PM ET Position Goal The Case Manager is responsible for performing care coordination, utilization review support, and discharge planning. This includes assessment, identification ...
Case Manager Full Time
Phenix City, AL · On-site
Shift: 8:00AM - 5:00PM ET Position Goal The Case Manager is responsible for performing care coordination, utilization review support, and discharge planning. This includes assessment, identification ...
Case Manager Full Time
Phenix City, AL · On-site
Shift: 8:00AM - 5:00PM ET Position Goal The Case Manager is responsible for performing care coordination, utilization review support, and discharge planning. This includes assessment, identification ...
Case Manager Full Time
Phenix City, AL · On-site
Shift: 8:00AM - 5:00PM ET Position Goal The Case Manager is responsible for performing care coordination, utilization review support, and discharge planning. This includes assessment, identification ...
An RN Case Manager will oversee and coordinate patient care from admission through discharge to ... Utilization Review: monitor the use of hospital resources and services to ensure appropriate care ...
An RN Case Manager will oversee and coordinate patient care from admission through discharge to ... Utilization Review: monitor the use of hospital resources and services to ensure appropriate care ...
RN Case Manager
Gadsden, AL · On-site
An RN Case Manager will oversee and coordinate patient care from admission through discharge to ... Utilization Review: monitor the use of hospital resources and services to ensure appropriate care ...
RN Case Manager
Gadsden, AL · On-site
An RN Case Manager will oversee and coordinate patient care from admission through discharge to ... Utilization Review: monitor the use of hospital resources and services to ensure appropriate care ...
American Traveler is hiring an experienced RN Case Manager with a CA RN license and inpatient acute ... utilization managers, medical social workers, and bedside RNs to ensure timely progression of ...
American Traveler is hiring an experienced RN Case Manager with a CA RN license and inpatient acute ... utilization managers, medical social workers, and bedside RNs to ensure timely progression of ...
RN Case Manager
Gadsden, AL · On-site
An RN Case Manager will oversee and coordinate patient care from admission through discharge to ... Utilization Review: monitor the use of hospital resources and services to ensure appropriate care ...
RN Case Manager
Gadsden, AL · On-site
An RN Case Manager will oversee and coordinate patient care from admission through discharge to ... Utilization Review: monitor the use of hospital resources and services to ensure appropriate care ...
RN Case Manager
Gadsden, AL · On-site
An RN Case Manager will oversee and coordinate patient care from admission through discharge to ... Utilization Review: monitor the use of hospital resources and services to ensure appropriate care ...
RN Case Manager
Gadsden, AL · On-site
An RN Case Manager will oversee and coordinate patient care from admission through discharge to ... Utilization Review: monitor the use of hospital resources and services to ensure appropriate care ...
RN Case Manager
Gadsden, AL · On-site
An RN Case Manager will oversee and coordinate patient care from admission through discharge to ... Utilization Review: m onitor the use of hospital resources and services to ensure appropriate care ...
RN Case Manager
Gadsden, AL · On-site
An RN Case Manager will oversee and coordinate patient care from admission through discharge to ... Utilization Review: m onitor the use of hospital resources and services to ensure appropriate care ...
Minimum 2 years of experience in Case Management, including Utilization Review and Discharge Planning in an inpatient rehabilitation setting.
Minimum 2 years of experience in Case Management, including Utilization Review and Discharge Planning in an inpatient rehabilitation setting.
American Traveler is hiring a Registered Nurse Case Manager for a 13-week acute care assignment ... utilization review, • Knowledge of CMS, CPT coding, DRG, and HIPAA guidelines, • Two ...
New
American Traveler is hiring a Registered Nurse Case Manager for a 13-week acute care assignment ... utilization review, • Knowledge of CMS, CPT coding, DRG, and HIPAA guidelines, • Two ...
New
Case Manager
Dothan, AL · On-site
$18.25 - $23.50/hr
Summary The Case Manager is responsible for performing case management and discharge planning in ... Demonstrates appropriate utilization of the skills as approved by the Alabama Board of Nursing or ...
Case Manager
Dothan, AL · On-site
$18.25 - $23.50/hr
Summary The Case Manager is responsible for performing case management and discharge planning in ... Demonstrates appropriate utilization of the skills as approved by the Alabama Board of Nursing or ...
Case Manager
Dothan, AL · On-site
$18.25 - $23.50/hr
Summary The Case Manager is responsible for performing case management and discharge planning in ... Demonstrates appropriate utilization of the skills as approved by the Alabama Board of Nursing or ...
Case Manager
Dothan, AL · On-site
$18.25 - $23.50/hr
Summary The Case Manager is responsible for performing case management and discharge planning in ... Demonstrates appropriate utilization of the skills as approved by the Alabama Board of Nursing or ...
American Traveler is hiring a Travel RN Case Manager for a hospital-based Case Management department requiring acute care case management experience and a FL or compact RN license. Job Details • ...
American Traveler is hiring a Travel RN Case Manager for a hospital-based Case Management department requiring acute care case management experience and a FL or compact RN license. Job Details • ...
Utilization Case Manager information
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.
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 degree do I need for utilization review?
Utilization case managers typically need at least a bachelor's degree in healthcare, nursing, social work, or a related field. Some positions may require a master's degree or professional certification, such as a Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ), to advance in the role or handle complex cases.
What are the key skills and qualifications needed to thrive as a utilization case manager?
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?
| Aspect | Utilization Case Manager | Utilization Review Nurse |
|---|---|---|
| Credentials | RN license, case management certification | RN license, certification in utilization review |
| Work Environment | Case management teams, hospitals, insurance companies | Utilization review departments, hospitals, insurance providers |
| Primary Focus | Coordinating patient care, discharge planning, resource allocation | Assessing medical necessity, reviewing patient records for appropriateness |
| Common Usage | Broader case management roles, patient advocacy | Specific 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.
What are popular job titles related to Utilization Case Manager jobs in Alabama? For Utilization Case Manager jobs in Alabama, the most frequently searched job titles are:
What job categories do people searching Utilization Case Manager jobs in Alabama look for? The top searched job categories for Utilization Case Manager jobs in Alabama are:
What cities in Alabama are hiring for Utilization Case Manager jobs? Cities in Alabama with the most Utilization Case Manager job openings:
Travel RN - Case Management/Utilization Review - Case Management
Estillfork, AL • On-site
Other
Re-posted 8 days ago
Job description
American Traveler is seeking an experienced RN Case Manager with inpatient case management experience and an active CA RN license for a primarily virtual role supporting complex cases across a health system and the community.
Job Details
• Primarily virtual position supporting complex cases across the health system and patients in the community,
• Occasional floating required between offices in Emeryville and San Francisco,
• Works across acute hospital and ambulatory settings,
• Day shift schedule: 5x8s, 8:00 AM-4:30 PM,
• Case management responsibilities include discharge planning, concurrent review, continued stay reviews, utilization review, prior authorizations, care coordination, admission criteria evaluation, and disease management,
• Patient ratio of 1:25,
• Epic EMR required,
• Teaching hospital experience required,
• Community hospital experience required,
Job Requirements
• Active CA RN license required,
• BLS certification required (AHA or ARC),
• Minimum 2 years of inpatient case management experience required,
• Travel nursing experience required,
• Epic EMR proficiency required,
• Experience with InterQual Criteria, DRG, CMS, and HIPAA guidelines required,
• Teaching hospital and community hospital experience required,
• Trauma Level I or II experience preferred,
• Charge nurse experience preferred,
• Ambulatory, behavioral health, and telephonic case management experience preferred,
• 2 supervisor references obtained within the past year required for consideration,
• 7-year work history verification required,
Additional Information
• Responsibilities include utilization review, medical necessity determinations, retrospective review, plan of care development, needs assessment, DME ordering, and benefits eligibility evaluation,
• Knowledge of CMS, DRG, HIPAA, and Joint Commission/Core Measures/National Safety Goals expected,
• Preferred specialty experience includes behavioral health, ED, ICU, SDU/PCU/IMC/Obs, and surgical services,
• Local candidates are accepted; candidates must reside more than 50 miles from the facility to qualify for travel pay rates,
• Former employees or travelers may return without a required separation period; former manager's name must be provided on the application (note: recruiter notes indicate a 1-year separation may apply - confirm with your recruiter),
• RTO is limited to a maximum of 7 days per contract; only 1 holiday may be requested off per contract,
• Holidays with coverage expectations include New Year's Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, and Christmas Day,
• Any background or licensure disclosures must be accompanied by supporting documentation for facility HR review