Case Manager The Case Manager is responsible to assist in the development, planning, coordination and administration of the activities of Utilization Review and Discharge Planning. Including but not ...
Case Manager The Case Manager is responsible to assist in the development, planning, coordination and administration of the activities of Utilization Review and Discharge Planning. Including but not ...
Overview The Case Manager is responsible to assist in the development, planning, coordination and administration of the activities of Utilization Review and Discharge Planning. Including but not ...
Overview The Case Manager is responsible to assist in the development, planning, coordination and administration of the activities of Utilization Review and Discharge Planning. Including but not ...
This role integrates and coordinates Utilization management, care coordination and discharge planning functions. The Case Manager is accountable for a designated patient caseload and plans ...
This role integrates and coordinates Utilization management, care coordination and discharge planning functions. The Case Manager is accountable for a designated patient caseload and plans ...
This role integrates and coordinates Utilization management, care coordination and discharge planning functions. The Case Manager is accountable for a designated patient caseload and plans ...
This role integrates and coordinates Utilization management, care coordination and discharge planning functions. The Case Manager is accountable for a designated patient caseload and plans ...
This role integrates and coordinates Utilization management, care coordination and discharge planning functions. The Case Manager is accountable for a designated patient caseload and plans ...
This role integrates and coordinates Utilization management, care coordination and discharge planning functions. The Case Manager is accountable for a designated patient caseload and plans ...
Utilization Review or Case Management experience Required License/Registration/Certification: Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) or Licensed Registered Nurse Preferred ...
Utilization Review or Case Management experience Required License/Registration/Certification: Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) or Licensed Registered Nurse Preferred ...
Utilization Review or Case Management experience Required License/Registration/Certification: Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) or Licensed Registered Nurse Preferred ...
Utilization Review or Case Management experience Required License/Registration/Certification: Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) or Licensed Registered Nurse Preferred ...
Case Manager- Social Worker
Montgomery, AL · On-site
$18 - $23.50/hr
Under the direction of the Manager, Clinical Resource Management; the Case Manager is responsible for the activities of utilization management, case coordination and the development and ...
New
Case Manager- Social Worker
Montgomery, AL · On-site
$18 - $23.50/hr
Under the direction of the Manager, Clinical Resource Management; the Case Manager is responsible for the activities of utilization management, case coordination and the development and ...
New
This role integrates and coordinates Utilization management, care coordination and discharge planning functions. The Case Manager is accountable for a designated patient caseload and plans ...
This role integrates and coordinates Utilization management, care coordination and discharge planning functions. The Case Manager is accountable for a designated patient caseload and plans ...
Utilization Review or Case Management experience Required License/Registration/Certification: Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) or Licensed Registered Nurse Preferred ...
Utilization Review or Case Management experience Required License/Registration/Certification: Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) or Licensed Registered Nurse Preferred ...
Case Manager- Social Worker
$18 - $23.50/hr
Under the direction of the Manager, Clinical Resource Management; the Case Manager is responsible for the activities of utilization management, case coordination and the development and ...
New
Case Manager- Social Worker
$18 - $23.50/hr
Under the direction of the Manager, Clinical Resource Management; the Case Manager is responsible for the activities of utilization management, case coordination and the development and ...
New
CASE MANAGER FT (13195)
Cullman, AL · On-site
Promote effective utilization and monitoring of healthcare resources and assumes a leadership role ... case management. Advanced communication and interpersonal skills with all levels of internal and ...
CASE MANAGER FT (13195)
Cullman, AL · On-site
Promote effective utilization and monitoring of healthcare resources and assumes a leadership role ... case management. Advanced communication and interpersonal skills with all levels of internal and ...
This role integrates and coordinates Utilization management, care coordination and discharge planning functions. The Case Manager is accountable for a designated patient caseload and plans ...
This role integrates and coordinates Utilization management, care coordination and discharge planning functions. The Case Manager is accountable for a designated patient caseload and plans ...
This role integrates and coordinates Utilization management, care coordination and discharge planning functions. The Case Manager is accountable for a designated patient caseload and plans ...
This role integrates and coordinates Utilization management, care coordination and discharge planning functions. The Case Manager is accountable for a designated patient caseload and plans ...
Utilization Review or Case Management experience Required License/Registration/Certification: Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) or Licensed Registered Nurse Preferred ...
Utilization Review or Case Management experience Required License/Registration/Certification: Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) or Licensed Registered Nurse Preferred ...
Utilization Review or Case Management experience Required License/Registration/Certification: Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) or Licensed Registered Nurse Preferred ...
Utilization Review or Case Management experience Required License/Registration/Certification: Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) or Licensed Registered Nurse Preferred ...
American Traveler is hiring an experienced RN Case Manager for an Acute Care Case Management role requiring 2+ years of hospital-based discharge planning experience and a CA RN license. Job Details ...
American Traveler is hiring an experienced RN Case Manager for an Acute Care Case Management role requiring 2+ years of hospital-based discharge planning experience and a CA RN license. Job Details ...
American Traveler is hiring an experienced RN Case Manager for a 13-week acute care hospital assignment requiring 2 years of case management experience and a CA RN license. Job Details • Acute care ...
New
American Traveler is hiring an experienced RN Case Manager for a 13-week acute care hospital assignment requiring 2 years of case management experience and a CA RN license. Job Details • Acute care ...
New
AMCT Case Manager
Cullman, AL · On-site
: Adult Mobile Crisis Team Case Managers work closely with our Cullman County First Responders, First ... Maintain high quality client documentation and records management utilization electronic charting.
AMCT Case Manager
Cullman, AL · On-site
: Adult Mobile Crisis Team Case Managers work closely with our Cullman County First Responders, First ... Maintain high quality client documentation and records management utilization electronic charting.
This role integrates and coordinates Utilization management, care coordination and discharge planning functions. The Case Manager is accountable for a designated patient caseload and plans ...
This role integrates and coordinates Utilization management, care coordination and discharge planning functions. The Case Manager is accountable for a designated patient caseload and plans ...
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:
Requisition RN Case Mgr - Highlands Case Management - FT - 1st Shift
Scottsboro, AL • On-site
Other
Re-posted 7 days ago
Job description
Case Manager
The Case Manager is responsible to assist in the development, planning, coordination and administration of the activities of Utilization Review and Discharge Planning. Including but not limited to daily review of medical records to determine appropriateness and medical necessity of admission, continued hospital stay and use of ancillary services.
Associates degree in Nursing. Minimum of three years nursing experience required. Three years' experience in case management or utilization management preferred.
Highlands Medical Center is a 170-bed hospital located in Scottsboro, offering a wide variety of emergency, inpatient and outpatient services to support the wellness of our community. A part of the Huntsville Hospital Health System, HMC has the strength of a collaborative group of high-performing hospitals across North Alabama to share information, processes, ideas and best practices for continual enhancements to the care and services offered to meet the health care needs of our diverse community. Accredited by the Joint Commission, Highlands Medical Center stands out as one of the top-rated healthcare providers in the state.
In addition to Highlands Medical Center, the system provides many services through owned-entities across the community - Highlands Family Medicine, Highlands Home Health, Highlands Occupational Medicine, Highlands Surgical Services, Jackson County Family Medicine, Scottsboro OB-GYN, Highlands Pediatrics, and Highlands Health & Rehab and Cumberland Health & Rehab, two rehabilitation and long-term care nursing homes. With over 720 employees, HMC is one of the largest employers in Jackson County.
About Huntsville Hospital
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Huntsville Hospital, located in Huntsville, Alabama, USA, operates in the healthcare industry. The organization's official website can be visited at huntsvillehospital.org. The hospital is a community-owned, not-for-profit healthcare system that was first established in 1895. This institution of paramount importance currently offers comprehensive health services dedicated to meeting the diverse needs of its community. The institution provides its services across a broad spectrum; this includes a children's hospital, women and infants’ hospital, a senior-orientated network, surgical services, orthopedic services, and more. Above all, Huntsville Hospital's core values emphasize patient safety, dignity, and care. Their mission is to deliver high-quality care and create a healthier community.
Industry
Hospitals
Company size
10,000+ Employees
Headquarters location
Huntsville, AL, US