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Utilization Case Manager Jobs in Alaska (NOW HIRING)

Care Career

Travel Nurse RN - Care Manager

Anchorage, AK · On-site

  • Medical

  • Dental

  • Vision

Case management and discharge planning * Care coordination * Assess patient needs and develop care plans * Utilization review and medical necessity * Prior authorizations * Continued-stay reviews

Mat-Su Regional Medical Center

Care Manager RN

Palmer, AK

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

... continued hospital stay, and utilization of diagnostic services. * Collaborates with ... Maintains accurate and timely documentation of case management activities, including records of ...

Pacs

$30 - $40.25/hr

Performs utilization review activities to provide resident appropriate, timely and cost-effective ... Certificate as a certified Case Manager (CCM) a plus. * Must maintain all required continuing ...

New

CVS Health

Care Plan Reviewer- OhioRISE

Homer, AK · On-site

$60K - $129K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Managed care/utilization review experience. Case management and discharge planning experience Education Minimum of a Master's degree in Counseling, Social Work, or Marriage and Family Therapy is ...

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All JobsUtilization Case JobsUtilization Case Manager JobsUtilization Case Manager Jobs in Alaska

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?

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.

What are popular job titles related to Utilization Case Manager jobs in Alaska?

For Utilization Case Manager jobs in Alaska, the most frequently searched job titles are:

What job categories do people searching Utilization Case Manager jobs in Alaska look for?

The top searched job categories for Utilization Case Manager jobs in Alaska are:

What cities in Alaska are hiring for Utilization Case Manager jobs?

Cities in Alaska with the most Utilization Case Manager job openings:

Utilization Case Manager jobs near you

Public Health LPN / Community Health Aide Practitioner Case Manager

Yukon-Kuskokwim Health Corporation

Bethel, AK • On-site

$28.75 - $38/hr

Full-time

Medical, Life, Retirement, PTO

Re-posted 18 days ago

Job description

Public Health LPN / Community Health Aide Practitioner Case Manager
Bethel, Alaska
We are working together to achieve excellent health. Come join us!
The Yukon-Kuskokwim Health Corporation is a Tribal health care organization, serving nearly 30,000 people living across rural, southwest Alaska in villages with populations from about 10 to more than 1,000. Bethel, the regional hub and location of the only hospital in the region, has a population of nearly 7,000. The Yukon-Kuskokwim Delta is home to thousands of lakes and two primary rivers-the Kuskokwim and Yukon.
We offer a broad range of employment opportunities and the chance to make a meaningful impact on the health of people in the region.
Position Summary: This position is accountable for assessing, planning, coordinating, monitoring and evaluating, and providing public health services for patients and their families, fostering quality, continuity, and appropriate utilization of health care resources throughout the continuum of care. Public Health LPN Case Managers facilitate a cooperative effort between patients, parents, doctors, nurses, payers, and allied health care workers, community agencies and home care services, promoting a smooth journey through the entire span of care. The case manager facilitates the coordinated utilization of resources for maximization of health outcomes, patient/family satisfaction and financial outcomes.
This position assists with procurement and management of vaccines and other essential program supplies, and ensures that all vaccines and other supplies are strictly handled according to State of Alaska. The LPN Case Manager may provide direct patient care in support of program goals and corporate priorities.
Position Qualifications:
Minimum Education: Graduate from an LNL school for LPN's or LVN's or Certified Community Health Aide Practitioner. In addition must be certified as a CHP or licensed as an LPN in the State of Alaska in good standing.
Minimum Experience: 3 - 5 years prior experience in nursing.
License, Certification, Registration: Current CPR certification (BCLS) required. Must be licensed in good standing in the State of Alaska as a Registered Professional Nurse. Current BLS. The successful candidate will be required to pass and maintain competencies for this position.
Equipment/Tools: Office machines (i.e. computer, copier, fax, telephone, Microsoft Office)
Specialized Knowledge and Skills
1. Knowledge of medical terminology.
2. Ability to work in patient care setting.
Benefits Include:
  • Generous PTO - starting at 4.5 weeks per year, accrued over time
  • Eleven paid holidays
  • Comprehensive healthcare coverage
  • Life and Disability Insurance
  • Flexible Spending Account
  • Retirement plans
  • Employee Wellness Center
  • Plus More!

C#
Additional Information:
ID:18316Location:BethelDepartment:Well Child/ImmunizationEmployment Duration:80 Full timeTemporary Status:Not ApplicableHours per Week:40Minimum Hourly Pay:35.23FLSA Status:Non-exempt
Yukon Kuskokwim Health Corporation is an Affirmative Action/Equal Opportunity Employer. All qualified individuals will receive consideration for employment without regard to race, ethnicity, age, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status and any other basis protected by law. Individuals with disabilities needing assistance in the recruitment process are encouraged to contact Human Resources directly.
Under P.L. 93-638, preference is given to Alaska Native/American Indian applicants.
For more information, please contact the YKHC Recruitment Department at YKHCRecruitment@YKHC.org or phone (907) 543-6060 and ask to speak with a recruiter.
To view more positions available please visit YKHC Career Center (https://chu.tbe.taleo.net/chu01/ats/careers/v2/jobSearch?org=YKHC&cws=41)

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