ZipRecruiter

Log In

1

Utilization Case Manager Jobs in Arizona (NOW HIRING)

Phoenix Children's Hospital

Case Manager

Phoenix, AZ · On-site

$19.75 - $25.50/hr

The Case Manager is responsible for Length of Stay management and discharge planning ... Develops, implements, monitors and documents the utilization of resources and progress of the ...

Phoenix Children's Hospital

Case Manager

Phoenix, AZ · On-site

$19.75 - $25.50/hr

The Case Manager is responsible for Length of Stay management and discharge planning ... Develops, implements, monitors and documents the utilization of resources and progress of the ...

HOPCO

RN Case Manager - Utilization Review

Phoenix, AZ · On-site

  • Medical

  • Retirement

Case Manager/Utilization Review Nurse At The CORE Institute, we are dedicated to taking care of you so you can take care of business! Our robust benefits package includes the following: * Competitive ...

HOPCo

RN Case Manager - Utilization Review

Phoenix, AZ · On-site

  • Medical

  • Retirement

A Case Manager/Utilization Review Nurse, in collaboration with patients/families, physicians and the interdisciplinary team, provides leadership and advocacy in the coordination of patient-centered ...

US Government Jobs

Nurse (Case Manager)

Parker, AZ · On-site

Position will provide professional nursing case management, utilization management, and discharge planning services by independently planning and executing inpatient case management activities ...

Staffingine LLC

MSW Case Manager

Tuba City, AZ · On-site

$24.50 - $32/hr

The Social Worker/RN Case Manager is responsible for utilization review of patient cases in the inpatient and outpatient services departments, and review of medical necessity of referrals to ...

AMERICAS REHAB CAMPUSES LLC

Case Manager

Tucson, AZ · On-site

$17.25 - $22.25/hr

The Case Manager at America's Rehab Campus (ARC) provides comprehensive case management and ... Tracks and reports on client progress, discharge outcomes, and service utilization. * Maintains ...

AMERICAS REHAB CAMPUSES LLC

Case Manager

Tucson, AZ

$17.25 - $22.25/hr

The Case Manager at America's Rehab Campus (ARC) provides comprehensive case management and ... Tracks and reports on client progress, discharge outcomes, and service utilization. * Maintains ...

Encompass Health Corporation

Case Manager

Mesa, AZ · On-site

$17.50 - $22.75/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...

next page

Showing results 1-20

All JobsUtilization Case JobsUtilization Case Manager JobsUtilization Case Manager Jobs in Arizona

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 Arizona?

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

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

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

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

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

Utilization Case Manager jobs near you

Case Manager

Phoenix Children's Hospital

Phoenix, AZ • On-site

$19.75 - $25.50/hr

Per diem

Re-posted 9 days ago

Job description

Position Details
Department: PCH-MAIN | Case Management
Location: Phoenix
Shift: Mon-Fri, Sat, Sun, (Days Vary), Days, 8am-5pm
Category: Nursing
Posting #: 987048
Employee Type: PRN
Position Summary
The position provides comprehensive care coordination for patients as assigned and assesses the patients plan of care. The Case Manager is responsible for Length of Stay management and discharge planning. Develops, implements, monitors and documents the utilization of resources and progress of the patient through their care, advocating and facilitating options and services to meet the patients health care needs. Interacts extensively with the care teams to support the clinical roadmap. The intensity of care coordination provided is situational and appropriate based on patient need and payer requirements. This position works independently, receiving supervision of work activities from the Lead CM team, Supervisor of Case Management and Manager of Case Management and is accountable for the quality of clinical services delivered by both them and community partners and identifies/resolves barriers which may hinder effective patient care.
Position Duties
  • Coordination of Care
    Manages a defined service line patient population to achieve optimal discharge and continuity of care outcomes in a manner that promotes sound financial stewardship and patient-family advocacy.
    Establishes estimated Length of Stay via MCG criteria and tools,
    Completes an initial screen of all patients on admission (not to exceed within 24 hours of admission) utilizing MCG criteria to identify needs related to care coordination and/or discharge planning.
    Leveraging MCG and other evidence-based guidelines, coordinates development and implementation of a comprehensive discharge care plan in collaboration with the clinical care team.
    Ensures plan of care is in place with all team members. Proactively collaborates with members of the interdisciplinary clinical care team to define and document a clear and comprehensive treatment plan, including post-discharge needs. Identifies and facilitates resolution of variances in the plan of care that may impact length of stay. Facilitates referrals to other disciplines, and monitors for appropriate follow-up.
    Facilitates and provides on-going communication with patient/family and escalates unresolved barriers to timely discharge to Case Management, Manager or Utilization Management Medical Director, as per department protocols.
    Reviews and analyzes third-party payer denials for in house patients, and communicates to attending physician , Case Management, Manager, Utilization Management Medical Director, and Utilization Management Nurse as per department protocols.
    Cultivates and maintains effective interaction/communication with members of the interdisciplinary care team and proactively engages patient and families in the delivery of care across the continuum of care.
    Reviews the patient daily for appropriate patient status , level of care and goal length of stay per established Case Management daily prioritization protocol , utilizing MCG criteria and communicates goal length of stay to clinical care team, patient and family.
    Keeps patient discharge information current in Case Manager EMR documentation. Assesses each patients status and activities daily as appropriate to patient needs. Ensures timeliness of care and identifies barriers to transition of care or discharge.
    Participates in interdisciplinary rounds and/or service line rounds with clinical care team.
  • Regulatory responsibilities
    Reviews the patient daily (Observation and Inpatient) for appropriate status and meeting admission or discharge criteria.
    Obtains and reviews necessary medical reports and subsequent treatment plan requests to conduct ongoing care planning and discharge planning.
    Utilizes MCG guidelines/pathways to determine admission status, level of care, goal length of stay and continued provision of services as evidenced by audit of documentation in EMR.
    Documents avoidable days, extended length of stay, authorizations and denials for medical necessity in SCM and SAM as evidenced by audit.
    Communicates to Utilization Management Nurse data supporting denial appeals, or notification of potential denials.
    Communicates with payers to resolve potential denials.
    Working knowledge of DRG payment methodology and ICD-9/10 coding system.
    Provides Medicare/Tricare Rights and Detailed Notice of Discharge to patient and families.
  • Transition and Discharge Planning
    Assures thorough, early and ongoing transition/discharge plans by collaborating with patients, families, payers and providers across the continuum of care.
    Assesses patient for appropriate discharge placement. Identifies presumed discharge location on admission.
    Consults with social services and other resources as needs or problems are identified.
    Communicates transition/discharge plans and problems to other case managers as care is transitioned. Ensures that health care team is proactive in making arrangements for transition/discharge, and ensures that each transition/discharge plan has clear goals that are attainable. Ensures that all elements of patients` needs are addressed in the transition/discharge plans.
    Validates that family and patient are aware and understand discharge plan as demonstrated by documentation and feedback.
    Ensures that education and teaching for family and patient to support transition/discharge is begun as quickly as possible with the health care team.
    When appropriate, performs outpatient and clinic care coordination and monitors patients care as they transition between inpatient and outpatient service.
  • Provides excellent customer service
    Ensures that all elements of patients` needs are addressed in the transition/discharge plans.
    Keeps families and patients involved and informed as demonstrated by feedback.
    Facilitates and provides on-going communication with patient/family and interdisciplinary staff to identify and resolve potential barriers to discharge
    Communicates with payers to resolve potential denials.
    Responds to emails within 24 hours.
    Clear communication skills with all internal and external customers.
    Provides excellent service routinely in interactions with all customers, i.e. Co workers, patients, visitors, physicians, volunteers, etc.
  • Leadership care coordination
    Provides unit and team leadership demonstrates strong, consistent clear communication and serves as central point of information informing all team members, including physicians, on patient status and goal length of stay.
    Keeps families and patients involved and informed as demonstrated by feedback.
    Cultivates and maintains effective interaction/communication with members of the medical staff, nursing staff, social workers, Utilization Management team and families to drive the care coordination process and to facilitate continuity of patient care.
  • Performs miscellaneous job related duties as requested.

Phoenix Children's Mission, Vision, & Values
Mission
To advance hope, healing and the best healthcare for children and their families
Vision
Phoenix Children's will be the leading pediatric health system in the Southwest, nationally recognized for exceptional care, innovative research and advanced medical education.
We realize this vision by:
  • Offering the most comprehensive care across ages, communities and specialties
  • Investing in innovative research, including emerging treatments, tools and technologies
  • Advancing education and training to shape the next generation of clinical leaders
  • Advocating for the health and well-being of children and families
Values
  • We place children and families at the center of all we do
  • We deliver exceptional care, every day and in every way
  • We collaborate with colleagues, partners and communities to amplify our impact
  • We set the standards of pediatric healthcare today, and innovate for the future
  • We are accountable for making the highest quality care accessible and affordable
Phoenix Children's Hospital logo

About Phoenix Children's Hospital

Sourced by ZipRecruiter

Phoenix Children's Hospital, located in Phoenix, AZ, is a prominent establishment within the healthcare industry. Known for its commitment to pediatric healthcare, the hospital provides a vast range of services catering to the unique health needs of children. Originally founded in 1983, Phoenix Children's Hospital prides itself on being one of the largest and most respected children's hospitals in the country. Guided by its mission–"to provide hope, healing and the best healthcare for children and their families"–the hospital holds strong on its core values of family-centered care, excellence in clinical care, innovation, and stewardship.

Industry

Health care and social assistance

Company size

1,001 - 5,000 Employees

Headquarters location

Phoenix, AZ, US

Year founded

1983

Social media

FacebookTwitter

View All Phoenix Children's Hospital Jobs

Apply