Job Title: RN Case Manager/Utilization Review Location: Tuba City, AZ Job Type: Contract (13 weeks) Position Details: * Schedule: Monday to Friday, 8 AM - 5 PM; Weekend on-call rotation (1 weekend ...
Job Title: RN Case Manager/Utilization Review Location: Tuba City, AZ Job Type: Contract (13 weeks) Position Details: * Schedule: Monday to Friday, 8 AM - 5 PM; Weekend on-call rotation (1 weekend ...
Job Title: RN Case Manager/Utilization Review Location: Tuba City, AZ Job Type: Contract (13 weeks) Position Details: * Schedule: Monday to Friday, 8 AM - 5 PM; Weekend on-call rotation (1 weekend ...
Job Title: RN Case Manager/Utilization Review Location: Tuba City, AZ Job Type: Contract (13 weeks) Position Details: * Schedule: Monday to Friday, 8 AM - 5 PM; Weekend on-call rotation (1 weekend ...
Outpatient/Inpatient Case Manager/Utilization Review Registered Nurse Incumbent serves as an Outpatient/Inpatient Case Manager/Utilization Review Registered Nurse (CM/UR RN) for TCRHCC and is ...
Outpatient/Inpatient Case Manager/Utilization Review Registered Nurse Incumbent serves as an Outpatient/Inpatient Case Manager/Utilization Review Registered Nurse (CM/UR RN) for TCRHCC and is ...
Case Manager-Case Management-HHK-Sacaton
Sacaton, AZ · On-site
$20.50 - $26.50/hr
The Case Manager performs Utilization Review of the medical necessity and appropriateness of care using InterQual criteria of patients admitted to Gila River Health Care inpatient unit: assessing ...
Case Manager-Case Management-HHK-Sacaton
Sacaton, AZ · On-site
$20.50 - $26.50/hr
The Case Manager performs Utilization Review of the medical necessity and appropriateness of care using InterQual criteria of patients admitted to Gila River Health Care inpatient unit: assessing ...
The Case Manager performs Utilization Review of the medical necessity and appropriateness of care using InterQual criteria of patients admitted to Gila River Health Care inpatient unit: assessing ...
The Case Manager performs Utilization Review of the medical necessity and appropriateness of care using InterQual criteria of patients admitted to Gila River Health Care inpatient unit: assessing ...
Case Manager-Case Management-HHK-Sacaton
Sacaton, AZ · On-site
$20.50 - $26.50/hr
The Case Manager performs Utilization Review of the medical necessity and appropriateness of care using InterQual criteria of patients admitted to Gila River Health Care inpatient unit: assessing ...
Case Manager-Case Management-HHK-Sacaton
Sacaton, AZ · On-site
$20.50 - $26.50/hr
The Case Manager performs Utilization Review of the medical necessity and appropriateness of care using InterQual criteria of patients admitted to Gila River Health Care inpatient unit: assessing ...
Case Manager-Case Management-HHK-Sacaton
Sacaton, AZ · On-site
$20.50 - $26.50/hr
The Case Manager performs Utilization Review of the medical necessity and appropriateness of care using InterQual criteria of patients admitted to Gila River Health Care inpatient unit: assessing ...
Case Manager-Case Management-HHK-Sacaton
Sacaton, AZ · On-site
$20.50 - $26.50/hr
The Case Manager performs Utilization Review of the medical necessity and appropriateness of care using InterQual criteria of patients admitted to Gila River Health Care inpatient unit: assessing ...
CASE MANAGER - RN
Mesa, AZ · On-site
The Case Manager is responsible for coordinating and monitoring day to day operations of the Case Management and Utilization Management programs. He/She directs the activities necessary to ensure ...
CASE MANAGER - RN
Mesa, AZ · On-site
The Case Manager is responsible for coordinating and monitoring day to day operations of the Case Management and Utilization Management programs. He/She directs the activities necessary to ensure ...
Certified Case Manager (CCM) issued by the Commission for Case Manager Certification. --OR-- * Possess two (2) years of full-time broad based registered nurse experience in a utilization management ...
Certified Case Manager (CCM) issued by the Commission for Case Manager Certification. --OR-- * Possess two (2) years of full-time broad based registered nurse experience in a utilization management ...
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 ...
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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 ...
CASE MANAGER - RN
Mesa, AZ · On-site
The Case Manager is responsible for coordinating and monitoring day to day operations of the Case Management and Utilization Management programs. He/She directs the activities necessary to ensure ...
CASE MANAGER - RN
Mesa, AZ · On-site
The Case Manager is responsible for coordinating and monitoring day to day operations of the Case Management and Utilization Management programs. He/She directs the activities necessary to ensure ...
Certified Case Manager (CCM) issued by the Commission for Case Manager Certification. --OR-- * Possess two (2) years of full-time broad based registered nurse experience in a utilization management ...
Certified Case Manager (CCM) issued by the Commission for Case Manager Certification. --OR-- * Possess two (2) years of full-time broad based registered nurse experience in a utilization management ...
Case Manager - Per Diem
Tucson, AZ · On-site
$17.25 - $22.25/hr
CASE MANAGER Vista Specialty Hospital Case Manager Summary: Coordinates management of care for a ... optimum utilization of resources, service delivery and compliance with external review agencies.
Case Manager - Per Diem
Tucson, AZ · On-site
$17.25 - $22.25/hr
CASE MANAGER Vista Specialty Hospital Case Manager Summary: Coordinates management of care for a ... optimum utilization of resources, service delivery and compliance with external review agencies.
RN - Utilization Management
Phoenix, AZ · On-site
Certified Case Manager (CCM) issued by the Commission for Case Manager Certification. -OR- * Possess two (2) years of full-time broad based registered nurse experience in a utilization management ...
RN - Utilization Management
Phoenix, AZ · On-site
Certified Case Manager (CCM) issued by the Commission for Case Manager Certification. -OR- * Possess two (2) years of full-time broad based registered nurse experience in a utilization management ...
Utilization Review RN
Chandler, AZ · On-site
Job Summary and Responsibilities As our Utilization Review Nurse at the Utilization Management Hub ... Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification Where You'll ...
Utilization Review RN
Chandler, AZ · On-site
Job Summary and Responsibilities As our Utilization Review Nurse at the Utilization Management Hub ... Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification Where You'll ...
Medical Case Manager
Scottsdale, AZ · Hybrid
To provide comprehensive quality telephonic case management to proactively drive a medically ... Perform Utilization Review activities prospectively, concurrently or retrospectively in accordance ...
Medical Case Manager
Scottsdale, AZ · Hybrid
To provide comprehensive quality telephonic case management to proactively drive a medically ... Perform Utilization Review activities prospectively, concurrently or retrospectively in accordance ...
Medical Case Manager
Scottsdale, AZ · On-site
To provide comprehensive quality telephonic case management to proactively drive a medically ... Perform Utilization Review activities prospectively, concurrently or retrospectively in accordance ...
Medical Case Manager
Scottsdale, AZ · On-site
To provide comprehensive quality telephonic case management to proactively drive a medically ... Perform Utilization Review activities prospectively, concurrently or retrospectively in accordance ...
Medical Case Manager
Scottsdale, AZ · On-site
To provide comprehensive quality telephonic case management to proactively drive a medically ... Perform Utilization Review activities prospectively, concurrently or retrospectively in accordance ...
Medical Case Manager
Scottsdale, AZ · On-site
To provide comprehensive quality telephonic case management to proactively drive a medically ... Perform Utilization Review activities prospectively, concurrently or retrospectively in accordance ...
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
$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 ...
Utilization Case Manager information
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.
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 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 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.
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Job description
Job Title: RN Case Manager/Utilization Review
Location: Tuba City, AZ
Job Type: Contract (13 weeks)
Position Details:
Location: Tuba City, AZ
Job Type: Contract (13 weeks)
Position Details:
- Schedule: Monday to Friday, 8 AM - 5 PM; Weekend on-call rotation (1 weekend/month)
- EMR System: Allscripts
- Pay: Competitive rates (details provided upon application)
- Provide case management and utilization review for inpatient and outpatient settings.
- Conduct patient assessments, service planning, and monitor progress.
- Collaborate with multidisciplinary teams for discharge planning and care transitions.
- Perform chart reviews for clinical documentation, claims denials, and peer review.
- Link clients with healthcare, social, mental health, and substance abuse services.
- Education: Associate Degree in Nursing (ADN); BSN required within 2 years of hire.
- Licensure: Valid RN license in the U.S., Puerto Rico, or U.S. territories.
- Certification: Current BLS (AHA).
- Experience: Minimum 3 years of clinical nursing, including 2+ years in an inpatient setting (Med-Surg, ICU, Step-Down, etc.) or home health.
- Knowledge of case management, utilization review processes, and electronic health records.
About InstantServe
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InstantServe provides a one-stop solution to all Healthcare, IT/Non-IT Staffing needs. Established in 2016, InstantServe is a strong workforce of over 100+ go-getters with a demonstrated background in IT/Non-IT service. We are a nationally certified SBE from the Department of Administration (State of PA). As a proud Minority Woman Owned Small Business Enterprise (M/WBE), InstantServe boasts of a strong team of professionals who have extensive experience catering to several Federal, Public, Commercial, and Healthcare Clients which includes 26 States and 46 government agencies. InstantServe is a client-centric organization that offers cost-effective and reliable solutions. Client satisfaction is sacrosanct! Our team strives to provide the best staffing and IT solutions to take your business to the next level.
Industry
Recruiting and staffing services
Company size
11 - 50 Employees
Headquarters location
Wayne, PA, US
Year founded
2016