Case Manager*
$20.50 - $26.25/hr
Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria ...
Case Manager*
$20.50 - $26.25/hr
Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria ...
Case Manager
Murrieta, CA · On-site
$59.18 - $79.60/hr
Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria ...
Case Manager
Murrieta, CA · On-site
$59.18 - $79.60/hr
Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria ...
Case Manager
Murrieta, CA · On-site
$20.50 - $26.25/hr
Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria ...
Case Manager
Murrieta, CA · On-site
$20.50 - $26.25/hr
Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria ...
Case Manager
Murrieta, CA · On-site
$59.18 - $79.60/hr
Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria ...
Case Manager
Murrieta, CA · On-site
$59.18 - $79.60/hr
Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria ...
Case Manager
$20.50 - $26.25/hr
Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria ...
Case Manager
$20.50 - $26.25/hr
Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria ...
Case Manager
San Diego, CA · On-site
$29.14 - $38/hr
Previous experience in case management and/or utilization review preferred. Licenses/Certifications ... AOD Registration is required. * AOD Certification is preferred. * Registration/Certification must ...
Case Manager
San Diego, CA · On-site
$29.14 - $38/hr
Previous experience in case management and/or utilization review preferred. Licenses/Certifications ... AOD Registration is required. * AOD Certification is preferred. * Registration/Certification must ...
Case Manager
San Diego, CA · On-site
$29.14 - $38/hr
Previous experience in case management and/or utilization review preferred. Licenses/Certifications ... AOD Registration is required. * AOD Certification is preferred. * Registration/Certification must ...
Case Manager
San Diego, CA · On-site
$29.14 - $38/hr
Previous experience in case management and/or utilization review preferred. Licenses/Certifications ... AOD Registration is required. * AOD Certification is preferred. * Registration/Certification must ...
Travel Nurse RN - Case Manager, Utilization Review
Sacramento, CA · On-site
$1.8K - $2.7K/wk
AMN Healthcare Nursing is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Sacramento, California. & Requirements * Specialty: Utilization Review * Discipline ...
Travel Nurse RN - Case Manager, Utilization Review
Sacramento, CA · On-site
$1.8K - $2.7K/wk
AMN Healthcare Nursing is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Sacramento, California. & Requirements * Specialty: Utilization Review * Discipline ...
Case Manager
San Diego, CA · On-site
$29.14 - $38/hr
Previous experience in case management and/or utilization review preferred. Licenses/Certifications ... AOD Registration is required. * AOD Certification is preferred. * Registration/Certification must ...
Case Manager
San Diego, CA · On-site
$29.14 - $38/hr
Previous experience in case management and/or utilization review preferred. Licenses/Certifications ... AOD Registration is required. * AOD Certification is preferred. * Registration/Certification must ...
Case Manager
$20.50 - $26.50/hr
Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria ...
Case Manager
$20.50 - $26.50/hr
Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria ...
Case Manager
Loma Linda, CA · On-site
$20.50 - $26.50/hr
Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria ...
Case Manager
Loma Linda, CA · On-site
$20.50 - $26.50/hr
Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria ...
Case Manager
Loma Linda, CA · On-site
$59.18 - $79.60/hr
Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria ...
Case Manager
Loma Linda, CA · On-site
$59.18 - $79.60/hr
Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria ...
Case Manager
Loma Linda, CA · On-site
$59.18 - $79.60/hr
Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria ...
Case Manager
Loma Linda, CA · On-site
$59.18 - $79.60/hr
Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria ...
Case Manager
Loma Linda, CA · On-site
$59.18 - $79.60/hr
Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria ...
Case Manager
Loma Linda, CA · On-site
$59.18 - $79.60/hr
Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria ...
Case Manager
$20.50 - $26.50/hr
Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria ...
Case Manager
$20.50 - $26.50/hr
Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria ...
Case Manager
$20.50 - $26.50/hr
Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria ...
Case Manager
$20.50 - $26.50/hr
Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria ...
Case Manager
Loma Linda, CA · On-site
$20.50 - $26.50/hr
Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria ...
Case Manager
Loma Linda, CA · On-site
$20.50 - $26.50/hr
Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria ...
Case Manager
Loma Linda, CA · On-site
$20.50 - $26.50/hr
Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria ...
Case Manager
Loma Linda, CA · On-site
$20.50 - $26.50/hr
Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria ...
Case Manager*
Murrieta, CA · On-site
Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria ...
Case Manager*
Murrieta, CA · On-site
Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria ...
Case Manager*
Murrieta, CA · On-site
$68.03 - $91.49/hr
Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria ...
Case Manager*
Murrieta, CA · On-site
$68.03 - $91.49/hr
Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria ...
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.
What does a utilization case manager do?
A utilization case manager reviews and authorizes healthcare services to ensure they are necessary and appropriate, often working with insurance companies and healthcare providers. They analyze patient records, coordinate care plans, and ensure compliance with policies, typically using case management software and requiring strong communication skills.
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 jobs pay 4000 a week without a degree?
Utilization Case Managers typically do not earn $4,000 weekly without relevant experience or certifications; most roles in healthcare or social services pay less. High-paying jobs that can reach this level without a degree are rare and often involve specialized skills, sales, or entrepreneurship. Generally, achieving such income without a degree requires significant experience, licensing, or working in high-demand fields like real estate or certain trades.
What is the highest paid case manager?
The highest paid case managers are often those with advanced certifications, specialized skills, or experience in high-demand fields such as healthcare or insurance. Senior or managerial roles, such as Utilization Review Managers, can earn salaries exceeding $80,000 to $100,000 annually. Compensation varies based on location, industry, and level of responsibility.
Is being a MOA a good entry level job?
A Medical Office Assistant (MOA) role is often considered an entry-level position in healthcare, requiring basic administrative and clinical skills. It provides experience with medical records, patient communication, and office procedures, which can serve as a foundation for advancing in healthcare careers. However, the job's suitability depends on individual career goals and the specific workplace environment.
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.
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 California? For Utilization Case Manager jobs in California, the most frequently searched job titles are:
- Case Management Supervisor
- Cdms Certification
- Disability Cdms
- Remote Cvs Utilization Management Nurse
- Work From Home Nurse Case Management
- Commission Cvs Health Utilization Management
- Remote Telephonic Nurse
- Remote Utilization Management Pharmacist
- Evening Remote Telephonic Nurse Case Manager
- Senior Case Manager
What job categories do people searching Utilization Case Manager jobs in California look for? The top searched job categories for Utilization Case Manager jobs in California are:
What cities in California are hiring for Utilization Case Manager jobs? Cities in California with the most Utilization Case Manager job openings:
Loma Linda University Health rating
8.2
Based on 88 frontline employees who took The Breakroom Quiz
95th of 1,020 rated hospitals
Job description
MH: Case Management and Social- ( Unscheduled, Days) -
Job Summary: The Case Manager serves as a key member of the patient care delivery team and works efficiently in a fast-paced environment and utilizes clinical expertise, discretion and independent judgment in performing the nursing process (assessment, care planning, intervention, evaluation) within a patient-centered care professional practice model (Duffy's Quality-Caring Model) as it relates to case management functions. Maintains a solid working knowledge of specialized case and utilization management methodologies and practices and applies concepts to everyday practice. Ensures medical appropriateness criteria (medical necessity) are met for level of care provided and is documented from admission through discharge. Practices in a collaborative healthcare environment to oversee implementation of a well-thought-out interdisciplinary plan of care with an individualized discharge plan that is comprehensive and best meets the continuing healthcare needs of the patient. Reevaluates plan of care and ensures continued appropriateness based on the patients changing needs and condition. Represents nursing as an empowered profession and readily embraces new knowledge, innovations and improvements. Exhibits positivity and serves as an instrumental change agent and expertly minimizes resistance to change in the workforce, clinical practice and operational setting. Engages in opportunities to directly or indirectly influence decision-making for clinical practice by supporting and participating in committees, task forces and staff meetings. Performs other duties as needed.
Education and Experience: Bachelor of Science degree in nursing (BSN) required. Minimum two years of hospital nursing experience required. Minimum two years of case management, utilization review, or discharge planning experience in acute care environment preferred.
Knowledge and Skills: Basic knowledge of case and utilization management practice and methodologies and state and federal healthcare regulations and accreditation required. Able to: speak, read and write legibly in English (and Spanish preferred) with professional quality; use computer, printer and software programs necessary to the position, e.g., Microsoft Office Suite, Outlook, electronic medical record, electronic event reporting program. Relate and communicate positively, effectively and exhibit professional behavior at all times; work calmly and respond courteously when under pressure; be assertive and consistent in following policies; teach, and collaborate; accept direction; think critically; work independently with minimal supervision; perform basic math and statistical functions; manage multiple assignments effectively; organize and prioritize workload; problem solve; recall information with accuracy; pay close attention to detail; hear sufficiently for general conversation in person and on the telephone; identify and distinguish various sounds associated with the work place; see adequately to read computer screens, medical records, and written documents necessary to position.
Licensures and Certifications: Active and unrestricted California Registered Nurse (RN) license required. Current Basic Life Support (BLS) certification issued by the American Heart Association required. Nationally recognized certification in Utilization Management or Case Management preferred.
Loma Linda University Health is a Seventh-day Adventist, faith and values based Christian institution. Candidates must understand and embrace the mission, purpose, and identity of Loma Linda and its affiliated entities.
We are an equal opportunity employer committed to the principles of diversity. We provide equal opportunities in all aspects of the employment process to every individual, regardless of gender, race, color, age, national origin, ancestry, physical or mental disability, marital or veteran status, genetic information or any other characteristic protected by law. In addition, we will provide reasonable accommodations for otherwise qualified individuals requesting an accommodation due to a disability. If you need accommodation assistance with accessing our job listings or completing an application, or during any other phase of employment with us, please contact Human Resources Management at (909) 651-4001.
Loma Linda University Medical Center Murrieta is a religiously-qualified Equal Opportunity Employer under Title VII of Civil Rights Act of 1964. No question on this application is asked for the purpose of unlawfully limiting or excluding any applicant's consideration for employment because of race, color, religion, gender, age, national origin, disability, genetic information, or any other status protected by applicable law. If you need a reasonable accommodation in the hiring process, please notify Human Resource Management.
We appreciate your interest in Loma Linda and wish you success in your job search!
What Loma Linda University Health employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About Loma Linda University Health
Sourced by ZipRecruiter
Loma Linda University Health (LLUH) is an esteemed healthcare organization situated in Loma Linda, California, US. Established in 1905, it was initially known as the College of Medical Evangelists, and it operated as the official medical institution of the Seventh-day Adventist Church until the name was changed to LLUH in 1961. LLUH is very much active in the healthcare and education sectors, providing a vast range of services such as medical treatment, research, and health education. The organization’s core mission is "to continue the teaching and healing ministry of Jesus Christ", which underlines its binding values of compassion, integrity, excellence, freedom, and justice.
Industry
Health care and social assistance and hospitality services
Company size
10,000+ Employees
Headquarters location
Loma Linda, CA, US