Department Integrated Case Management Job Summary The Utilization Management Case Manager (UMCM) utilizes professional nursing and critical thinking skills to assess patients for a clinically ...
Department Integrated Case Management Job Summary The Utilization Management Case Manager (UMCM) utilizes professional nursing and critical thinking skills to assess patients for a clinically ...
Utilization Mgmt Case Mgr II
Sarasota, FL · On-site
Department Integrated Case Management Job Summary The Utilization Management Case Manager (UMCM) utilizes professional nursing and critical thinking skills to assess patients for a clinically ...
Utilization Mgmt Case Mgr II
Sarasota, FL · On-site
Department Integrated Case Management Job Summary The Utilization Management Case Manager (UMCM) utilizes professional nursing and critical thinking skills to assess patients for a clinically ...
Works proactively to maximize the effectiveness of resource utilization. Anticipates, initiates ... HR 5. Maintains current knowledge of case management, utilization management, and discharge ...
Works proactively to maximize the effectiveness of resource utilization. Anticipates, initiates ... HR 5. Maintains current knowledge of case management, utilization management, and discharge ...
Case Manager (H)
Hialeah, FL · On-site +1
Works proactively to maximize the effectiveness of resource utilization. Anticipates, initiates ... HR 5. Maintains current knowledge of case management, utilization management, and discharge ...
Case Manager (H)
Hialeah, FL · On-site +1
Works proactively to maximize the effectiveness of resource utilization. Anticipates, initiates ... HR 5. Maintains current knowledge of case management, utilization management, and discharge ...
Current Case Manager Certification (CCM or ACM) * Knowledge/Skills/Abilities: Current working knowledge of care transitions, utilization management, case management and managed care reimbursement ...
New
Current Case Manager Certification (CCM or ACM) * Knowledge/Skills/Abilities: Current working knowledge of care transitions, utilization management, case management and managed care reimbursement ...
New
Current Case Manager Certification (CCM or ACM) * Knowledge/Skills/Abilities: Current working knowledge of care transitions, utilization management, case management and managed care reimbursement ...
New
Current Case Manager Certification (CCM or ACM) * Knowledge/Skills/Abilities: Current working knowledge of care transitions, utilization management, case management and managed care reimbursement ...
New
Current Case Manager Certification (CCM or ACM) * Knowledge/Skills/Abilities: Current working knowledge of care transitions, utilization management, case management and managed care reimbursement ...
Current Case Manager Certification (CCM or ACM) * Knowledge/Skills/Abilities: Current working knowledge of care transitions, utilization management, case management and managed care reimbursement ...
Travel Nurse RN - Case Manager, Utilization Review
Fort Myers, FL · On-site
$1.8K - $2.7K/wk
AMN Healthcare Revenue Cycle is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Fort Myers, Florida. & Requirements * Specialty: Utilization Review * Discipline ...
Travel Nurse RN - Case Manager, Utilization Review
Fort Myers, FL · On-site
$1.8K - $2.7K/wk
AMN Healthcare Revenue Cycle is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Fort Myers, Florida. & Requirements * Specialty: Utilization Review * Discipline ...
Travel Nurse RN - Case Manager, Utilization Review
Spring Hill, FL · On-site
$1.8K - $2.7K/wk
AMN Healthcare Revenue Cycle is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Spring Hill, Florida. & Requirements * Specialty: Utilization Review
Travel Nurse RN - Case Manager, Utilization Review
Spring Hill, FL · On-site
$1.8K - $2.7K/wk
AMN Healthcare Revenue Cycle is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Spring Hill, Florida. & Requirements * Specialty: Utilization Review
Case Manager
Miami, FL · On-site
$75K - $112K/yr
... utilization management criteria, and implementation of safe and appropriate discharge plans. The Case Manager assesses the psychosocial needs of the patient and provides intervention as part of the ...
Case Manager
Miami, FL · On-site
$75K - $112K/yr
... utilization management criteria, and implementation of safe and appropriate discharge plans. The Case Manager assesses the psychosocial needs of the patient and provides intervention as part of the ...
Case Manager
$75K - $112K/yr
... utilization management criteria, and implementation of safe and appropriate discharge plans. The Case Manager assesses the psychosocial needs of the patient and provides intervention as part of the ...
Case Manager
$75K - $112K/yr
... utilization management criteria, and implementation of safe and appropriate discharge plans. The Case Manager assesses the psychosocial needs of the patient and provides intervention as part of the ...
Case Manager
Miami, FL · On-site
$75K - $112K/yr
... utilization management criteria, and implementation of safe and appropriate discharge plans. The Case Manager assesses the psychosocial needs of the patient and provides intervention as part of the ...
Case Manager
Miami, FL · On-site
$75K - $112K/yr
... utilization management criteria, and implementation of safe and appropriate discharge plans. The Case Manager assesses the psychosocial needs of the patient and provides intervention as part of the ...
Telephonic Case Manager
Boca Raton, FL · On-site
Provision of comprehensive Utilization Management, incorporating the strategies of cost containment, appropriate utilization of services, and Case Management in a cooperative effort with other ...
Telephonic Case Manager
Boca Raton, FL · On-site
Provision of comprehensive Utilization Management, incorporating the strategies of cost containment, appropriate utilization of services, and Case Management in a cooperative effort with other ...
Strong knowledge of care coordination, discharge planning, utilization management, and regulatory ... Description The Director of Case Management provides strategic and operational leadership for ...
Strong knowledge of care coordination, discharge planning, utilization management, and regulatory ... Description The Director of Case Management provides strategic and operational leadership for ...
Telephonic Case Manager
Boca Raton, FL · On-site
Provision of comprehensive Utilization Management, incorporating the strategies of cost containment, appropriate utilization of services, and Case Management in a cooperative effort with other ...
Telephonic Case Manager
Boca Raton, FL · On-site
Provision of comprehensive Utilization Management, incorporating the strategies of cost containment, appropriate utilization of services, and Case Management in a cooperative effort with other ...
Telephonic Case Manager
Boca Raton, FL · On-site
Provision of comprehensive Utilization Management, incorporating the strategies of cost containment, appropriate utilization of services, and Case Management in a cooperative effort with other ...
Telephonic Case Manager
Boca Raton, FL · On-site
Provision of comprehensive Utilization Management, incorporating the strategies of cost containment, appropriate utilization of services, and Case Management in a cooperative effort with other ...
Nurse Case Manager
Daytona Beach, FL · On-site
The role integrates and coordinates utilization management, care facilitation and discharge planning functions. In addition, the Case Manager helps drive change by identifying areas where performance ...
Nurse Case Manager
Daytona Beach, FL · On-site
The role integrates and coordinates utilization management, care facilitation and discharge planning functions. In addition, the Case Manager helps drive change by identifying areas where performance ...
Nurse Case Manager
Daytona Beach, FL · On-site
The role integrates and coordinates utilization management, care facilitation and discharge planning functions. In addition, the Case Manager helps drive change by identifying areas where performance ...
Nurse Case Manager
Daytona Beach, FL · On-site
The role integrates and coordinates utilization management, care facilitation and discharge planning functions. In addition, the Case Manager helps drive change by identifying areas where performance ...
Case Manager
Navarre, FL · On-site
$18.50 - $23.75/hr
Previous experience in case management and/or utilization review preferred. LICENSES/DESIGNATIONS ... CERTIFICATIONS: Current license required within the state the facility is operating in if required.
Case Manager
Navarre, FL · On-site
$18.50 - $23.75/hr
Previous experience in case management and/or utilization review preferred. LICENSES/DESIGNATIONS ... CERTIFICATIONS: Current license required within the state the facility is operating in if required.
Nurse Case Manager
Daytona Beach, FL · On-site
The role integrates and coordinates utilization management, care facilitation and discharge planning functions. In addition, the Case Manager helps drive change by identifying areas where performance ...
Nurse Case Manager
Daytona Beach, FL · On-site
The role integrates and coordinates utilization management, care facilitation and discharge planning functions. In addition, the Case Manager helps drive change by identifying areas where performance ...
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 Florida? For Utilization Case Manager jobs in Florida, the most frequently searched job titles are:
What job categories do people searching Utilization Case Manager jobs in Florida look for? The top searched job categories for Utilization Case Manager jobs in Florida are:
What cities in Florida are hiring for Utilization Case Manager jobs? Cities in Florida with the most Utilization Case Manager job openings:
Full-time
Re-posted 2 hours ago
Sarasota Memorial Health Care System rating
7.5
Based on 104 frontline employees who took The Breakroom Quiz
234th of 887 rated healthcare providers
Job description
Department
Integrated Case Management
Job Summary
Required Qualifications
Preferred Qualifications
Mandatory Education
Preferred Education
Required License and Certs
Preferred License and Certs
Employment Screening Requirements
As part of Sarasota Memorial Health Care System's commitment to keeping people safe, all individuals providing care to vulnerable populations are required to undergo background screening through The Florida Care Provider Background Screening Clearinghouse. https://info.flclearinghouse.com/Qualifications:
Integrated Case Management
Job Summary
The Utilization Management Case Manager (UMCM) utilizes professional nursing and critical thinking skills to assess patients for a clinically appropriate level of care. The UMCM maintains a strong knowledge base of evidence-based clinical criteria, federal and state UR requirements, and adeptly identifies pertinent clinical information that will support admission and continued stay hospitalization. When potential denials for payment or level of care arise, the UMCM collaborates with the floor ICM staff, Revenue Cycle, involved physicians and/or the Physician Advisors (PA) as needed to attain second level review/approval to effectively overturn the denial or help determine appropriate transition for the patient. UMCM interact extensively with clinical staff throughout the hospital, other ICM staff, physicians, payers, and hospital financial staff in order to achieve appropriate level of care or placement authorizations, and to avoid denials. The UMCM collaborates with other ICM staff to evaluate opportunities to optimize utilization and secure payer approvals across populations of patients to meet organizational strategic objectives. The UMCM acts as a mentor/preceptor for new staff.
Required Qualifications
- Require a Bachelor of Science in Nursing (BSN) from an accredited school of nursing.
- Require three (3) years of utilization review experience.- Require a minimum of three (3) years in an acute care setting.
- Require previous experience with hospital information systems (order entry, results reporting, case management).- Require basic experience using PC/computer (word processing minimum).
Preferred Qualifications
- Prefer active Case Management Certification (CCM or ACM) or within one (1) year of hire and membership in relevant CM/UM organization.
- Prefer demonstrated ability to manage multiple tasks and adjust priorities according to patient and department/hospital needs.
- Prefer solid clinical assessment, critical thinking, decision making and organizational skills.
- Prefer strong ability to communicate effectively both verbally and in written work.
- Prefer strong interpersonal skills and ability to work collaboratively with leaders, staff, patients, families, healthcare team, payers and external agencies.
- Prefer knowledge of relevant federal and state utilization review and appeal requirements.
Mandatory Education
Preferred Education
Required License and Certs
FL RN: FL Registered Nurse License
Preferred License and Certs
Rotating weekends, Hybrid role
Employment Screening Requirements
As part of Sarasota Memorial Health Care System's commitment to keeping people safe, all individuals providing care to vulnerable populations are required to undergo background screening through The Florida Care Provider Background Screening Clearinghouse. https://info.flclearinghouse.com/Qualifications:
- Prefer active Case Management Certification (CCM or ACM) or within one (1) year of hire and membership in relevant CM/UM organization.
- Prefer demonstrated ability to manage multiple tasks and adjust priorities according to patient and department/hospital needs.
- Prefer solid clinical assessment, critical thinking, decision making and organizational skills.
- Prefer strong ability to communicate effectively both verbally and in written work.
- Prefer strong interpersonal skills and ability to work collaboratively with leaders, staff, patients, families, healthcare team, payers and external agencies.
- Prefer knowledge of relevant federal and state utilization review and appeal requirements.
What Sarasota Memorial Health Care System employees say
Pay
Benefits
Hours and flexibility
Workplace
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About Sarasota Memorial Health Care System
Sourced by ZipRecruiter
Sarasota Memorial Health Care System, based in Sarasota, FL, US, is a community-owned and operated healthcare provider entrenched in the medical and health services industry. Known for offering a wide array of comprehensive care, their extensive services range from disease prevention and detection to advanced treatment and rehabilitation. The company, established in 1925, began as a 14-bed hospital and has evolved into an 839-bed regional medical center, becoming one of the region's largest public health systems. Sarasota Memorial's mission is to deliver healthcare service of the highest quality in keeping with their core values, including community, excellence, loyalty, innovation, respect, and teamwork.
Industry
Health care and social assistance
Company size
5,001 - 10,000 Employees
Headquarters location
Sarasota, FL, US
Year founded
1925