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Utilization Case Manager Jobs in Iowa (NOW HIRING)

HealthCheck360

Bilingual RN Case Manager

Dubuque, IA

$20.25 - $25.75/hr

Provide telephonic case management and utilization review for assigned consumers. * Develop, implement, and monitor individualized care plans to ensure quality and cost-effective outcomes.

HealthCheck360

Bilingual RN Case Manager

Des Moines, IA · Remote

$21 - $26.50/hr

Provide telephonic case management and utilization review for assigned consumers. * Develop, implement, and monitor individualized care plans to ensure quality and cost-effective outcomes.

HealthCheck360

Bilingual RN Case Manager

Des Moines, IA · Remote

$21 - $26.50/hr

Provide telephonic case management and utilization review for assigned consumers. * Develop, implement, and monitor individualized care plans to ensure quality and cost-effective outcomes.

HealthCheck360

Bilingual RN Case Manager

Des Moines, IA · Remote

$21 - $26.50/hr

Provide telephonic case management and utilization review for assigned consumers. * Develop, implement, and monitor individualized care plans to ensure quality and cost-effective outcomes.

HealthCheck360

Bilingual RN Case Manager

Des Moines, IA · On-site

$21 - $26.50/hr

Provide telephonic case management and utilization review for assigned consumers. * Develop, implement, and monitor individualized care plans to ensure quality and cost-effective outcomes.

Trinity Health

Case Manager RN

Des Moines, IA · On-site

ED Patient Case Manager RN (Onsite) Shift/Hours -Full Time DAY and NIGHT shifts available -Mix of ... Perform admission, concurrent, and post-discharge utilization reviews in accordance with the ...

Trinity Health

Case Manager RN

Des Moines, IA

ED Patient Case Manager RN (Onsite) Shift/Hours -Full Time DAY and NIGHT shifts available-Mix of 12 ... Perform admission, concurrent, and post-discharge utilization reviews in accordance with the ...

Trinityhealth

Case Manager RN

Des Moines, IA

ED Patient Case Manager RN (Onsite) Shift/Hours -Full Time DAY and NIGHT shifts available-Mix of 12 ... Perform admission, concurrent, and post-discharge utilization reviews in accordance with the ...

UnityPoint Health

RN-Case Manager

Marshalltown, IA · On-site

RN Case Manager Marshalltown Hospital Shift: Part-Time | 28 Hours per Week | 8:00 AM-4:30 PM ... This role focuses on care coordination, utilization review, and interdisciplinary collaboration to ...

UnityPoint Health

RN-Case Manager

Marshalltown, IA · On-site

Overview RN Case Manager Marshalltown Hospital Shift: Part-Time | 28 Hours per Week | 8:00 AM-4:30 ... This role focuses on care coordination, utilization review, and interdisciplinary collaboration to ...

Trinity Health

Case Manager-RN

Mason City, IA · On-site

Day Shift Description: Full Time Days 8-hour shifts Position Summary: -The Utilization Review (UR) Case Manager - Post-Acute Prior Authorization role performs Utilization Review activities and serves ...

Corvel

Telephonic Case Manager I

West Des Moines, IA · Remote

$62.31K - $93.12K/yr

The Case Manager communicates directly with treating physicians to evaluate and recommend ... Strong cost containment background, such as utilization review or managed care helpful

Corvel

Telephonic Case Manager I

West Des Moines, IA · On-site

$62.31K - $93.12K/yr

The Case Manager communicates directly with treating physicians to evaluate and recommend ... Strong cost containment background, such as utilization review or managed care helpful

Corvel

Telephonic Case Manager I

West Des Moines, IA · On-site

$62.31K - $93.12K/yr

The Case Manager communicates directly with treating physicians to evaluate and recommend ... Strong cost containment background, such as utilization review or managed care helpful

CorVel

Telephonic Case Manager I

West Des Moines, IA · Remote

$62.31K - $93.12K/yr

The Case Manager communicates directly with treating physicians to evaluate and recommend ... utilization review or managed care helpful Certification as a CIRS or CCM preferred Pay Range ...

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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?

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 Iowa? For Utilization Case Manager jobs in Iowa, the most frequently searched job titles are:
What job categories do people searching Utilization Case Manager jobs in Iowa look for? The top searched job categories for Utilization Case Manager jobs in Iowa are:
What cities in Iowa are hiring for Utilization Case Manager jobs? Cities in Iowa with the most Utilization Case Manager job openings:
Utilization Case Manager jobs near you
Bilingual RN Case Manager

Bilingual RN Case Manager

HealthCheck360

Dubuque, IA

$20.25 - $25.75/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 26 days ago

Job description

Bilingual RN Case Manager

Location: Onsite in Dubuque, IA. Also accepting remote applicants.

We are seeking a compassionate and detail-oriented Bilingual RN Case Manager to join our team. This role is responsible for delivering comprehensive case management services across the continuum of care. The RN Case Manager will assess, plan, implement, coordinate, monitor, and evaluate care for assigned consumers, ensuring quality outcomes and cost-effective treatment. This role is based in our Dubuque office and is also available remotely.

Key Responsibilities:

  • Provide telephonic case management and utilization review for assigned consumers.
  • Develop, implement, and monitor individualized care plans to ensure quality and cost-effective outcomes.
  • Collaborate with healthcare providers, payors, and internal teams to coordinate care.
  • Serve as a liaison between consumers and benefit administrators, ensuring clear communication and support.
  • Track and report case outcomes, including cost savings and quality improvements.

Qualifications:

  • Bilingual: the ability to speak Spanish
  • Education: RN licensure in the State of Iowa required. BSN or higher preferred.
  • Experience: Minimum 2 years of clinical practice. Case management or utilization review experience strongly preferred.
  • Skills: Strong communication, problem-solving, and computer skills. Ability to work independently.

Full-Time Benefits - Most benefits start day 1

  • Medical, Dental, Vision Insurance
  • Flex Spending or HSA
  • 401(k) with company match
  • Profit-Sharing/Defined Contribution (1-year waiting period)
  • PTO/Paid Holidays
  • Company-paid ST and LT Disability
  • Maternity Leave/Parental Leave
  • Subsidized Parking
  • Company-paid Term Life/Accidental Death Insurance

About HealthCheck360

HealthCheck 360 was created with the employer's needs and the participant's experience in mind. We focus on reducing medical costs, while increasing employee engagement and productivity. This is accomplished by providing onsite biometric screenings, engaging participants through technology and programming, educating the participant with risk-specific targeted communications, and supporting positive behavior change through our Health Coaching and Condition Management programs.