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Utilization Case Manager Jobs in Kentucky (NOW HIRING)

Encompass Health Corporation

Case Manager

Lexington, KY · On-site

$17.50 - $22.75/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 ...

Encompass Health

Case Manager

Lexington, KY · On-site

$20 - $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 ...

Encompass Health Corporation

Case Manager

Louisville, KY · On-site

$18.25 - $23.50/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 ...

Encompass Health

Case Manager

Louisville, KY · On-site

$19.25 - $24.75/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 ...

Taphealthcare

Director of Case Management

Mayfield, KY · On-site

$95K - $125K/yr

Accredited Case Manager (ACM) certification through ACMA, or ability to obtain the required certification within two (2) years of hire. * Strong understanding of care coordination, utilization ...

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

Case Manager

Encompass Health Corporation

Lexington, KY • On-site

$17.50 - $22.75/hr

Full-time, Part-time, Per diem

Medical, Dental, Vision, Retirement, PTO

Re-posted 7 days ago

Encompass Health rating

7.0

Company rating: 7.0 out of 10

Based on 421 frontline employees who took The Breakroom Quiz

414th of 887 rated healthcare providers

Job description


Case Manager Career Opportunity - PRN schedule. Primarily weekend coverage, but weekdays are also available.
Recognized for your abilities as a Case Manager
Are you ready for a Case Management role that brings your career closer to home and heart? Join Encompass Health, where being a Case Manager goes beyond just a job; it positions you as a vital link between exceptional care and the transformative impact on each patient's journey. As the leading provider of rehabilitation care in the nation, this opportunity allows you to leverage your clinical expertise while contributing to the well-being of individuals in your community. Manage resources, coordinate patient care from admission to post-discharge, and oversee interdisciplinary plan-of-care decisions. This is more than a career move; it's a chance to shape a future where care and compassion converge for truly meaningful outcomes.
A Glimpse into Our World
At Encompass Health, you'll experience the difference the moment you become a part of our team. Working with us means aligning with a rapidly growing national inpatient rehabilitation leader. We take pride in the growth opportunities we offer and how our team unites for the greater good of our patients. Our achievements include being named one of the "World's Most Admired Companies" and receiving the Fortune 100 Best Companies to Work For® Award, among other accolades, which is nothing short of amazing.
Starting Perks and Benefits
At Encompass Health, we are committed to creating a supportive, inclusive, and caring environment where you can thrive. From day one, you will have access to:
  • Affordable medical, dental, and vision plans for both full-time and part-time employees and their families.
  • Generous paid time off that accrues over time.
  • Opportunities for tuition reimbursement and continuous education.
  • Company-matching 401(k) and employee stock purchase plans.
  • Flexible spending and health savings accounts.
  • A vibrant community of individuals passionate about the work they do!

Become the Case Manager you always wanted to be
  • Work with interdisciplinary team, guiding treatment plans based on patient needs and preferences.
  • Coordinate with interdisciplinary team to establish tentative discharge plan and contingency plans.
  • Participate in planning for and the execution of patient discharge experience.
  • Monitor patient experience: quality/timeliness/service appropriateness/payors/expectations.
  • Facilitate team conferences weekly and coordinate all treatment plan modifications.
  • Complete case management addendums and all required documentation.
  • Maintain knowledge of regulations/standards, company policies/procedures, and department operations.
  • Review/analyze case management reports, including Key Care Indicators, and plan appropriate actions.
  • Understand commercial contract levels, exclusions, payor requirements, and recertification needs.
  • Attend Acute Care Transfer (ACT) meetings to identify trends and collaboratively reduce ACTs.
  • Meet with patient/family per Patient Arrival and Initial Visit Standard within 24 hrs of admission.
  • Perform assessment of goals and complete case management addendum within 48 hours of admission.
  • Educate patient/family on rehabilitation and Case Manager role; establish communication plan.
  • Schedule and facilitate family conferences as needed.
  • Assist patient with timely procuring/planning of resources to avoid discharge delays or issues.
  • Monitor compliance with regulations for orthotics and prosthetics ordering and payment.
  • Make appropriate/timely referrals, including documentation to post discharge providers/physicians.
  • Ensure accuracy of discharge and payor-related information in the patient record.
  • Participate in utilization review process: data collection, trend review, and resolution actions.
  • Participate in case management on-call schedule as needed.

Qualifications
  • License or Certification:
    • Must be qualified to independently complete an assessment within the scope of practice of his/her discipline (for example, RN, SW, OT, PT, ST, and Rehabilitation Counseling).
    • If licensure is required for one's discipline within the state, individual must hold an active license.
    • Must meet eligibility requirements for CCM® or ACM™ certification upon entry into this position OR within two years of entry into the position.
    • CCM® or ACM™ certification required OR must be obtained within two years of being placed in the Case Manager II position.
  • Minimum Qualifications:
    • For Nursing, must possess minimum of an Associate Degree in Nursing, RN licensure with BSN preferred. A diploma is acceptable only in those states whose minimum requirement for licensure or certification is a diploma rather than an Associate Degree.
    • For all other eligible licensed or certified health care professionals, must possess a minimum of a bachelor's degree and graduate degree is preferred.
    • 2 years of rehabilitation experience preferred.

About Us
The Encompass Health Way
We proudly set the standard in care by leading with empathy, doing what's right, focusing on the positive, and standing stronger together. Encompass Health is a trusted leader in post-acute care with over 150 nationwide locations and a team of 36,000 exceptional individuals and growing!
At Encompass Health, we celebrate and welcome diversity in our inclusive culture. We provide equal employment opportunities regardless of race, ethnicity, gender, sexual orientation, gender identity or expression, religion, national origin, color, creed, age, mental or physical disability, or any other protected classification.

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About Encompass Health

Sourced by ZipRecruiter

Helping patients regain hope and independence, Encompass Health is a national leader in post-acute care. We operate rehabilitation hospitals in 36 states as well as Puerto Rico. Following the Encompass Way, we are driven by our core values: We proudly set the standard, lead with empathy, do what's right, focus on the positive, and remain stronger together.

Industry

Hospitals

Company size

10,000+ Employees

Headquarters location

Birmingham, AL, US

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