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Utilization Case Manager Jobs in Kentucky (NOW HIRING)

Nurse Case Manager II Telephonic Nurse Case Manager II Location: This role enables associates to ... Assists with development of utilization/care management policies and procedures. Minimum ...

Nurse Case Manager II Telephonic Nurse Case Manager II Location: This role enables associates to ... Assists with development of utilization/care management policies and procedures. Minimum ...

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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:

RN Case Manager- *Home Visits

Interim HealthCare

Owenton, KY • On-site

Full-time

Posted 16 days ago


Job description

Description

Our Registered Nurse Case Managers (RNCM) have been called to care when they’re needed most. At Interim HealthCare, you’ll support a full range of patient services to bring comfort and dignity to our clients. 

What we offer our Registered Nurse Case Managers (RNCM):    

·           Competitive pay, benefits, and incentives.  

·           Truly flexible scheduling – a dedication to work/life balance – Full-time/ Part-time / PRN / Weekends  

·           Daily Pay option available    

·           No Overtime Required    

·           1:1 patient care   

Excited to hear more? 

Working at Interim HealthCare means a career unlike any other. With integrity at the center of all we do, we know that when we support you and your community, you’ll change lives every day.    

As a Registered Nurse Case Manager (RNCM), you will:   

·           Conduct In Person patient interviews and comprehensive physical assessments.

·           Oversee the implementation and ongoing assessment of the patient’s plan of care through the management of home health aides, LPNs, RNs, and other caregivers.

·           Communicate patient conditions and collaborate with appropriate providers to deliver care when patient needs evolve.

·           Provide education to patients and families on proper home health care procedures. Ie. Wound care, IV administration, medication management.

·           Work to decrease readmissions by promoting preventative care and ensuring continuity of care.

To qualify as a Registered Nurse Case Manager (RNCM) with us, you will need:    

·           Licensure: Current unrestricted license to practice as a Registered Nurse (RN) in the state associated with this position    

·           Current CPR/AED/BLS/First Aid certification    

·           Reliable transportation to/from care sites and/or work locations.

·           One (1) year of professional experience practicing as a Registered Nurse (RN) in home health or similar setting; previous case management/utilization review experience preferred.

·           OASIS experience preferred.

·           Practical trach and/or ventilator experience preferred, not required.

At Interim HealthCare, we know that being our best is non-negotiable – that’s why we treat your family like our own. We take a patient-centric approach to address each individual’s mind, body, and spirit, our caregivers work tirelessly to help their patients and families find peace. From our unmatched referral response times to our focus on quality improvement, the most beautifully complicated time of your life is our life’s work.  

We're an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, or disability status.

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