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 ...
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 ...
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 ...
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 ...
... case management/utilization review experience preferred. · OASIS experience preferred. · Practical trach and/or ventilator experience preferred, not required. At Interim HealthCare, we know that ...
... case management/utilization review experience preferred. · OASIS experience preferred. · Practical trach and/or ventilator experience preferred, not required. At Interim HealthCare, we know that ...
... case management/utilization review experience preferred. • OASIS experience preferred. • Practical trach and/or ventilator experience preferred, not required. At Interim HealthCare, we know that ...
... case management/utilization review experience preferred. • OASIS experience preferred. • Practical trach and/or ventilator experience preferred, not required. At Interim HealthCare, we know that ...
... case management/utilization review experience preferred. • OASIS experience preferred. • Practical trach and/or ventilator experience preferred, not required. At Interim HealthCare, we know that ...
... case management/utilization review experience preferred. • OASIS experience preferred. • Practical trach and/or ventilator experience preferred, not required. At Interim HealthCare, we know that ...
... case management/utilization review experience preferred. · OASIS experience preferred. · Practical trach and/or ventilator experience preferred, not required. At Interim HealthCare, we know that ...
... case management/utilization review experience preferred. · OASIS experience preferred. · Practical trach and/or ventilator experience preferred, not required. At Interim HealthCare, we know that ...
RN Case Manager- *Home Visits
Owenton, KY · On-site
... case management/utilization review experience preferred. · OASIS experience preferred. · Practical trach and/or ventilator experience preferred, not required. At Interim HealthCare, we know that ...
RN Case Manager- *Home Visits
Owenton, KY · On-site
... case management/utilization review experience preferred. · OASIS experience preferred. · Practical trach and/or ventilator experience preferred, not required. At Interim HealthCare, we know that ...
RN Case Manager- *Home Visits
Owenton, KY · On-site
... case management/utilization review experience preferred. · OASIS experience preferred. · Practical trach and/or ventilator experience preferred, not required. At Interim HealthCare, we know that ...
RN Case Manager- *Home Visits
Owenton, KY · On-site
... case management/utilization review experience preferred. · OASIS experience preferred. · Practical trach and/or ventilator experience preferred, not required. At Interim HealthCare, we know that ...
... case management/utilization review experience preferred. · OASIS experience preferred. · Practical trach and/or ventilator experience preferred, not required. At Interim HealthCare, we know that ...
... case management/utilization review experience preferred. · OASIS experience preferred. · Practical trach and/or ventilator experience preferred, not required. At Interim HealthCare, we know that ...
... case management/utilization review experience preferred. • OASIS experience preferred. • Practical trach and/or ventilator experience preferred, not required. At Interim HealthCare, we know that ...
... case management/utilization review experience preferred. • OASIS experience preferred. • Practical trach and/or ventilator experience preferred, not required. At Interim HealthCare, we know that ...
... case management/utilization review experience preferred. • OASIS experience preferred. • Practical trach and/or ventilator experience preferred, not required. At Interim HealthCare, we know that ...
... case management/utilization review experience preferred. • OASIS experience preferred. • Practical trach and/or ventilator experience preferred, not required. At Interim HealthCare, we know that ...
RN Case Manager- *Home Visits
Owenton, KY · On-site
... case management/utilization review experience preferred. • OASIS experience preferred. • Practical trach and/or ventilator experience preferred, not required. At Interim HealthCare, we know that ...
RN Case Manager- *Home Visits
Owenton, KY · On-site
... case management/utilization review experience preferred. • OASIS experience preferred. • Practical trach and/or ventilator experience preferred, not required. At Interim HealthCare, we know that ...
... case management/utilization review experience preferred. · OASIS experience preferred. · Practical trach and/or ventilator experience preferred, not required. At Interim HealthCare, we know that ...
... case management/utilization review experience preferred. · OASIS experience preferred. · Practical trach and/or ventilator experience preferred, not required. At Interim HealthCare, we know that ...
RN Case Manager- *Home Visits
Owenton, KY · On-site
... case management/utilization review experience preferred. • OASIS experience preferred. • Practical trach and/or ventilator experience preferred, not required. At Interim HealthCare, we know that ...
RN Case Manager- *Home Visits
Owenton, KY · On-site
... case management/utilization review experience preferred. • OASIS experience preferred. • Practical trach and/or ventilator experience preferred, not required. At Interim HealthCare, we know that ...
Case Management and Utilization Management experience preferred. * Current Registered Nurse (RN) license in the state of practice. * Basic Life Support (BLS) certification from the American Heart ...
Case Management and Utilization Management experience preferred. * Current Registered Nurse (RN) license in the state of practice. * Basic Life Support (BLS) certification from the American Heart ...
Nurse Case Manager/UKHC
Lexington, KY · On-site
$75K - $95K/yr
The RN Case Manager will facilitate appropriate care coordination to patients and their families in cases where specific problems related to clinical aspects influence effective utilization of ...
Nurse Case Manager/UKHC
Lexington, KY · On-site
$75K - $95K/yr
The RN Case Manager will facilitate appropriate care coordination to patients and their families in cases where specific problems related to clinical aspects influence effective utilization of ...
Targeted Case Manager
California, KY · On-site
$18 - $22/hr
❤️ Make an Impact Every Day to Shape Futures Targeted Case Manager ????Highland Heights , KY ... Responsible for the management of a caseload of 25 referred clients, and meeting agency utilization ...
Quick apply
Targeted Case Manager
California, KY · On-site
$18 - $22/hr
❤️ Make an Impact Every Day to Shape Futures Targeted Case Manager ????Highland Heights , KY ... Responsible for the management of a caseload of 25 referred clients, and meeting agency utilization ...
Director of Case Management -- Registered Nurse (RN)
Mayfield, KY · On-site
$95K - $125K/yr
Oversee daily case management operations, driving clinical care coordination, utilization review, and discharge planning. * Strategic Planning: Develop and implement departmental goals, policies, and ...
Quick apply
Director of Case Management -- Registered Nurse (RN)
Mayfield, KY · On-site
$95K - $125K/yr
Oversee daily case management operations, driving clinical care coordination, utilization review, and discharge planning. * Strategic Planning: Develop and implement departmental goals, policies, and ...
RN, Case Manager (Exempt)
Corbin, KY · On-site
Case Management monitors Utilization reviews and patients LOS. * Direct the quality improvement activities for the department and promotes the maintenance of high-quality, safe and effective patient ...
RN, Case Manager (Exempt)
Corbin, KY · On-site
Case Management monitors Utilization reviews and patients LOS. * Direct the quality improvement activities for the department and promotes the maintenance of high-quality, safe and effective patient ...
Case Manager - Medicaid/HCB Waiver Services
Edmonton, KY · On-site
$65K - $70K/yr
Review service utilization, identifying and correcting under or overutilization. * Participate in ... Experience in case management, care coordination, or waiver services (required) * Knowledge of ...
Case Manager - Medicaid/HCB Waiver Services
Edmonton, KY · On-site
$65K - $70K/yr
Review service utilization, identifying and correcting under or overutilization. * Participate in ... Experience in case management, care coordination, or waiver services (required) * Knowledge of ...
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 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:
Full-time, Part-time, Per diem
Re-posted 15 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.
About Interim HealthCare of Downstate Illinois
Sourced by ZipRecruiter
Industry
Health care and social assistance
Company size
1 - 10 Employees
Headquarters location
Peoria, IL, US
Year founded
1975