RN-Case Manager
Southaven, MS · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication ... Certified Case Manager Special Skills * . Minimum Required * Critical thinking skills ...
RN-Case Manager
Southaven, MS · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication ... Certified Case Manager Special Skills * . Minimum Required * Critical thinking skills ...
RN-Case Manager
Southaven, MS · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication ... Certified Case Manager Special Skills * . Minimum Required * Critical thinking skills ...
RN-Case Manager
Southaven, MS · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication ... Certified Case Manager Special Skills * . Minimum Required * Critical thinking skills ...
RN-Case Manager
Southaven, MS · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication ... Certified Case Manager Special Skills Minimum Required * Critical thinking skills, communication ...
RN-Case Manager
Southaven, MS · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication ... Certified Case Manager Special Skills Minimum Required * Critical thinking skills, communication ...
RN-Case Manager
Kosciusko, MS · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication ... Certified Case Manager Special Skills Minimum Required Critical thinking skills, communication ...
RN-Case Manager
Kosciusko, MS · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication ... Certified Case Manager Special Skills Minimum Required Critical thinking skills, communication ...
RN-Case Manager
Kosciusko, MS · On-site
$60 - $80/hr
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication ... Certified Case Manager Special Skills Minimum Required Critical thinking skills, communication ...
RN-Case Manager
Kosciusko, MS · On-site
$60 - $80/hr
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication ... Certified Case Manager Special Skills Minimum Required Critical thinking skills, communication ...
RN-Case Manager
Southaven, MS · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication ... Certified Case Manager Special Skills * . Minimum Required * Critical thinking skills ...
RN-Case Manager
Southaven, MS · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication ... Certified Case Manager Special Skills * . Minimum Required * Critical thinking skills ...
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication ... Certified Case Manager Special Skills * . Minimum Required * Critical thinking skills ...
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication ... Certified Case Manager Special Skills * . Minimum Required * Critical thinking skills ...
RN Case Manager
Jackson, MS · On-site
$2.2K - $2.3K/wk
Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Jackson, Mississippi Start Date: August 6, 2026 Profession: Registered Nurse (RN) Facility: Estimated Pay: $2241 ...
RN Case Manager
Jackson, MS · On-site
$2.2K - $2.3K/wk
Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Jackson, Mississippi Start Date: August 6, 2026 Profession: Registered Nurse (RN) Facility: Estimated Pay: $2241 ...
Oversee the management of patient care utilization, ensuring appropriate healthcare services are ... Resolve complex case issues and provide guidance on challenging utilization decisions * Ensure ...
Oversee the management of patient care utilization, ensuring appropriate healthcare services are ... Resolve complex case issues and provide guidance on challenging utilization decisions * Ensure ...
Utilization Review Specialist
Lucedale, MS · On-site
$55 - $75/hr
At least 2 years of experience in utilization review, case management, or clinical healthcare roles. * Strong knowledge of medical terminology, clinical procedures, and healthcare regulations.
Utilization Review Specialist
Lucedale, MS · On-site
$55 - $75/hr
At least 2 years of experience in utilization review, case management, or clinical healthcare roles. * Strong knowledge of medical terminology, clinical procedures, and healthcare regulations.
Nursing experience with at least 2 years in Utilization Management or case management role Preferred: 2 years * Leadership or management experience in nursing or related field Core Competencies ...
Nursing experience with at least 2 years in Utilization Management or case management role Preferred: 2 years * Leadership or management experience in nursing or related field Core Competencies ...
RN - Case Manager
Jackson, MS · On-site
$2.2K - $2.3K/wk
Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Jackson, Mississippi Start Date: August 26, 2026 Profession: Registered Nurse (RN) Facility: Estimated Pay: $2206 ...
RN - Case Manager
Jackson, MS · On-site
$2.2K - $2.3K/wk
Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Jackson, Mississippi Start Date: August 26, 2026 Profession: Registered Nurse (RN) Facility: Estimated Pay: $2206 ...
Manager - Case Management - RN - Coordinated Care
Jackson, MS · On-site
$80 - $110/hr
Oversees utilization reviews, case coordination, discharge planning, and patient placement ... Certified Case Manager from the Certified Case Management Commission and Accredited Case Manager ...
Manager - Case Management - RN - Coordinated Care
Jackson, MS · On-site
$80 - $110/hr
Oversees utilization reviews, case coordination, discharge planning, and patient placement ... Certified Case Manager from the Certified Case Management Commission and Accredited Case Manager ...
Manager - Case Management - RN - Coordinated Care Job Summary:Functions as the direct supervisor ... Oversees utilization reviews, case coordination, discharge planning, and patient placement.
Manager - Case Management - RN - Coordinated Care Job Summary:Functions as the direct supervisor ... Oversees utilization reviews, case coordination, discharge planning, and patient placement.
Manager - Case Management - RN - Coordinated Care Job Summary: Functions as the direct supervisor ... Oversees utilization reviews, case coordination, discharge planning, and patient placement.
Manager - Case Management - RN - Coordinated Care Job Summary: Functions as the direct supervisor ... Oversees utilization reviews, case coordination, discharge planning, and patient placement.
The Case Management: Utilization Review and Discharge Planner serve as a liaison between patients, families, referral sources, insurance providers, physicians, and treatment team members to promote ...
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The Case Management: Utilization Review and Discharge Planner serve as a liaison between patients, families, referral sources, insurance providers, physicians, and treatment team members to promote ...
RN Case Manager - PRN
Jackson, MS · On-site
Three (3) years of RN experience, one (1) year of which is in case management, utilization review, utilization management, or performance improvement. Certifications, Licenses or Registration ...
RN Case Manager - PRN
Jackson, MS · On-site
Three (3) years of RN experience, one (1) year of which is in case management, utilization review, utilization management, or performance improvement. Certifications, Licenses or Registration ...
Three (3) years of RN experience, one (1) year of which is in case management, utilization review, utilization management, or performance improvement. Certifications, Licenses or Registration ...
Three (3) years of RN experience, one (1) year of which is in case management, utilization review, utilization management, or performance improvement. Certifications, Licenses or Registration ...
RN Case Manager - PRN
Jackson, MS · On-site
Three (3) years of RN experience, one (1) year of which is in case management, utilization review, utilization management, or performance improvement. Certifications, Licenses or Registration ...
RN Case Manager - PRN
Jackson, MS · On-site
Three (3) years of RN experience, one (1) year of which is in case management, utilization review, utilization management, or performance improvement. Certifications, Licenses or Registration ...
CASE MGR-SWING BED CRD
Hattiesburg, MS · On-site
Case Manager plans, coordinates, develops, evaluates, and monitors the care of assigned group of ... Is involved in utilization review activities as defined by the Utilization Management. Participates ...
CASE MGR-SWING BED CRD
Hattiesburg, MS · On-site
Case Manager plans, coordinates, develops, evaluates, and monitors the care of assigned group of ... Is involved in utilization review activities as defined by the Utilization Management. Participates ...
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.
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.
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 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 degree do I need for utilization case manager?
Utilization case managers typically need at least a bachelor's degree in healthcare, social work, nursing, or a related field. Some positions may prefer or require a master's degree or relevant certifications, such as Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ).
What job categories do people searching Utilization Case Manager jobs in Mississippi look for?
The top searched job categories for Utilization Case Manager jobs in Mississippi are:
What cities in Mississippi are hiring for Utilization Case Manager jobs?
Cities in Mississippi with the most Utilization Case Manager job openings:
Baptist Memorial Health Care rating
7.3
Based on 115 frontline employees who took The Breakroom Quiz
305th of 898 rated healthcare providers
Job description
Overview
Job Summary
Manages the care for a specific population; facilitates the safe transition of patients throughout the continuum of care for appropriate utilization of resources, service delivery and compliance with federal and other payer requirements. Provides early assessment of transitional needs identified during their hospitalization, illness, and/or life situation. Performs other duties as assigned.
Responsibilities
Experience
Minimum Required
Minimum Required
Minimum Required
Preferred/Desired
Job Summary
Manages the care for a specific population; facilitates the safe transition of patients throughout the continuum of care for appropriate utilization of resources, service delivery and compliance with federal and other payer requirements. Provides early assessment of transitional needs identified during their hospitalization, illness, and/or life situation. Performs other duties as assigned.
Responsibilities
- Utilization Review
- Discharge planning
- Readmission Reduction Participation
- Payer Communication and denial reduction
- Completes assigned goals.
Experience
Minimum Required
- RN with at least one (1) year of clinical experience
- RN with 3 years of clinical experience with Case Management experience in a hospital or payer setting
Minimum Required
- Diploma or Associate Degree in Nursing
- BSN or MSN
Minimum Required
Preferred/Desired
- Certified Case Manager
- .
- Critical thinking skills, communication, organization, interpersonal and computer skills. Problem solving; and governmental regulations.
- Critical thinking skills, communication, organization, interpersonal and computer skills. Knowledge of payer requirements; problem solving; and governmental regulations.
- RN
- RN
- RN;CCM;ACM
What Baptist Memorial Health Care employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About Baptist Memorial
Sourced by ZipRecruiter
Baptist Memorial, based in Memphis, TN, US, is a leading health care organization renowned in the healthcare industry. The company's official website is baptistonline.org which provides a comprehensive view of their services and operations. Baptist Memorial operates a myriad of hospitals, health clinics, and medical facilities providing expert and compassionate care. Founded in 1912, it has a rich legacy of over a hundred years of dedication to its community, offering services which include acute care, diagnostic services, and a broad range of speciality health services fulfilling various patient needs.
Industry
Hospitals
Company size
10,000+ Employees
Headquarters location
Memphis, TN, US