Job Title RN, Utilization Case Manager The RN, Utilization Case Manager will coordinate care between physicians, patients, and pharmacies, facilitating access to specialty medications for patients ...
Job Title RN, Utilization Case Manager The RN, Utilization Case Manager will coordinate care between physicians, patients, and pharmacies, facilitating access to specialty medications for patients ...
Review chart notes and perform utilization management on patient/drug specific case basis. * Coordinate facilitation of patients' specialty drug treatment, ensuring timely delivery to the appropriate ...
Review chart notes and perform utilization management on patient/drug specific case basis. * Coordinate facilitation of patients' specialty drug treatment, ensuring timely delivery to the appropriate ...
Review chart notes and perform utilization management on patient/drug specific case basis. * Coordinate facilitation of patients' specialty drug treatment, ensuring timely delivery to the appropriate ...
Review chart notes and perform utilization management on patient/drug specific case basis. * Coordinate facilitation of patients' specialty drug treatment, ensuring timely delivery to the appropriate ...
Review chart notes and perform utilization management on patient/drug specific case basis. * Coordinate facilitation of patients' specialty drug treatment, ensuring timely delivery to the appropriate ...
Review chart notes and perform utilization management on patient/drug specific case basis. * Coordinate facilitation of patients' specialty drug treatment, ensuring timely delivery to the appropriate ...
Review chart notes and perform utilization management on patient/drug specific case basis. * Coordinate facilitation of patients' specialty drug treatment, ensuring timely delivery to the appropriate ...
Review chart notes and perform utilization management on patient/drug specific case basis. * Coordinate facilitation of patients' specialty drug treatment, ensuring timely delivery to the appropriate ...
Case Manager
Saint Louis, MO · On-site
$18.75 - $24/hr
... utilization management criteria, and implementation of safe and appropriate discharge plans. The Case Manager assesses the psychosocial needs of the patient and provides intervention as part of the ...
Case Manager
Saint Louis, MO · On-site
$18.75 - $24/hr
... utilization management criteria, and implementation of safe and appropriate discharge plans. The Case Manager assesses the psychosocial needs of the patient and provides intervention as part of the ...
Case Manager
$19 - $24.50/hr
... utilization management criteria, and implementation of safe and appropriate discharge plans. The Case Manager assesses the psychosocial needs of the patient and provides intervention as part of the ...
Case Manager
$19 - $24.50/hr
... utilization management criteria, and implementation of safe and appropriate discharge plans. The Case Manager assesses the psychosocial needs of the patient and provides intervention as part of the ...
Case Manager
Lake Saint Louis, MO · On-site
$19 - $24.50/hr
... utilization management criteria, and implementation of safe and appropriate discharge plans. The Case Manager assesses the psychosocial needs of the patient and provides intervention as part of the ...
Case Manager
Lake Saint Louis, MO · On-site
$19 - $24.50/hr
... utilization management criteria, and implementation of safe and appropriate discharge plans. The Case Manager assesses the psychosocial needs of the patient and provides intervention as part of the ...
Case Manager
Lake Saint Louis, MO · On-site
$19 - $24.50/hr
... utilization management criteria, and implementation of safe and appropriate discharge plans. The Case Manager assesses the psychosocial needs of the patient and provides intervention as part of the ...
Case Manager
Lake Saint Louis, MO · On-site
$19 - $24.50/hr
... utilization management criteria, and implementation of safe and appropriate discharge plans. The Case Manager assesses the psychosocial needs of the patient and provides intervention as part of the ...
Case Manager
$18.75 - $24/hr
... utilization management criteria, and implementation of safe and appropriate discharge plans. The Case Manager assesses the psychosocial needs of the patient and provides intervention as part of the ...
Case Manager
$18.75 - $24/hr
... utilization management criteria, and implementation of safe and appropriate discharge plans. The Case Manager assesses the psychosocial needs of the patient and provides intervention as part of the ...
Case Manager
Saint Louis, MO · On-site
$18.75 - $24/hr
... utilization management criteria, and implementation of safe and appropriate discharge plans. The Case Manager assesses the psychosocial needs of the patient and provides intervention as part of the ...
Case Manager
Saint Louis, MO · On-site
$18.75 - $24/hr
... utilization management criteria, and implementation of safe and appropriate discharge plans. The Case Manager assesses the psychosocial needs of the patient and provides intervention as part of the ...
Case Manager
Columbia, MO · On-site
$19 - $24.50/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 ...
Case Manager
Columbia, MO · On-site
$19 - $24.50/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 ...
Case Manager
Columbia, MO · On-site
$19 - $24.50/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 ...
Case Manager
Columbia, MO · On-site
$19 - $24.50/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 ...
Case Manager
$19 - $24.50/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 ...
Case Manager
$19 - $24.50/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 ...
Case Manager
$19 - $24.50/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 ...
Case Manager
$19 - $24.50/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 ...
Case Manager
Ballwin, MO · On-site
$19.50 - $25/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 ...
Case Manager
Ballwin, MO · On-site
$19.50 - $25/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 ...
Case Manager
Kansas City, MO · On-site
$18.50 - $23.75/hr
The Case Manager plays a pivotal role within the client operations team, holding direct ... Monitor and work towards increasing the utilization and ensure authorized hours are effectively ...
Case Manager
Kansas City, MO · On-site
$18.50 - $23.75/hr
The Case Manager plays a pivotal role within the client operations team, holding direct ... Monitor and work towards increasing the utilization and ensure authorized hours are effectively ...
Case Manager
Kansas City, MO · On-site
$19.50 - $25.25/hr
The Case Manager plays a pivotal role within the client operations team, holding direct ... Monitor and work towards increasing the utilization and ensure authorized hours are effectively ...
Case Manager
Kansas City, MO · On-site
$19.50 - $25.25/hr
The Case Manager plays a pivotal role within the client operations team, holding direct ... Monitor and work towards increasing the utilization and ensure authorized hours are effectively ...
Case Manager - Case Management South
Springfield, MO · On-site
$18.25 - $23.50/hr
The nurse case manager serves as a resource to the physicians and provides education and information on resource utilization, national and local coverage determinations, and use of hospital admission ...
Case Manager - Case Management South
Springfield, MO · On-site
$18.25 - $23.50/hr
The nurse case manager serves as a resource to the physicians and provides education and information on resource utilization, national and local coverage determinations, and use of hospital admission ...
Case Manager - Case Management South
$18.25 - $23.50/hr
The nurse case manager serves as a resource to the physicians and provides education and information on resource utilization, national and local coverage determinations, and use of hospital admission ...
Quick apply
Case Manager - Case Management South
$18.25 - $23.50/hr
The nurse case manager serves as a resource to the physicians and provides education and information on resource utilization, national and local coverage determinations, and use of hospital admission ...
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 Missouri? For Utilization Case Manager jobs in Missouri, the most frequently searched job titles are:
What job categories do people searching Utilization Case Manager jobs in Missouri look for? The top searched job categories for Utilization Case Manager jobs in Missouri are:
What cities in Missouri are hiring for Utilization Case Manager jobs? Cities in Missouri with the most Utilization Case Manager job openings:
Other
Medical, Dental, Vision, Retirement, PTO
Posted 6 days ago
Job description
Job Title
RN, Utilization Case Manager
Job DescriptionThe RN, Utilization Case Manager will coordinate care between physicians, patients, and pharmacies, facilitating access to specialty medications for patients with complex disease states.
ResponsibilitiesHow do I make an impact on my team?
- Review chart notes and perform utilization management on patient/drug specific case basis.
- Coordinate facilitation of patients' specialty drug treatment, ensuring timely delivery to the appropriate site of care.
- Handle case assignments, review case progress, properly document case notes, and determine case closure.
- Follow established procedures, processes, and standards for production, productivity, quality, and customer service. Meet performance targets for speed, efficiency, and quality.
- Complete care management clinical escalations. Escalate to account management as appropriate.
- Ensure all external and internal customers receive the level of customer service required by Archimedes and serve as a representative of Archimedes to all external customers.
- Participate in, adhere to, and support compliance, people and culture, and learning programs.
- Perform other duties as assigned.
What our team expects from you?
- Education: Associate's degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN) required; BSN preferred. Master of Science in Nursing (MSN) a plus.
- Certification/Licenses: Current, active Registered Nurse (RN) license in good standing with the applicable State Board of Nursing is required.
- Experience:
- Utilization and Case management experience required.
- Experience in an infusion setting, physician office or pharmacy required.
- Experience with managing specialty medications for patients with chronic illness is highly preferred.
- Expert at Microsoft Office Suite.
What can you expect from Archimedes?
- Top of the industry benefits for Health, Dental, and Vision insurance
- 20 days paid time off
- 4 weeks paid parental leave
- 9 paid holidays
- 401K company match of up to 5% - No vesting requirement
- Adoption Assistance Program
- Flexible Spending Account
- Educational Assistance Plan and Professional Membership assistance
502 Earth City Expy STE 300, Earth City, MO 63045, US