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
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 ...
New
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 ...
New
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
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 ...
New
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 ...
New
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
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 ...
New
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 ...
New
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
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
$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
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
$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
$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 ...
How you'll contribute A Case Manager, who excels in this role coordinates management of care and ensures optimum utilization of resources, service delivery and compliance with external review ...
How you'll contribute A Case Manager, who excels in this role coordinates management of care and ensures optimum utilization of resources, service delivery and compliance with external review ...
Provision of comprehensive Utilization Management, incorporating the strategies of cost containment, appropriate utilization of services, and Case Management in a cooperative effort with other ...
Provision of comprehensive Utilization Management, incorporating the strategies of cost containment, appropriate utilization of services, and Case Management in a cooperative effort with other ...
Provision of comprehensive Utilization Management, incorporating the strategies of cost containment, appropriate utilization of services, and Case Management in a cooperative effort with other ...
Provision of comprehensive Utilization Management, incorporating the strategies of cost containment, appropriate utilization of services, and Case Management in a cooperative effort with other ...
Provision of comprehensive Utilization Management, incorporating the strategies of cost containment, appropriate utilization of services, and Case Management in a cooperative effort with other ...
Provision of comprehensive Utilization Management, incorporating the strategies of cost containment, appropriate utilization of services, and Case Management in a cooperative effort with other ...
RN Case Manager - Florida
Kansas City, MO · On-site
Description: RN Case Manager * Yearly continuing education allowance * Medical, Dental, Vision and ... Identify and verify appropriate utilization of resources across the continuum of care. * Actively ...
RN Case Manager - Florida
Kansas City, MO · On-site
Description: RN Case Manager * Yearly continuing education allowance * Medical, Dental, Vision and ... Identify and verify appropriate utilization of resources across the continuum of care. * Actively ...
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 does a utilization case manager do?
A utilization case manager reviews and authorizes healthcare services to ensure they are necessary and appropriate, often working with insurance companies and healthcare providers. They analyze patient records, coordinate care plans, and ensure compliance with policies, typically using case management software and requiring strong communication skills.
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 jobs pay 4000 a week without a degree?
Utilization Case Managers typically do not earn $4,000 weekly without relevant experience or certifications; most roles in healthcare or social services pay less. High-paying jobs that can reach this level without a degree are rare and often involve specialized skills, sales, or entrepreneurship. Generally, achieving such income without a degree requires significant experience, licensing, or working in high-demand fields like real estate or certain trades.
What is the highest paid case manager?
The highest paid case managers are often those with advanced certifications, specialized skills, or experience in high-demand fields such as healthcare or insurance. Senior or managerial roles, such as Utilization Review Managers, can earn salaries exceeding $80,000 to $100,000 annually. Compensation varies based on location, industry, and level of responsibility.
Is being a MOA a good entry level job?
A Medical Office Assistant (MOA) role is often considered an entry-level position in healthcare, requiring basic administrative and clinical skills. It provides experience with medical records, patient communication, and office procedures, which can serve as a foundation for advancing in healthcare careers. However, the job's suitability depends on individual career goals and the specific workplace environment.
What are the key skills and qualifications needed to thrive as a Utilization Case Manager, and why are they important?
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:
- Evening Optum Health Utilization Review
- Telephonic Nurse Case Manager
- Evening Remote Telephonic Nurse Case Manager
- Remote Cvs Utilization Management Nurse
- Behavioral Health Case Manager
- Psych Case Manager
- Utilization Management
- Remote Telephonic Nurse
- Commission Cvs Health Utilization Management
- Cdms Certification
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:
- Vocational Case Manager
- Field Nurse Case Manager
- Contract Case Manager
- Flex Schedule Behavioral Health Case Manager Remote
- Insurance Utilization Reviewer
- Workers Comp Nurse Case Manager
- Full Time Behavioral Health Case Manager Remote
- Full Time Maternity Case Management
- Registered Nurse Case Review
- Case Manager Veteran Services
What cities in Missouri are hiring for Utilization Case Manager jobs? Cities in Missouri with the most Utilization Case Manager job openings:
Full-time
Medical, Dental, Vision, Retirement, PTO
Re-posted 19 days ago
Navitus Health Solutions rating
7.0
Based on 5 frontline employees who took The Breakroom Quiz
262nd of 479 rated business services
Job description
Archimedes
Archimedes - Transforming the Specialty Drug Benefit - Archimedes is the industry leader in specialty drug management solutions. Founded with the goal of transforming the PBM industry to provide the necessary ingredients for the sustainability of the prescription drug benefit alignment, value and transparency Archimedes achieves superior results for clients by eliminating tightly held PBM conflicts of interest including drug spread, rebate retention and pharmacy ownership and delivering the most rigorous clinical management at the lowest net cost. .____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________. Current associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities.________We are committed to providing equal employment opportunity to all applicants and employees and comply with all applicable nondiscrimination regulations, including those related to protected veterans and individuals with disabilities. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or handicap.
USD $0.00 - USD $0.00 /Yr.
0.00 - Ineligible
Our Core Business Hours- Hybrid 3 Days in Office
502 Earth City Expy STE 300
Earth City
MO
63045
Archimedes - Transforming the Specialty Drug Benefit - Archimedes is the industry leader in specialty drug management solutions. Founded with the goal of transforming the PBM industry to provide the necessary ingredients for the sustainability of the prescription drug benefit alignment, value and transparency Archimedes achieves superior results for clients by eliminating tightly held PBM conflicts of interest including drug spread, rebate retention and pharmacy ownership and delivering the most rigorous clinical management at the lowest net cost. .____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________. Current associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities.________We are committed to providing equal employment opportunity to all applicants and employees and comply with all applicable nondiscrimination regulations, including those related to protected veterans and individuals with disabilities. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or handicap.
USD $0.00 - USD $0.00 /Yr.
0.00 - Ineligible
Our Core Business Hours- Hybrid 3 Days in Office
The RN, Utilization Case Manager will coordinate care between physicians, patients, and pharmacies, facilitating access to specialty medications for patients with complex disease states.
How 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
About Navitus Health Solutions
Sourced by ZipRecruiter
Industry
Health care and social assistance
Company size
501 - 1,000 Employees
Headquarters location
Madison, WI, US
Year founded
2003