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Utilization Case Manager Jobs in Missouri (NOW HIRING)

North Kansas City Hospital

Case Manager

Kansas City, MO · On-site

$19.50 - $25.25/hr

This position partners with the Case Management and multidisciplinary teams to identify appropriate utilization of resources and to ensure reimbursement. EXPERIENCE: Minimum 2-3 years' experience in ...

SSM Health Rehabilitation Hospital

Case Manager

Bridgeton, 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 ...

SSM Health Rehabilitation Hospital

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 ...

SSM Health Rehabilitation Hospital

Case Manager

Bridgeton, 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 ...

Select Medical

Case Manager

Bridgeton, MO

$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 ...

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All JobsUtilization Case JobsUtilization Case Manager JobsUtilization Case Manager Jobs in Missouri

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?

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 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 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:

Utilization Case Manager jobs near you
Infographic showing various Utilization Case Manager job openings in Missouri as of August 2026, with employment types broken down into 12% As Needed, 82% Full Time, and 6% Part Time. Highlights an 76% In-person, and 24% Remote job distribution.

RN, Utilization Case Manager - Archimedes

Archimedes

Earth City, MO • On-site

Other

Medical, Dental, Vision, Retirement, PTO

Posted 26 days ago

Job description

Job Title

RN, Utilization Case Manager

Job Description

The RN, Utilization Case Manager will coordinate care between physicians, patients, and pharmacies, facilitating access to specialty medications for patients with complex disease states.

Responsibilities

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.
Qualifications

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.
Benefits

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
Location

502 Earth City Expy STE 300, Earth City, MO 63045, US

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