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Utilization Case Manager Jobs in Missouri (NOW HIRING)

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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?

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 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 13% As Needed, 80% Full Time, and 7% Part Time. Highlights an 73% In-person, and 27% Remote job distribution.

Case Manager Care Continuity Services RN - Care Continuity - UH Truman Medical Center (4 days per...

Truman Medical Centers

Kansas City, MO • On-site

Full-time

Re-posted 11 days ago

University Health System (San Antonio) rating

8.0

Company rating: 8.0 out of 10

Based on 63 frontline employees who took The Breakroom Quiz

87th of 887 rated healthcare providers

Job description

If you are a current University Health or University Health Physicians employee and wish to be considered, you must apply via the internal career site.

Please log into myWORKDAY to search for positions and apply.

Case Manager Care Continuity Services RN - Care Continuity - UH Truman Medical Center (4 days per week; 6a-4:30p)101 Truman Medical CenterJob LocationUH Lakewood Medical Center, University Health Truman Medical CenterKansas City, Missouri
Department
Care Continuity UHTMC
Position Type
Full time
Work Schedule
6:00AM - 4:30PM
Hours Per Week
40
Job Description

Case Manager (RN)

Champion quality care. Advocate for patients. Drive positive outcomes.

Position Overview:

We are seeking a dedicated and detail-oriented Case Manager (CM)-a registered nurse committed to optimizing both patient outcomes and healthcare resources. In this role, you will identify patients who would benefit from case management services and coordinate care across the continuum by collaborating with patients, their support systems, and the multidisciplinary healthcare team.

You'll assess individual needs, develop and implement personalized care plans, monitor progress, and advocate for the services and support that enable patients to achieve the best possible outcomes-clinically, functionally, and financially.

Key Responsibilities:

  • Assess patient needs and determine eligibility for case management services

  • Collaborate with patients, families, and the healthcare team to create individualized care plans

  • Monitor patient progress and adjust plans to support optimal outcomes

  • Serve as a patient advocate, ensuring access to appropriate services and resources

  • Facilitate transitions of care to improve continuity and reduce readmissions

  • Maintain accurate and timely documentation in accordance with organizational standards

  • Build strong partnerships with internal and external stakeholders

Minimum Requirements:

  • Bachelor of Science in Nursing (BSN) or equivalent combination of education and experience

  • Current RN license in the state of Missouri

  • 2+ years of acute care experience with a solid medical-surgical knowledge base

  • Exceptional verbal, telephonic, electronic, and written communication skills

  • Strong organizational and prioritization abilities; effective in team-based environments

  • Proficient computer skills, including Microsoft Word, Outlook, and Excel

  • Proficiency in English, both spoken and written

Preferred Qualifications:

  • RN experience in hospital utilization review, utilization management, or case management

Why Join Us?

  • Make a real difference by advocating for patients and improving their care journey

  • Collaborate with a supportive, mission-driven team

  • Grow your expertise in case management and care coordination

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