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Utilization Case Manager Jobs in Nebraska (NOW HIRING)

CHI Health Saint Elizabeth

Care Coordinator RN

Lincoln, NE · On-site

$32.70 - $48.65/hr

Job Summary and Responsibilities As a Case Manager, you will be a pivotal healthcare professional ... The role integrates and coordinates utilization management, care facilitation and discharge ...

CHI Health Lakeside

RN Care Coordinator

Omaha, NE

$32.70 - $48.65/hr

... utilization of inpatient resources using established evidence based guidelines/criteria ... Masters Other Case Management or Nursing field. and 1 year of experience, upon hire and

Sky Mavis

RN Care Manager

Lincoln, NE · On-site

$85 - $105/hr

Through case finding, data and other tools, high risk patients will be identified and guided to ... The Care Manager may be responsible for activities overlapping with utilization review and quality ...

P3 Health Partners

RN Care Manager

Lincoln, NE · On-site

$85K - $105K/yr

Through case finding, data and other tools, high risk patients will be identified and guided to ... The Care Manager may be responsible for activities overlapping with utilization review and quality ...

P3 Health Partners, Inc.

RN Care Manager

Lincoln, NE · On-site

$85 - $105/hr

Through case finding, data and other tools, high risk patients will be identified and guided to ... The Care Manager may be responsible for activities overlapping with utilization review and quality ...

P3 Health Partners

RN Care Manager

Lincoln, NE · On-site

$85 - $105/hr

Through case finding, data and other tools, high risk patients will be identified and guided to ... The Care Manager may be responsible for activities overlapping with utilization review and quality ...

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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.

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 job categories do people searching Utilization Case Manager jobs in Nebraska look for?

The top searched job categories for Utilization Case Manager jobs in Nebraska are:

What cities in Nebraska are hiring for Utilization Case Manager jobs?

Cities in Nebraska with the most Utilization Case Manager job openings:

Utilization Case Manager jobs near you

RN Care Coordinator

CommonSpirit Health

Omaha, NE • On-site

Full-time

Re-posted 27 days ago

CommonSpirit Health rating

7.0

Company rating: 7.0 out of 10

Based on 543 frontline employees who took The Breakroom Quiz

421st of 898 rated healthcare providers

Job description

CHI Health Lakeside is West Omaha's only full-service hospital. We believe that patient-focused care heals the body, mind, and spirit of every person. Our campus is designed for patients and sets the tone for a comfortable, less stressful hospital stay. As one of the most technologically advanced hospitals in the world, we provide a full range of services including: maternity, cancer and surgery care as well as diagnostics and emergency services.


As a RN Care Coordinator, you will be a central figure in patient care, seamlessly navigating the healthcare journey to achieve optimal outcomes and an exceptional patient experience.
Every day, you will strategically assess, plan, and facilitate comprehensive care across the continuum, expertly advocating for patients while collaborating with physicians, nursing, departments, insurers, and post-acute providers to ensure timely, high-quality transitions.
To be successful in this role, you will possess strong clinical acumen, exceptional communication and advocacy skills, and a strategic mindset, all driven by a passion for optimizing patient care across every touchpoint.

  • Completes and documents a discharge planning assessment on those patients identified by the designated screening process, or upon request. Reassess the patient as appropriate and update the plan accordingly.
  • Facilitates the development of a multidisciplinary discharge plan, engaging other relevant health team members, the patient and/or patient representative and post acute care providers in accordance with the patients clinical or psychosocial needs, choices and available resources.
  • Oversees and evaluates the implementation of the discharge plan.
  • Collaborates with the multidisciplinary team to ensure progression of care and appropriate utilization of inpatient resources using established evidence based guidelines/criteria.
  • Collaborates with the healthcare team and post-acute service providers to ensure timely and smooth transitions to the most appropriate type and setting of post-acute services based upon patients clinical needs.
  • Identifies risk for readmission and implements interventions to mitigate those risks for at least a 30-day period.

Required

  • Graduate of an accredited school of nursing and Minimum two (2) years of acute hospital clinical experience, upon hire or
  • Masters Other Case Management or Nursing field. and 1 year of experience, upon hire and
  • Registered Nurse: NE, upon hire and
  • Basic Life Support - CPR, within 90 Days and


Preferred

  • Bachelors Of Science Nursing and At least five (5) years of nursing experience., upon hire
  • Certified Case Manager, upon hire and
  • Accredited Case Manager, upon hire

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