Seeks to evaluate outcomes based on an integration among established clinical, financial and utilization data. Defines the unit of care (family and patient). Demonstrates knowledge of hospice ...
Seeks to evaluate outcomes based on an integration among established clinical, financial and utilization data. Defines the unit of care (family and patient). Demonstrates knowledge of hospice ...
Travel RN MDS/IP
Nebraska City, NE · On-site
$75/hr
GLC On-The-Go is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Nebraska City, Nebraska. & Requirements * Specialty: Utilization Review * Discipline: RN * ...
Travel RN MDS/IP
Nebraska City, NE · On-site
$75/hr
GLC On-The-Go is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Nebraska City, Nebraska. & Requirements * Specialty: Utilization Review * Discipline: RN * ...
Care Coordinator RN
Lincoln, NE · On-site
As a Case Manager, you will be a pivotal healthcare professional, delivering compassionate, high ... The role integrates and coordinates utilization management, care facilitation and discharge ...
New
Care Coordinator RN
Lincoln, NE · On-site
As a Case Manager, you will be a pivotal healthcare professional, delivering compassionate, high ... The role integrates and coordinates utilization management, care facilitation and discharge ...
New
As a Case Manager, you will be a pivotal healthcare professional, delivering compassionate, high ... The role integrates and coordinates utilization management, care facilitation and discharge ...
New
As a Case Manager, you will be a pivotal healthcare professional, delivering compassionate, high ... The role integrates and coordinates utilization management, care facilitation and discharge ...
New
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 ...
New
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 ...
New
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 ...
New
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 ...
New
Care Coordinator RN
$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 ...
New
Care Coordinator RN
$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 ...
New
Care Coordinator RN
$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 ...
New
Care Coordinator RN
$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 ...
New
Care Coordinator RN
$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 ...
New
Care Coordinator RN
$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 ...
New
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 ...
New
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 ...
New
Care Coordinator RN
Lincoln, NE · On-site
The role integrates and coordinates utilization management, care facilitation and discharge planning functions. As a Case Manager, you will be a pivotal healthcare professional, delivering ...
New
Care Coordinator RN
Lincoln, NE · On-site
The role integrates and coordinates utilization management, care facilitation and discharge planning functions. As a Case Manager, you will be a pivotal healthcare professional, delivering ...
New
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
Behavioral Health Senior Clinical Admin Nurse
Omaha, NE · Remote
$60K - $107K/yr
CCM * 2+ years of case management experience * 2+ years of managed care experience * Critical care, pediatric, med-surg and/or telemetry experience * Utilization management experience * Adverse ...
Behavioral Health Senior Clinical Admin Nurse
Omaha, NE · Remote
$60K - $107K/yr
CCM * 2+ years of case management experience * 2+ years of managed care experience * Critical care, pediatric, med-surg and/or telemetry experience * Utilization management experience * Adverse ...
Seeks to evaluate outcomes based on an integration among established clinical, financial and utilization data. Functions in structured and unstructured health care settings described as a geographic ...
Seeks to evaluate outcomes based on an integration among established clinical, financial and utilization data. Functions in structured and unstructured health care settings described as a geographic ...
Seeks to evaluate outcomes based on an integration among established clinical, financial and utilization data. Functions in structured and unstructured health care settings described as a geographic ...
Seeks to evaluate outcomes based on an integration among established clinical, financial and utilization data. Functions in structured and unstructured health care settings described as a geographic ...
Seeks to evaluate outcomes based on an integration among established clinical, financial and utilization data. Functions in structured and unstructured health care settings described as a geographic ...
Seeks to evaluate outcomes based on an integration among established clinical, financial and utilization data. Functions in structured and unstructured health care settings described as a geographic ...
RN Hospice Float MNA, VNA of Cape Cod
$70K - $88K/yr
... utilization. * Annual outcomes meet National Benchmarks. * Refers to community resources as ... Participates in inter-disciplinary patient case conferences; evaluates effectiveness of established ...
RN Hospice Float MNA, VNA of Cape Cod
$70K - $88K/yr
... utilization. * Annual outcomes meet National Benchmarks. * Refers to community resources as ... Participates in inter-disciplinary patient case conferences; evaluates effectiveness of established ...
... case coverage and training. * Influence stakeholders within the hospital setting. * Drive product utilization in key growth categories and driving sales/placement of capital to support product ...
... case coverage and training. * Influence stakeholders within the hospital setting. * Drive product utilization in key growth categories and driving sales/placement of capital to support product ...
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 Nebraska?
For Utilization Case Manager jobs in Nebraska, the most frequently searched job titles are:
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:
Sanford Health rating
6.8
Based on 548 frontline employees who took The Breakroom Quiz
493rd of 887 rated healthcare providers
Job description
Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America's heartland.
Work Shift:
Scheduled Weekly Hours:
24Compensation:
Salary Range: $34.00 - $51.00Union Position:
NoDepartment Details
Summary
Provides care to assigned patients in a caring, safe, and efficient manner and provides leadership to staff and is responsible to perform the following according to location standards, procedures, and individualized patient plans of care.Job Description
Seeks to evaluate outcomes based on an integration among established clinical, financial and utilization data. Defines the unit of care (family and patient). Demonstrates knowledge of hospice palliative care, hospice philosophy, and scope of services. Recognizes different cultural attitudes and values towards death and dying. Identifies the five stages of grieving process. Explains advanced directives, clinical requirements, and interdisciplinary services available. Utilizes independent nursing judgment when integrating health care. Participates in creation of the plan of care and ensures the plan of care is implemented by the interdisciplinary group. Has knowledge of and utilizes appropriate age-specific structured care methodologies, such as protocols/integrated clinical pathways/guidelines/standards of care relating to the overall health care needs of neonatal, pediatric, adolescent, adult and/or geriatric patients/residents. Interviews potential residents and assesses residents in compliance with regulations, policy and procedure. Uses assessment information for admission and continued stay in the hospice community. Establishes a service plan for each resident and evaluates on an on-going basis. Ability to communicate with patients/residents, family members and others on the health care team. Must demonstrate independence, assertiveness and critical thinking when working with patients and co-workers. Ability to document clearly. Ability to solve problems. Self-motivated. Works with little direction. Ability to incorporate teaching/learning principles and adapt teaching to age group. Ability to facilitate groups and implement projects when necessary. Must be able to establish priorities, have strong flexibility and organizational skills. Must be knowledgeable about reimbursement for services provided.Will be required to work primarily day hours, scheduled weekends, and occasional evenings. May be exposed to communicable or infectious disease, hazardous materials and injury from performance of assigned duties. Is subject to multiple sensory and environmental stressors.Qualifications
Bachelor's degree in Nursing strongly preferred. Graduate from an accredited nursing program, including, but not limited to, those accredited by the Commission on Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN), or National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA).Minimum of two years' clinical experience preferred.
Currently holds an unencumbered RN license with the State Board of Nursing where the practice of nursing is occurring and/or possess multistate licensure if in a Nurse Licensure Compact (NLC) state. Obtains and subsequently maintains required department specific competencies and certifications. Must possess a valid driver's license.
Sanford is an EEO/AA Employer M/F/Disability/Vet.
If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-949-5678 or send an email to talent@sanfordhealth.org.
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About Sanford Health
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Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.
Industry
Health care and social assistance and hospitals
Company size
10,000+ Employees
Headquarters location
Sioux Falls, SD, US