Utilization Review or Discharge Planning * Professional certification preferred, including: * Certified Case Manager (CCM) * Accredited Case Manager (ACM) * Membership in professional organizations ...
Utilization Review or Discharge Planning * Professional certification preferred, including: * Certified Case Manager (CCM) * Accredited Case Manager (ACM) * Membership in professional organizations ...
Nurse Case Manager
$83.20K - $131K/yr
Utilization Review or Discharge Planning * Professional certification preferred, including: * Certified Case Manager (CCM) * Accredited Case Manager (ACM) * Membership in professional organizations ...
Quick apply
Nurse Case Manager
$83.20K - $131K/yr
Utilization Review or Discharge Planning * Professional certification preferred, including: * Certified Case Manager (CCM) * Accredited Case Manager (ACM) * Membership in professional organizations ...
Recent Utilization Review experience a plus * One or more of the following certifications or professional affiliations strongly preferred: * Certified Case Manager (CCM) * Accredited Case Manager ...
New
Recent Utilization Review experience a plus * One or more of the following certifications or professional affiliations strongly preferred: * Certified Case Manager (CCM) * Accredited Case Manager ...
New
Recent Utilization Review experience a plus * One or more of the following certifications or professional affiliations strongly preferred: * Certified Case Manager (CCM) * Accredited Case Manager ...
New
Recent Utilization Review experience a plus * One or more of the following certifications or professional affiliations strongly preferred: * Certified Case Manager (CCM) * Accredited Case Manager ...
New
Recent Utilization Review experience a plus * One or more of the following certifications or professional affiliations strongly preferred: * Certified Case Manager (CCM) * Accredited Case Manager ...
New
Recent Utilization Review experience a plus * One or more of the following certifications or professional affiliations strongly preferred: * Certified Case Manager (CCM) * Accredited Case Manager ...
New
Recent Utilization Review experience a plus * One or more of the following certifications or professional affiliations strongly preferred: * Certified Case Manager (CCM) * Accredited Case Manager ...
New
Recent Utilization Review experience a plus * One or more of the following certifications or professional affiliations strongly preferred: * Certified Case Manager (CCM) * Accredited Case Manager ...
New
Recent Utilization Review experience a plus * One or more of the following certifications or professional affiliations strongly preferred: * Certified Case Manager (CCM) * Accredited Case Manager ...
New
Recent Utilization Review experience a plus * One or more of the following certifications or professional affiliations strongly preferred: * Certified Case Manager (CCM) * Accredited Case Manager ...
New
Nurse Case Manager
Las Vegas, NV · On-site
At least one (1) year of experience in Case Management, Discharge Planning, or Utilization Review * At the discretion of our client, a Master's degree in nursing with a concentration in case ...
Quick apply
Nurse Case Manager
Las Vegas, NV · On-site
At least one (1) year of experience in Case Management, Discharge Planning, or Utilization Review * At the discretion of our client, a Master's degree in nursing with a concentration in case ...
Recent Utilization Review experience a plus * One or more of the following certifications or professional affiliations strongly preferred: * Certified Case Manager (CCM) * Accredited Case Manager ...
New
Recent Utilization Review experience a plus * One or more of the following certifications or professional affiliations strongly preferred: * Certified Case Manager (CCM) * Accredited Case Manager ...
New
Recent Utilization Review experience a plus * One or more of the following certifications or professional affiliations strongly preferred: * Certified Case Manager (CCM) * Accredited Case Manager ...
New
Recent Utilization Review experience a plus * One or more of the following certifications or professional affiliations strongly preferred: * Certified Case Manager (CCM) * Accredited Case Manager ...
New
Nurse Case Manager
Las Vegas, NV · On-site
$40.72 - $63.12/hr
Nurse Case Manager Location: Las Vegas, NV Shift: Full-time | Day shift Salary: $40.72 - $63.12 ... Support discharge planning and utilization review processes * Serve as a clinical resource for ...
Quick apply
Nurse Case Manager
Las Vegas, NV · On-site
$40.72 - $63.12/hr
Nurse Case Manager Location: Las Vegas, NV Shift: Full-time | Day shift Salary: $40.72 - $63.12 ... Support discharge planning and utilization review processes * Serve as a clinical resource for ...
Minimum three (3) years of nursing experience in an acute care hospital setting, one (1) year of which was in Case Management, Discharge Planning, or Utilization Review. At the sole discretion of the ...
Quick apply
Minimum three (3) years of nursing experience in an acute care hospital setting, one (1) year of which was in Case Management, Discharge Planning, or Utilization Review. At the sole discretion of the ...
Case Manager
Henderson, NV · On-site
$18.75 - $24/hr
Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * Must be qualified to ...
Case Manager
Henderson, NV · On-site
$18.75 - $24/hr
Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * Must be qualified to ...
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
Las Vegas, NV · On-site
$19.25 - $24.75/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
Las Vegas, NV · On-site
$19.25 - $24.75/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 ...
Nurse Case Manager
Las Vegas, NV · On-site
$40.72 - $63.12/hr
Recent documented Utilization Review experience a plus. Knowledge of MCG (Milliman). One or more of the following A PLUS. Certified Case Manager (CCM) Accredited Case Manager (ACM) Membership in: The ...
Nurse Case Manager
Las Vegas, NV · On-site
$40.72 - $63.12/hr
Recent documented Utilization Review experience a plus. Knowledge of MCG (Milliman). One or more of the following A PLUS. Certified Case Manager (CCM) Accredited Case Manager (ACM) Membership in: The ...
RN Case Manager
Las Vegas, NV · On-site
$40 - $63/hr
Facilitates safe and timely discharge planning while ensuring appropriate resource utilization ... One (1) year in Case Management, Discharge Planning, or Utilization Review Preferred Qualifications:
Quick apply
RN Case Manager
Las Vegas, NV · On-site
$40 - $63/hr
Facilitates safe and timely discharge planning while ensuring appropriate resource utilization ... One (1) year in Case Management, Discharge Planning, or Utilization Review Preferred Qualifications:
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status at ...
Minimum three (3) years of nursing experience in an acute care hospital setting, one (1) year of which was in Case Management, Discharge Planning, or Utilization Review. At the sole discretion of the ...
Quick apply
Minimum three (3) years of nursing experience in an acute care hospital setting, one (1) year of which was in Case Management, Discharge Planning, or Utilization Review. At the sole discretion of the ...
Nurse Case Manager "High Demand"
Las Vegas, NV · On-site
$40 - $63/hr
Facilitates safe and timely discharge planning while ensuring appropriate resource utilization ... One (1) year in Case Management, Discharge Planning, or Utilization Review Preferred Qualifications:
Quick apply
Nurse Case Manager "High Demand"
Las Vegas, NV · On-site
$40 - $63/hr
Facilitates safe and timely discharge planning while ensuring appropriate resource utilization ... One (1) year in Case Management, Discharge Planning, or Utilization Review Preferred Qualifications:
Utilization Case Manager information
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.
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 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 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 Nevada? For Utilization Case Manager jobs in Nevada, the most frequently searched job titles are:
What job categories do people searching Utilization Case Manager jobs in Nevada look for? The top searched job categories for Utilization Case Manager jobs in Nevada are:
What cities in Nevada are hiring for Utilization Case Manager jobs? Cities in Nevada with the most Utilization Case Manager job openings:
Other
Posted 13 days ago
Job description
Position Summary
A healthcare organization is seeking a Registered Nurse (RN) Case Manager to support a coordinated, multidisciplinary approach to patient care across the care continuum. This role is responsible for assessing, planning, coordinating, and evaluating patient care needs while serving as a clinical resource for patients, families, physicians, and care teams.
The Nurse Case Manager plays a key role in facilitating safe, efficient, and effective care delivery by ensuring appropriate utilization of healthcare services and supporting optimal patient outcomes across inpatient and post-acute settings.
Education & Experience
A healthcare organization is seeking a Registered Nurse (RN) Case Manager to support a coordinated, multidisciplinary approach to patient care across the care continuum. This role is responsible for assessing, planning, coordinating, and evaluating patient care needs while serving as a clinical resource for patients, families, physicians, and care teams.
The Nurse Case Manager plays a key role in facilitating safe, efficient, and effective care delivery by ensuring appropriate utilization of healthcare services and supporting optimal patient outcomes across inpatient and post-acute settings.
Education & Experience
- Graduation from an accredited school of nursing required
- Minimum of three (3) years of clinical nursing experience in an acute care hospital setting
- Minimum of three (3) years of experience in Case Management, Discharge Planning, or Utilization Review
- Active Registered Nurse (RN) license in the state of practice (e.g., Nevada or equivalent)
- Current Basic Life Support (BLS) certification from the American Heart Association (AHA)
- Recent, documented experience in acute care hospital settings preferred
- Experience in one or more of the following areas strongly preferred:
- Pediatric case management
- Emergency Department (ED) clinical experience
- Utilization Review or Discharge Planning
- Professional certification preferred, including:
- Certified Case Manager (CCM)
- Accredited Case Manager (ACM)
- Membership in professional organizations such as:
- Commission for Case Manager Certification (CCMC)
- American Case Management Association (ACMA)
- Strong understanding of healthcare reimbursement models and regulatory requirements
- Case management principles and nursing process standards
- Disease processes and standards of care across multiple specialties
- Patient care planning, assessment, and outcome evaluation techniques
- Nurse Practice Act, compliance standards, and regulatory requirements
- Third-party reimbursement systems and utilization management principles
- Hospital safety protocols, infection control, and patient rights
- Emergency response procedures and age-specific care considerations
- Manage patients with varying acuity levels across the care continuum
- Analyze and interpret clinical documentation and medical records effectively
- Apply utilization management and reimbursement guidelines appropriately
- Use healthcare systems, electronic medical records, and case management tools proficiently
- Communicate clearly and effectively with diverse patient populations in high-stress environments
- Build and maintain collaborative working relationships with interdisciplinary healthcare teams
- Demonstrate strong organizational skills and attention to detail in clinical documentation and coordination
- Ensure safe, effective, and compliant use of clinical tools and healthcare systems