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Utilization Case Manager Jobs in Nevada (NOW HIRING)

twenty80.io

Nurse Case Manager

Las Vegas, NV

$83K - $131K/yr

Utilization Review or Discharge Planning * Professional certification preferred, including: * Certified Case Manager (CCM) * Accredited Case Manager (ACM) * Membership in professional organizations ...

twenty80.io

Nurse Case Manager

Las Vegas, NV · On-site

Utilization Review or Discharge Planning * Professional certification preferred, including: * Certified Case Manager (CCM) * Accredited Case Manager (ACM) * Membership in professional organizations ...

Welsh and Associates

Nurse Case Manager

Las Vegas, NV · On-site

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 ...

SteveRecruiter, LLC

Nurse Case Manager

Las Vegas, NV · On-site

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 ...

Sun Recruiting Inc

Nurse Case Manager

Las Vegas, NV · On-site

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 ...

MJR Recruiting

Nurse Case Manager

Las Vegas, NV · On-site

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 ...

Soap Creek Resources

Nurse Case Manager

Las Vegas, NV · On-site

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 ...

KOB Solutions , Inc.

Nurse Case Manager

Las Vegas, NV · On-site

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 ...

United Future

Nurse Case Manager

Las Vegas, NV · On-site

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 ...

RRC Solutions Group

Nurse Case Manager

Las Vegas, NV · On-site

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 ...

JobFormance

Nurse Case Manager

Las Vegas, NV · On-site

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 ...

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All JobsUtilization Case JobsUtilization Case Manager JobsUtilization Case Manager Jobs in Nevada

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 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:

Utilization Case Manager jobs near you

Nurse Case Manager

twenty80.io

Las Vegas, NV

$83K - $131K/yr

Full-time

Re-posted 3 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
  • 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
Licensure & Certification
  • 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)
Additional & Preferred Qualifications
  • 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
Knowledge
  • 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
Skills & Abilities
  • 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