Routine case management, discharge planning, swing bed coordinator and utilization review duties. Evaluating and screening potential admissions to the facilities swing bed program knowledgeable of ...
Routine case management, discharge planning, swing bed coordinator and utilization review duties. Evaluating and screening potential admissions to the facilities swing bed program knowledgeable of ...
Case Manager
Grants, NM · On-site
$18.50 - $23.75/hr
The Case Manager / Utilization Review Nurse (RN) is responsible for coordinating patient care progression, discharge planning, and utilization review activities. This integrated role ensures ...
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Case Manager
Grants, NM · On-site
$18.50 - $23.75/hr
The Case Manager / Utilization Review Nurse (RN) is responsible for coordinating patient care progression, discharge planning, and utilization review activities. This integrated role ensures ...
Case Manager
Grants, NM · On-site
$18.50 - $23.75/hr
Job Type Full-time Description The Case Manager / Utilization Review Nurse (RN) is responsible for coordinating patient care progression, discharge planning, and utilization review activities. This ...
Case Manager
Grants, NM · On-site
$18.50 - $23.75/hr
Job Type Full-time Description The Case Manager / Utilization Review Nurse (RN) is responsible for coordinating patient care progression, discharge planning, and utilization review activities. This ...
Case Manager
$18.50 - $23.75/hr
Description The Case Manager / Utilization Review Nurse (RN) is responsible for coordinating patient care progression, discharge planning, and utilization review activities. This integrated role ...
Case Manager
$18.50 - $23.75/hr
Description The Case Manager / Utilization Review Nurse (RN) is responsible for coordinating patient care progression, discharge planning, and utilization review activities. This integrated role ...
Care Career is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Portales, New Mexico. & Requirements * Specialty: Utilization Review * Discipline: RN * Start ...
Care Career is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Portales, New Mexico. & Requirements * Specialty: Utilization Review * Discipline: RN * Start ...
Zack Group is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Portales, New Mexico. & Requirements * Specialty: Utilization Review * Discipline: RN * Start Date:
Zack Group is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Portales, New Mexico. & Requirements * Specialty: Utilization Review * Discipline: RN * Start Date:
MedPro Healthcare Staffing is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Portales, New Mexico. & Requirements * Specialty: Utilization Review * Discipline ...
MedPro Healthcare Staffing is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Portales, New Mexico. & Requirements * Specialty: Utilization Review * Discipline ...
RN-Case Manager
Portales, NM · On-site
$59 - $62/hr
MTK Healthcare Inc. is Hiring RN Case Manager - Utilization Review & Swing Bed | Portales, NM | Monday-Friday (8:00 AM-4:30 PM), Day Shift Position Details * Position: RN Case Manager - Utilization ...
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RN-Case Manager
Portales, NM · On-site
$59 - $62/hr
MTK Healthcare Inc. is Hiring RN Case Manager - Utilization Review & Swing Bed | Portales, NM | Monday-Friday (8:00 AM-4:30 PM), Day Shift Position Details * Position: RN Case Manager - Utilization ...
PRIDE Health is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Portales, New Mexico. & Requirements * Specialty: Utilization Review * Discipline: RN * Start ...
PRIDE Health is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Portales, New Mexico. & Requirements * Specialty: Utilization Review * Discipline: RN * Start ...
Case Manager
$19.50 - $25/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
$19.50 - $25/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 ...
RN Case Manager - Inpatient Care Coordination
Albuquerque, NM · On-site
$36.41 - $62/hr
The role integrates utilization management, care coordination, and transition planning functions. The Case Manager has the overall accountability for a designated case load and plans effectively in ...
RN Case Manager - Inpatient Care Coordination
Albuquerque, NM · On-site
$36.41 - $62/hr
The role integrates utilization management, care coordination, and transition planning functions. The Case Manager has the overall accountability for a designated case load and plans effectively in ...
$36.41 - $62/hr
The role integrates utilization management, care coordination, and transition planning functions. The Case Manager has the overall accountability for a designated case load and plans effectively in ...
$36.41 - $62/hr
The role integrates utilization management, care coordination, and transition planning functions. The Case Manager has the overall accountability for a designated case load and plans effectively in ...
$36.41 - $62/hr
The role integrates utilization management, care coordination, and transition planning functions. The Case Manager has the overall accountability for a designated case load and plans effectively in ...
$36.41 - $62/hr
The role integrates utilization management, care coordination, and transition planning functions. The Case Manager has the overall accountability for a designated case load and plans effectively in ...
... case management ... This role integrates utilization management, care coordination, and transition planning to ensure ...
... case management ... This role integrates utilization management, care coordination, and transition planning to ensure ...
... case management ... This role integrates utilization management, care coordination, and transition planning to ensure ...
... case management ... This role integrates utilization management, care coordination, and transition planning to ensure ...
... case management ... This role integrates utilization management, care coordination, and transition planning to ensure ...
... case management ... This role integrates utilization management, care coordination, and transition planning to ensure ...
RN - Case Manager
Espanola, NM · On-site
$36.41 - $62/hr
The role integrates utilization management, care coordination, and transition planning functions . The Case Manager has the overall accountability for a designated case load and plans effectively in ...
RN - Case Manager
Espanola, NM · On-site
$36.41 - $62/hr
The role integrates utilization management, care coordination, and transition planning functions . The Case Manager has the overall accountability for a designated case load and plans effectively in ...
RN - Case Manager
Espanola, NM · On-site
$36.41 - $62/hr
The role integrates utilization management, care coordination, and transition planning functions . The Case Manager has the overall accountability for a designated case load and plans effectively in ...
RN - Case Manager
Espanola, NM · On-site
$36.41 - $62/hr
The role integrates utilization management, care coordination, and transition planning functions . The Case Manager has the overall accountability for a designated case load and plans effectively in ...
This position functions to achieve optimal clinical and quality outcomes by effectively managing care and resources to reduce unnecessary utilization. * The Case Manager RN reports to the Director of ...
This position functions to achieve optimal clinical and quality outcomes by effectively managing care and resources to reduce unnecessary utilization. * The Case Manager RN reports to the Director of ...
The Case Manager works as part of the interdisciplinary team to facilitate and coordinate clients' continuum of care activities, ensuring optimum utilization of community resources, service delivery ...
The Case Manager works as part of the interdisciplinary team to facilitate and coordinate clients' continuum of care activities, ensuring optimum utilization of community resources, service delivery ...
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 does a utilization case manager do?
A utilization case manager reviews and authorizes healthcare services to ensure they are necessary and appropriate, often working with insurance companies and healthcare providers. They analyze patient records, coordinate care plans, and ensure compliance with policies, typically using case management software and requiring strong communication skills.
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 jobs pay 4000 a week without a degree?
Utilization Case Managers typically do not earn $4,000 weekly without relevant experience or certifications; most roles in healthcare or social services pay less. High-paying jobs that can reach this level without a degree are rare and often involve specialized skills, sales, or entrepreneurship. Generally, achieving such income without a degree requires significant experience, licensing, or working in high-demand fields like real estate or certain trades.
What is the highest paid case manager?
The highest paid case managers are often those with advanced certifications, specialized skills, or experience in high-demand fields such as healthcare or insurance. Senior or managerial roles, such as Utilization Review Managers, can earn salaries exceeding $80,000 to $100,000 annually. Compensation varies based on location, industry, and level of responsibility.
Is being a MOA a good entry level job?
A Medical Office Assistant (MOA) role is often considered an entry-level position in healthcare, requiring basic administrative and clinical skills. It provides experience with medical records, patient communication, and office procedures, which can serve as a foundation for advancing in healthcare careers. However, the job's suitability depends on individual career goals and the specific workplace environment.
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.
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 New Mexico? For Utilization Case Manager jobs in New Mexico, the most frequently searched job titles are:
What job categories do people searching Utilization Case Manager jobs in New Mexico look for? The top searched job categories for Utilization Case Manager jobs in New Mexico are:
What cities in New Mexico are hiring for Utilization Case Manager jobs? Cities in New Mexico with the most Utilization Case Manager job openings:
Full-time
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Job description
This position is responsible for: Routine case management, discharge planning, swing bed coordinator and utilization review duties. Evaluating and screening potential admissions to the facilities swing bed program knowledgeable of criteria for Medicare, Medicaid, HMO, swing bed and private insurance coverage Initiate ongoing communication with the resident and resident's family to assess discharge needs. Actively involvement in daily rounds with bedside staff, physicians and ancillary team members Communicate with physicians to ascertain their plans for a timely discharge. document updates and discharge planning as an ongoing review. Manage and collaborate with the healthcare team on swing bed placement and complete MDS documentation as necessary. assist with obtaining referrals, prior authorization for Home Health Care, CME, SNF, acute rehab and appointments. Educates physicians and staff regarding appropriate level of care/utilization and required documentation that meets admission status Run Interqual for each IP and OBS patient admitted to the floor
Shift: 0800-1630
Specialty Type: Mid-Revenue Cycle Solutions
Sub Specialties: Acute Care RN Case Manager - Discharge Planning, Acute Care RN Case Manager - Util Rev/Appeals & Denials, Acute Care RN Case Manager - Util Rev/Discharge Planning , Acute Care RN Case Manager - Utilization Review
General Certifications: N/A
Please CLICK HERE to view details.
Shift: 0800-1630
Specialty Type: Mid-Revenue Cycle Solutions
Sub Specialties: Acute Care RN Case Manager - Discharge Planning, Acute Care RN Case Manager - Util Rev/Appeals & Denials, Acute Care RN Case Manager - Util Rev/Discharge Planning , Acute Care RN Case Manager - Utilization Review
General Certifications: N/A
Please CLICK HERE to view details.
About InstantServe
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InstantServe provides a one-stop solution to all Healthcare, IT/Non-IT Staffing needs. Established in 2016, InstantServe is a strong workforce of over 100+ go-getters with a demonstrated background in IT/Non-IT service. We are a nationally certified SBE from the Department of Administration (State of PA). As a proud Minority Woman Owned Small Business Enterprise (M/WBE), InstantServe boasts of a strong team of professionals who have extensive experience catering to several Federal, Public, Commercial, and Healthcare Clients which includes 26 States and 46 government agencies. InstantServe is a client-centric organization that offers cost-effective and reliable solutions. Client satisfaction is sacrosanct! Our team strives to provide the best staffing and IT solutions to take your business to the next level.
Industry
Recruiting and staffing services
Company size
11 - 50 Employees
Headquarters location
Wayne, PA, US
Year founded
2016