ZipRecruiter

Log In

1

Utilization Case Manager Jobs in Oklahoma (NOW HIRING)

Encompass Health

Case Manager

Broken Arrow, OK

$17.50 - $22.50/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 ...

Encompass Health Corporation

Case Manager

Broken Arrow, OK · On-site

$17.50 - $22.50/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 ...

Encompass Health

Case Manager

Broken Arrow, OK

$17.50 - $22.50/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 ...

Healthcare Scouts

Hospital Case Manager

Tulsa, OK · On-site

Responsible for all case management activities assignedm, including case management and utilization management * The Case Manager provides concise management of patients hospitalization from pre ...

Mercy

Case Manager

Watonga, OK · On-site

$18 - $23/hr

CCM or RN-BC professional case management certification preferred or attained within 36 months of ... Understanding of managed care, utilization, quality improvement concepts and principles. Ability to ...

Mercy

Case Manager

Watonga, OK · On-site

$18 - $23/hr

CCM or RN-BC professional case management certification preferred or attained within 36 months of ... Understanding of managed care, utilization, quality improvement concepts and principles. Ability to ...

Mercy

Case Manager

Watonga, OK · On-site

$18 - $23/hr

CCM or RN-BC professional case management certification preferred or attained within 36 months of ... Understanding of managed care, utilization, quality improvement concepts and principles. Ability to ...

Dulyhealthandcare

The Case Manager is responsible for increasing efficient utilization of health care services; identifying chronic or catastrophic cases through the case management process and initiating intensive ...

next page

Showing results 1-20

All JobsUtilization Case JobsUtilization Case Manager JobsUtilization Case Manager Jobs in Oklahoma

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?

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 Oklahoma? For Utilization Case Manager jobs in Oklahoma, the most frequently searched job titles are:
What job categories do people searching Utilization Case Manager jobs in Oklahoma look for? The top searched job categories for Utilization Case Manager jobs in Oklahoma are:
What cities in Oklahoma are hiring for Utilization Case Manager jobs? Cities in Oklahoma with the most Utilization Case Manager job openings:
Utilization Case Manager jobs near you

Case Manager- Utilization Review Coordinator

Oklahoma Heart Hospital

Oklahoma City, OK • On-site

Full-time

Medical, Dental, Vision, Retirement, PTO

This job post has expired today. Applications are no longer accepted.

Oklahoma Heart Hospital rating

8.3

Company rating: 8.3 out of 10

Based on 41 frontline employees who took The Breakroom Quiz

78th of 1,054 rated hospitals

Job description

Overview
Join Our Team at Oklahoma Heart Hospital (OHH)

ONE TEAM. ALL HEART. At OHH, we believe that patient care is truly at the heart of everything we do. Our dedicated team members are involved in every step of our patients’ journeys, bringing hope, compassion, and healing to both patients and their families. Together with our physicians and caregivers, we’re shaping the future of heart care in Oklahoma by serving the state and leading the nation.

Why You'll Love Working Here:
  • Comprehensive Benefits:
    • Medical, Dental, and Vision coverage
    • 401(k) plan with employer match
    • Long-term and short-term disability
    • Employee Assistance Programs (EAP)
    • Paid Time Off (PTO)
    • Extended Medical Benefits (EMB)
    • Opportunities for continuing education and professional growth

Please note that benefits may vary by position, and some roles (like PRN, Flex, Float, etc.) may have exclusions. For eligible positions, benefits start on your first day!

We can’t wait for you to join our heart-centered team!


Responsibilities

Responsible for comprehensive coordination of care and service of individual patients and/or patient populations, promoting effective utilization of resources, and assuming a leadership role on the multidisciplinary team to achieve patient and physician satisfaction and optimal outcomes.  Responsible for all activities associated with the clinical documentation improvement program and Utilization Review process.   Must be able to work with all disciplines to meet patients’ needs from admission through discharge.  Will perform duties and responsibilities in a manner consistent with the mission and values of the Oklahoma Heart Hospital. 

Performs admission review to assure patient is placed in correct level of care and concurrent or focused reviews using Medicare and payer specific criteria.                                                                                           

Demonstrates an ability to identify cases where admission criteria not met. Contacts physicians for additional information and suggests alternatives if admission/continued stay is not appropriate                                                

Knowledgeable on inpatient, observation and outpatient criteria

Knowledgeable of billing, payer contracts, agreements and reimbursement issues for services provided to OHH patients.


Qualifications

Education: Graduate of an accredited school of nursing.  Bachelors or Master’s degree a plus. 

Experience: Minimum of three (3) years hospital based nursing practice with experience in utilization/case management.  Willing to pursue certification in Case Management (CCM) or CCDS (Certified Clinical Documentation Specialist). Proficient in computer usage.

Licensure/Certification: Registered Nurse with current Oklahoma licensure.

As part of our team, you are empowered to work collaboratively with our physicians and other caregivers, and play an integral role in setting the standard for excellence in patient care. Every team member at OHH plays an integral role in our patients’ experience. They are the reason OHH continues to serve the state and lead the nation. Be part of the future of cardiac care.

Qualifications:

Education: Graduate of an accredited school of nursing.  Bachelors or Master’s degree a plus. 

Experience: Minimum of three (3) years hospital based nursing practice with experience in utilization/case management.  Willing to pursue certification in Case Management (CCM) or CCDS (Certified Clinical Documentation Specialist). Proficient in computer usage.

Licensure/Certification: Registered Nurse with current Oklahoma licensure.

As part of our team, you are empowered to work collaboratively with our physicians and other caregivers, and play an integral role in setting the standard for excellence in patient care. Every team member at OHH plays an integral role in our patients’ experience. They are the reason OHH continues to serve the state and lead the nation. Be part of the future of cardiac care.

Education:UNAVAILABLEEmployment Type: FULL_TIME

What Oklahoma Heart Hospital employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply