Utilization Management supporting medical necessity and denial prevention; Transition Management ... Accredited Case Management (ACM) REQUIRED COURSES/ COMPLETIONS (e.g., CPR): N/A #LI-NS1 ...
Utilization Management supporting medical necessity and denial prevention; Transition Management ... Accredited Case Management (ACM) REQUIRED COURSES/ COMPLETIONS (e.g., CPR): N/A #LI-NS1 ...
Travel Nurse RN - Case Manager, Utilization Review
Dallas, TX ยท On-site
$1.8K - $2.7K/wk
AMN Healthcare Revenue Cycle is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Dallas, Texas. & Requirements * Specialty: Utilization Review * Discipline: RN * ...
Travel Nurse RN - Case Manager, Utilization Review
Dallas, TX ยท On-site
$1.8K - $2.7K/wk
AMN Healthcare Revenue Cycle is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Dallas, Texas. & Requirements * Specialty: Utilization Review * Discipline: RN * ...
Supplemental Case Manager
Houston, TX ยท On-site
$19 - $24.50/hr
The role integrates and coordinates resource utilization management, care facilitation and discharge planning functions. In addition, the Case Manager helps drive change by identifying areas where ...
Supplemental Case Manager
Houston, TX ยท On-site
$19 - $24.50/hr
The role integrates and coordinates resource utilization management, care facilitation and discharge planning functions. In addition, the Case Manager helps drive change by identifying areas where ...
Case Management Manager
$19 - $24.50/hr
Oversee care facilitation, utilization management, case management, discharge planning, and transitions of care. * Promote timely patient progression throughout the continuum and help remove barriers ...
Quick apply
Case Management Manager
$19 - $24.50/hr
Oversee care facilitation, utilization management, case management, discharge planning, and transitions of care. * Promote timely patient progression throughout the continuum and help remove barriers ...
Medical Case Manager
Dallas, TX ยท On-site
To provide comprehensive quality telephonic case management to proactively drive a medically ... Perform Utilization Review activities prospectively, concurrently or retrospectively in accordance ...
Medical Case Manager
Dallas, TX ยท On-site
To provide comprehensive quality telephonic case management to proactively drive a medically ... Perform Utilization Review activities prospectively, concurrently or retrospectively in accordance ...
Medical Case Manager
Dallas, TX ยท Remote
To provide comprehensive quality telephonic case management to proactively drive a medically ... Perform Utilization Review activities prospectively, concurrently or retrospectively in accordance ...
Medical Case Manager
Dallas, TX ยท Remote
To provide comprehensive quality telephonic case management to proactively drive a medically ... Perform Utilization Review activities prospectively, concurrently or retrospectively in accordance ...
Medical Case Manager
Dallas, TX ยท Remote
To provide comprehensive quality telephonic case management to proactively drive a medically ... Perform Utilization Review activities prospectively, concurrently or retrospectively in accordance ...
Medical Case Manager
Dallas, TX ยท Remote
To provide comprehensive quality telephonic case management to proactively drive a medically ... Perform Utilization Review activities prospectively, concurrently or retrospectively in accordance ...
The Nurse Case Manager- Inpatient is also responsible for ensuring that the patient is placed in the appropriate level of care while monitoring the utilization of healthcare resources and discharge ...
The Nurse Case Manager- Inpatient is also responsible for ensuring that the patient is placed in the appropriate level of care while monitoring the utilization of healthcare resources and discharge ...
Case Manager
Abilene, TX ยท On-site
$19.25 - $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 Certification:
Case Manager
Abilene, TX ยท On-site
$19.25 - $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 Certification:
Case Manager
Abilene, TX ยท On-site
$16 - $20.50/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 Certification:
Case Manager
Abilene, TX ยท On-site
$16 - $20.50/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 Certification:
Case Manager, Weekend
Houston, TX ยท On-site
The role integrates and coordinates resource utilization management, care facilitation and discharge planning functions. In addition, the Case Manager helps drive change by identifying areas where ...
Case Manager, Weekend
Houston, TX ยท On-site
The role integrates and coordinates resource utilization management, care facilitation and discharge planning functions. In addition, the Case Manager helps drive change by identifying areas where ...
Case Manager
$18.25 - $23.50/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
$18.25 - $23.50/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
$17.25 - $22/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
$17.25 - $22/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
$18 - $23.25/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 ...
Quick apply
Case Manager
$18 - $23.25/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
$18 - $23.25/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 ...
Quick apply
Case Manager
$18 - $23.25/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
$18.75 - $24.25/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 ...
Quick apply
Case Manager
$18.75 - $24.25/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
San Antonio, TX ยท On-site
$18 - $23.25/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
San Antonio, TX ยท On-site
$18 - $23.25/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
Midland, TX ยท On-site
$19.75 - $25.25/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
Midland, TX ยท On-site
$19.75 - $25.25/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
Austin, TX ยท On-site
$19.75 - $25.50/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
Austin, TX ยท On-site
$19.75 - $25.50/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
Round Rock, TX ยท 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 * License or ...
Case Manager
Round Rock, TX ยท 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 * License or ...
Utilization Case Manager information
What is a utilization case manager?
How does a utilization case manager typically collaborate with healthcare providers and insurance companies?
What degree do I need for utilization review?
What are the key skills and qualifications needed to thrive as a utilization case manager?
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.

Registered Nurse Case Manager (RN) PRN days
San Antonio, TX โข On-site
Other
Medical, Dental, Vision, Life, Retirement, PTO
Posted 7 days ago
Job description
๏ปฟ
Are you a results-driven leader ready to make a meaningful impact to patients, caregivers, and your community? At Westover Hills Baptist Hospital hospital, were seeking an innovative and experienced healthcare leader to drive excellence and inspire our team towards exceptional patient outcomes and operational success.
At Westover Hills Baptist Hospital, we understand that our greatest asset is our dedicated team of professionals. Thatโs why we offer more than a job โ we provide a comprehensive benefit package that prioritizes your health, professional development, and work-life balance. The available plans and programs include:
- Medical, dental, vision, and life insurance
- 401(k) retirement savings plan with employer match
- Generous paid time off
- Career development and continuing education opportunities
- Health savings accounts, healthcare & dependent flexible spending accounts
- Employee Assistance program, Employee discount program
- Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance
Note: Eligibility for benefits may vary by location and is determined by employment status
Job SummaryPer Diem, Days
Responsible to facilitate care along a continuum through effective resource coordination to help patient achieve optimal health, access to care and appropriate utilization of resources balanced with the patientโs resources and right to self-determination. Has overall responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity and to assess the patient for transition needs to provide timely throughput, safe discharge and prevent avoidable readmissions. Integrates the national standards for care management scope of services including: Utilization Management supporting medical necessity and denial prevention; Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction; Care Coordination by demonstrating efficient throughput while assuring care is sequenced and at appropriate level of care; Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy; Education provided to physicians, patients, families and caregivers. Completes established competencies for the position within designated introductory period. Other related duties as assigned
QualificationsMINIMUM EDUCATION: Graduate of an accredited School of Nursing
PREFERRED EDUCATION: Bachelors or Masters Degree in Nursing
MINIMUM EXPERIENCE: 2 years acute hospital patient care experience. Utilization/case management experience.
PREFERRED EXPERIENCE: Previous Case Management Supervisory experience.
REQUIRED CERTIFICATIONS/LICENSURE: Possession of current Texas State license for Registered Nurse
PREFERRED CERTIFICATIONS/LICENSURE: Accredited Case Management (ACM)
REQUIRED COURSES/ COMPLETIONS (e.g., CPR): N/A
#LI-NS1
Organization DescriptionBaptist Health System has more than 120 years history of caring for our community and making a positive difference. Our system of care includes six full-service hospitals, a specialized childrens hospital with a dedicated pediatric emergency unit, a comprehensive cancer care network, fitness and rehabilitation centers, a physician network, imaging centers, ambulatory services and the Baptist School of Health Professions. Wherever you go in the Baptist Health System, youll find that we have the same goal to help people achieve health for life through compassionate service inspired by faith. Join our team!
Employment practices will not be influenced or affected by an applicantโs or employeeโs race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Tenet participates in the E-Verify program. Follow the link below for additional information.
E-Verify: http://www.uscis.gov/e-verify
The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations.