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Utilization Case Manager Jobs in Utah (NOW HIRING)

University of Utah Health

Case Manager

Park City, UT · On-site

$21 - $27/hr

Case management services include monitoring patient care to ensure progress toward desired outcome ... Negotiates with third party payers relative to benefit levels, eligibility, utilization review, and ...

University of Utah Health

Case Manager

Salt Lake City, UT · On-site

$19.25 - $25/hr

Case management services include monitoring patient care to ensure progress toward desired outcome ... Negotiates with third party payers relative to benefit levels, eligibility, utilization review, and ...

University of Utah Health

Case Manager

Salt Lake City, UT · On-site

$19.25 - $25/hr

Case management services include monitoring patient care to ensure progress toward desired outcome ... Negotiates with third party payers relative to benefit levels, eligibility, utilization review, and ...

University of Utah Health

Case Manager

Salt Lake City, UT · On-site

$19.75 - $25.50/hr

Case management services include monitoring patient care to ensure progress toward desired outcome ... Negotiates with third party payers relative to benefit levels, eligibility, utilization review, and ...

University of Utah Health

Case Manager

Salt Lake City, UT · On-site

$19.25 - $25/hr

Case management services include monitoring patient care to ensure progress toward desired outcome ... Negotiates with third party payers relative to benefit levels, eligibility, utilization review, and ...

University of Utah Health

Case Manager

Salt Lake City, UT · On-site

$19.75 - $25.25/hr

Case management services include monitoring patient care to ensure progress toward desired outcome ... Negotiates with third party payers relative to benefit levels, eligibility, utilization review, and ...

University of Utah Health

Case Manager

Salt Lake City, UT · On-site

$19.25 - $25/hr

Case management services include monitoring patient care to ensure progress toward desired outcome ... Negotiates with third party payers relative to benefit levels, eligibility, utilization review, and ...

University of Utah Health

RN Case Manager

Park City, UT · On-site

  • Retirement

Case management services include monitoring patient care to ensure progress toward desired outcome ... Negotiates with third party payers relative to benefit levels, eligibility, utilization review, and ...

CVS Health

Case Manager, Registered Nurse

Mountain Home, UT · On-site

$54K - $155K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Founded in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support cost-effective quality care ...

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All JobsUtilization Case JobsUtilization Case Manager JobsUtilization Case Manager Jobs in Utah

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 Utah?

For Utilization Case Manager jobs in Utah, the most frequently searched job titles are:

What job categories do people searching Utilization Case Manager jobs in Utah look for?

The top searched job categories for Utilization Case Manager jobs in Utah are:

What cities in Utah are hiring for Utilization Case Manager jobs?

Cities in Utah with the most Utilization Case Manager job openings:

Utilization Case Manager jobs near you

Case Manager

University of Utah Health

Park City, UT • On-site

$21 - $27/hr

Full-time

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

University Of Utah Health rating

7.7

Company rating: 7.7 out of 10

Based on 142 frontline employees who took The Breakroom Quiz

157th of 887 rated healthcare providers

Job description

Overview
As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission. EO/AA
This position provides clinical case management services aimed at enhancing patient-centered care and maximizing outcomes across the patient care continuum from pre-admission through post-discharge. Case management services include monitoring patient care to ensure progress toward desired outcome, addressing patient and family needs, resolving obstacles to effective care, coordinating care with payers and vendors, patients and families. Together with the multiple other internal team member the case manager is responsible for establishing, monitoring and executing patients discharge plan. This position may be required to access and administer medications within their scope of practice and according to State Law.
Corporate Overview: The University of Utah is a Level 1 Trauma Center and is nationally ranked and recognized for our academic research, quality standards and overall patient experience. Our five hospitals and eleven clinics provide excellence in our comprehensive services, medical advancement, and overall patient outcomes.
Responsibilities
Essential Functions
  • Coordinates case management process from patient's entry into the healthcare system to post-discharge, including outpatient settings. Coordinates care and resources with physicians, social workers, and other team members to achieve optimal patient outcomes.
  • Identifies patients who are suitable for case management intervention based on criteria such as cost, case complexity, frequency of admission or patient/family/provider or other healthcare team member request.
  • Monitors and documents quality of care to ensure patient care plan goals are appropriate and that they are understood and implemented. Routinely assesses client and family response to services, while also measuring care plan effectiveness and necessity. Identifies patient needs, including those of an ethical and cultural nature, and ensures they are addressed.
  • Facilitates cost effective outcomes by determining appropriate level of care based on diagnosis, severity, intensity of services required, and other relevant criteria, using national and regional length of stay standards and community norms.
  • Assesses and discusses funding and insurance issues with client, family, and healthcare providers to enhance cost effective utilization of services and quality outcomes.
  • Negotiates with third party payers relative to benefit levels, eligibility, utilization review, and reimbursement.
  • Identifies actual and potential delays in service requests or treatment and communicates them to health care team so steps can be taken to eliminate or minimize delays.
  • Works with other team members to plan appropriate and timely discharges.
  • Establishes measurable discharge planning and self-management goals that promote safe, cost effective, high quality outcomes.
  • Provides oversight of issuance of CMS Important Message to patients.
  • Supervises technical support staff assigned to individual case management teams.
  • May set up patients' follow up appointments and performs post discharge phone calls to patients per care team design.
  • May be required to complete home or site visits as required by the department.
  • At the discretion of department operational and patient care needs, this position is required to work rotating schedules, which may include variable hours, weekends, nights, and holidays to meet the staffing and patient care demands of a 24/7 complex health system. Regular, reliable, and punctual attendance during assigned shifts is considered an essential function of the role.
Knowledge / Skills / Abilities
  • Ability to perform the essential functions of the job as outlined above.
  • Demonstrated availability to work variable and rotating shifts, including nights, weekends, and holidays, in a 24/7 patient care environment.
  • Demonstrated team leadership, relationship building, critical analysis, and written and verbal communication skills.
  • Knowledge of funding resources and clinical standards and outcomes.
  • Ability to provide care appropriate to the population served.
  • Demonstrated independent judgment to assess and meet client needs. Ability to have meaningful outcome oriented dialogues with patients, families, various patient care disciplines, ancillary departments, health care and community agencies, third party payors, and Health Science Center professional schools in coordinating care and services for patients.
  • The staff member must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served on his or her assigned area.
  • The individual must demonstrate knowledge of the principles of life span growth and development and the ability to assess data regarding the patient's status and provide care as described in the department's policies and procedures manual.

Qualifications
Required
  • Two years of professional experience in a clinically related area.
  • Dependent upon the department of hire, may be required to provide reliable transportation for site visits.
Licenses Required
  • One of the following
    • Current license to practice as a Registered Nurse in the State of Utah, or obtain one within 90 days of hire under the interstate compact if switching residency to State of Utah. Must maintain current Interstate Compact (multi-state) license if residency is not being changed to Utah.
    • Current Licensed Clinical Social Worker (L.C.S.W.) certificate for clinical practice in the State of Utah.
    • Current license to practice as a Clinical Mental Health Counselor in the State of Utah.
    • Current license to practice as a Physical Therapist in the State of Utah, or obtain one within 90 days of hire under the Physical Therapy Compact if switching residency to State of Utah. Must maintain current Physical Therapy Compact (multi-state) license if residency is not being changed to Utah.
    • Current licensure to practice as an Occupational Therapist in the State of Utah.
* Additional license requirements as determined by the hiring department.
Qualifications (Preferred)
Preferred
  • Basic Life Support Health Care Provider card through American Heart Association.
  • A Certified Case Management designation.
  • Previous experience in clinical resource management activities and third party payer interactions.
Working Conditions and Physical Demands
Employee must be able to meet the following requirements with or without an accommodation.
  • This position involves light work that may exert up to 20 pounds and may consistently require light work involving lifting, carrying, pushing, pulling or otherwise moving objects involving patient care or medical equipment. This position does not provide any direct patient care. Workers in this position may be exposed to infectious diseases and may be required to function around prisoners or behavioral health patients.

Physical Requirements
Carrying, Climbing, Color Determination, Crawling, Far Vision, Lifting, Listening, Manual Dexterity, Near Vision, Pulling and/or Pushing, Reaching, Sitting, Speaking, Standing, Stooping and Crouching, Walking

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