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Utilization Case Manager Jobs in Utah (NOW HIRING)

Pacs

Case Manager - RN

Francis, UT

Case Manager - RN Salary - 90K-110K General Purpose * Utilize clinical expertise and critical ... Performs utilization review activities to provide resident appropriate, timely and cost-effective ...

Imh

Utilization Management Behavioral Health

Murray, UT · Hybrid

$38.77 - $59.82/hr

Utilization Review, Case Management, discharge planning, managed care, health promotion, health coaching, behavioral health, or Patient Educator job role. * Intermediate computer and hardware set-up ...

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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 medical providers and insurance companies. They analyze patient records, coordinate care plans, and ensure compliance with policies, typically using case management software and clinical knowledge. Their goal is to optimize resource use while maintaining quality patient care.

What jobs pay 10,000 a month without a degree?

Utilization Case Managers typically do not earn $10,000 a month without specialized experience or certifications; most roles in this field pay lower salaries. High-paying jobs that can reach this level without a degree include sales, real estate, or entrepreneurship, often requiring strong skills, networking, and industry knowledge. Some trades, like certain construction or technical roles, may also offer high earnings with experience and certifications rather than formal degrees.

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 2000 a day?

Utilization Case Managers typically do not earn $2,000 a day; such high daily earnings are more common in specialized roles like senior executives, certain consulting positions, or high-level medical professionals. Most jobs with high daily pay require advanced skills, certifications, or extensive experience, and earnings can vary based on industry, location, and workload.

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 skills, familiarity with medical terminology, and sometimes certification. It provides experience in healthcare settings and can serve as a stepping stone to more advanced medical roles, but it may have limited responsibilities compared to specialized positions.

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 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
Registered Nurse - Case Manager w/BONUS

Registered Nurse - Case Manager w/BONUS

Vantage Search Group Inc

South Weber, UT

Other

Posted 5 days ago

Job description

Registered Nurse - Case Manager

We have a new opening for a Registered Nurse - Case Manager at Hill Air Force Base in Utah.

Core Duties: The duties include, but are not limited to the following:

  • Participate in all phases of the Case Management Program (CMP) and ensure that the CMP meets established case management (CM) standards of care.
  • Provide nursing expertise about the CM process, including assessment, planning, implementation, coordination, and monitoring. Identify opportunities for CM and identify and integrate local CM processes.
  • Develop and implement local strategies using inpatient, outpatient, onsite and telephonic CM
  • Develop and implement tools to support case management, such as those used for patient identification and patient assessment, clinical practice guidelines, algorithms, CM software, and databases for community resources.
  • Integrate CM and utilization management (UM) and integrating nursing case management with social work case management.
  • Maintain liaison with appropriate community agencies and organizations.
  • Accurately collect and document patient care data.
  • Develop treatment plans including preventive, therapeutic, rehabilitative, psychosocial, and clinical interventions to ensure continuity of care toward the goal of optimal wellness.
  • Establish mechanisms to ensure proper implementation of patient treatment plan and follow-up post discharge in ambulatory and community health care settings.
  • Provide appropriate health care instruction to patient and/or caregivers based on identified learning needs.
  • This position entails working at MacDill AFB and/or Sabal Park Clinic as needed

Work Schedule:

Monday - Friday, 9 hours between 7:00am and 5:00pm, including a one hour lunch

No weekends or holidays

No call

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