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Utilization Case Manager Jobs in Utah (NOW HIRING)

Imh

Nurse Care Manager

Salt Lake City, UT · Remote

$41.20 - $62.17/hr

Case Management Certification * Demonstrated experience in case management, utilization review, value-based care, and/or discharge planning. * Basic computer skills, including proficiency in word ...

Imh

RN Care Manager PRN

Murray, UT · Remote

$41.20 - $62.17/hr

Case Management Certification * Demonstrated experience in case management, utilization review, value-based care, and/or discharge planning. * Basic computer skills, including proficiency in word ...

Imh

RN Hospital Care Manager

Murray, UT · Hybrid

$41.20 - $62.17/hr

Case Management Certification * Demonstrated experience in case management, utilization review, value-based care, and/or discharge planning. * Basic computer skills, including proficiency in word ...

Imh

RN Hospital Care Manager

Murray, UT · Hybrid

$41.20 - $62.17/hr

Case Management Certification * Demonstrated experience in case management, utilization review, value-based care, and/or discharge planning. * Basic computer skills, including proficiency in word ...

Imh

RN Ambulatory Care Manager

Saint George, UT

Demonstrated experience in case management, utilization review, or discharge planning. Physical Requirements * Ongoing need for employee to see and read information, labels, assess patient needs ...

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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.

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.

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 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 degree do I need for utilization case manager?

Utilization case managers typically need at least a bachelor's degree in healthcare, social work, nursing, or a related field. Some positions may prefer or require a master's degree or relevant certifications, such as Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ).

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

Director of Care Coordination and Population Health

Moab Regional Hospital

Moab, UT • On-site

$100K - $143K/yr

Full-time

Retirement, PTO

Posted 9 days ago

Key responsibilities

  • Develop and implement a comprehensive care coordination strategy aligned with hospital and system goals.

  • Oversee processes related to patient flow, discharge planning, post-acute transitions, and readmission prevention.

  • Lead development and execution of population health programs targeting high-risk, high-cost, and vulnerable populations.

Job description

Director of Care Coordination and Population Health
Join our Care Coordination team at Moab Regional Hospital!
This is a salaried, exempt, year-round, benefited position.
Anticipated Schedule: Monday – Friday, requires some on call responsibilities to include weekends, evenings, and holidays.
Starting salary range: $100,880.00 to $143,665.60 DOE
Our Director of Care Coordination and Population Health position:
At Moab Regional Hospital, we believe exceptional healthcare extends far beyond the walls of the hospital. We are seeking a visionary and collaborative Director of Care Coordination (DCC) to lead and transform the delivery of coordinated, patient-centered care across our rural health system and community.
As a strategic and operational leader, the Director provides oversight for all care coordination functions, including case management, social work, discharge planning, care transitions, patient transportation, chronic disease management, and population health initiatives. Working closely with physicians, nursing leadership, community organizations, and regional partners, the Director will advance innovative models of care that improve health outcomes, reduce avoidable utilization, and support patients in navigating a seamless continuum of care.
Being a key architect of the future of care coordination at Moab Regional Hospital, the Director will play a pivotal role in designing new programs, developing sustainable service lines, and building a high-performing department that reflects the unique needs of rural Utah residents. This leader will also spearhead grant identification, development, and implementation efforts related to care coordination, population health, transportation access, behavioral health integration, and other strategic initiatives that strengthen healthcare delivery throughout the region.
This is an exceptional opportunity for a forward-thinking healthcare leader who is passionate about rural health, community impact, and innovation. The successful candidate will join an organization committed to advancing health opportunities, expanding access to care, and creating transformative solutions that improve the lives of patients and families throughout southeastern Utah.
Key Responsibilities:
Leadership amp; Strategic Direction
  • Develop and implement a comprehensive care coordination strategy aligned with hospital and system goals.
  • Lead, mentor, and support care coordination teams (RN case managers, social workers, discharge planners, non-RN coordinators, and population health staff).
  • Collaborate with medical, nursing, and administrative leadership to ensure alignment of care management across inpatient, outpatient, and community settings.
  • Design and drive data-informed interventions to address gaps in care and reduce preventable utilization.
Care Coordination Operations
  • Oversee processes related to patient flow, discharge planning, post-acute transitions, and readmission prevention.
  • Integrate workflows of care management, social work, and patient transport into cohesive, efficient operations.
  • Develop and maintain standardized policies, workflows, and documentation aligned with regulatory requirements and best practices.
  • Partner with revenue cycle and utilization management teams to support appropriate length of stay and resource use.
  • Manage and collaborate on care coordination for the PATH 1.5 Rural Health Transformation grant for Moab Regional Hospital and the Moab Free Clinic as well as potential grant opportunities in the future.
Population Health amp; Community Engagement
  • Lead development and execution of population health programs targeting high-risk, high-cost, and vulnerable populations.
  • Use analytics and risk stratification tools to identify and engage target groups.
  • Foster partnerships with community agencies, payers, and regional health networks to improve social determinants of health.
  • Monitor outcomes and financial metrics related to value-based care and population health contracts.
Quality, Compliance, and Education
  • Ensure compliance with state and federal regulations regarding case management and discharge planning.
  • Track and report key metrics such as readmission rates, care transition success, and patient satisfaction.
  • Develop training and education programs for interdisciplinary care coordination and population health initiatives.
Qualifications:
  • Master's degree in nursing, Social Work, Public Health, Health Administration, or a related field preferred; bachelor’s degree required.
  • RN or LCSW licensure recommended but not required.
  • Certification in Case Management (ACM, CCM) or Population Health (CPH) recommended and preferred within 18 months of hire.
  • Minimum 5 years of progressive leadership experience in care coordination, case management, or population health, preferably in a hospital or health system setting.
  • Proven ability to lead multidisciplinary teams and drive operational and cultural change.
  • Demonstrated success using data to guide decisions and measure outcomes.
  • Excellent interpersonal and communication skills.
  • Strategic thinker with a strong understanding of healthcare delivery and reimbursement models.
  • Passion for patient-centered care and innovation in rural health systems.
  • Effective collaborator across departments and community partners.
What’s great about working at Moab Regional Hospital?
We have an amazing team here at Moab Regional Hospital, with a skilled group of healthcare providers and physicians from a wide range of specialties who are committed to the Moab community. Every healthcare professional that works here at MRH in both a clinical and non-clinical setting cares about our patients because these are our friends, neighbors, and our family.
Each MRH employee calls Moab their home for a variety of reasons: they were born and raised here in Moab or the greater SE Utah; they have moved here after falling in love with the town’s tight-knit community; most are drawn here by some of the most stunning red rock landscapes on Earth.
Moab Regional Hospital strives to balance care for the community with care for its employees and offers a supportive work environment, competitive total compensation packages, and the flexibility to enjoy what makes this desert region one of the most unique and special places to live.
We offer:
  • Wide range of benefits, including insurance, retirement, and paid time off
  • Collaborative and supportive workplace
  • Professional growth opportunities including continuing education, trainings, and more!
Spectacular Location: Welcome to Moab, Utah, where Arches and Canyonlands National Parks are just a part of the breathtaking red rock landscapes that surround this charming town. Nestled at the base of the LaSal Mountains and along the banks of the Colorado River, small-town friendliness coupled with unparalleled natural beauty make this a great place to call home. Thanks to its perfect climate, Moab offers year round recreation opportunities, and is renowned for mountain biking, rock climbing, jeeping, hiking and river activities. There are an array of restaurants, microbreweries, art galleries and special events that create a vibrant community to live in.
Moab Regional Hospital is a Drug Free Workplace, and requires successful completion of a pre-employment drug test amp; background check.
Moab Regional Hospital is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws. This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. Moab Regional Hospital makes hiring decisions based solely on qualifications, merit, and business needs at the time.

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