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Utilization Case Manager Jobs in Utah (NOW HIRING)

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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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 cities in Utah are hiring for Utilization Case Manager jobs?

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

Registered Nurse (RN) - Case Management - $40+ per hour

Perm Staff Jobs

Ogden, UT โ€ข On-site

$40/hr

Other

Medical, Dental, Vision, Life, Retirement, PTO

Posted 15 days ago


Job description

Perm Staff Jobs is seeking a Registered Nurse (RN) Case Management for a nursing job in Ogden, Utah.

Job Description & Requirements
  • Specialty: Case Management
  • Discipline: RN
  • Duration: Ongoing
  • Employment Type: Staff
RN Case Manager

Strong staffing Support when it matters most. Technology and tools that streamline patient monitoring and communication to help you work more efficiently. Robust supply chains to keep you fully equipped. Ongoing clinical education to improve your skills. As a Registered Nurse at Ogden Regional Medical Center, youโ€™ll have all the staffing support, technology and resources you need to deliver safe, high-quality careโ€”so you can focus on what you do best.

Job Summary and Qualifications

The Case Manager (CM) ensures high-quality, patient-centered care by managing Rehabilitative care to ensure optimum outcomes. The CM provides, coordinates, and directs care specific to the needs of each Rehab patient. The CM collaborates with the Rehab Program Director and Facility Case Management Director regarding departmental functions. The CM coordinates efforts within the Rehabilitation team.

What you will do in this role:

  • You will provide program orientation to patients/families/caregivers. Orientation will include the case manager's role, Rehab philosophy, and continued stay and discharge criteria. Orientation will also include Medicare and insurance benefits, grievance procedures, treatment plan process, and rights and responsibilities.
  • You will act as the coordinator of patient/family/caregiver education. You will promote the participation of the patient/family/caregiver in team discussions related to plans, goals, and status. This will be conducted through Family Conferences and other interactions.
  • You will ensure the implementation of the patient's treatment plan that supports the patient's strengths, abilities, needs, and preferences. You will facilitate the involvement of the patient throughout the rehabilitation process.
  • You will document the findings of the Discharge Planning Evaluation (DPE) and psychosocial assessments. You will communicate the social, financial, or discharge needs and preferences of the patient/family/caregiver.
  • You will assume accountability for promoting consistent, positive patient interactions that advance the agenda of unparalleled patient service.

What qualifications you will need:

  • Current licensure as a Registered Nurse in the State of Alaska or RN compact license from participating compact states.
  • Associate Degree in Nursing required; BSN preferred.
  • 2+ years of experience in case management or 3+ years of experience in clinical nursing required.
  • American Red Cross or American Heart Association Basic Life Support Course (BLS or BCLS) and Certification.
  • Certification in case management or utilization review preferred.
  • InterQual experience preferred.
Benefits

Ogden Regional Medical Center, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

  • Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services
  • Wellbeing support, including free counseling and referral services
  • Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence
  • Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling
  • Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing
  • Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts

Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location

has been delivering exceptional care for over 75 years. Our 230 plus bed hospital offers a full array of medical services. We are dedicated to providing high-quality healthcare. Ogden Regional is a certified Level II Trauma Center, Stroke Center, and Joint Center.

Affiliated with our hospital is . This fully equipped, freestanding facility features board-certified physicians. Our nurses and technicians are specially trained in emergency medical care and available on a 24/7 basis.

Located 10 miles north of our main hospital, PVER features 10 plus treatment rooms, comprehensive imaging technology and a medical laboratory onsite, which help to ensure accurate and prompt care.

Ogden Regional Medical Center and Pleasant View Emergency Center sit at the heart of the Wasatch Mountain range. The area has abundant outdoor recreation including hiking, biking, rock climbing, watersports and three ski resorts within a half-hour drive; Ogden offers the lure of outdoor living and the culture of city life.

HCA Healthcare has been recognized as one of the World Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

"Nurses are essential to the delivery of healthcare and serve as its foundation. At HCA Healthcare, we are committed to equipping nurses with the tools and resources they need to deliver exceptional patient care, championing the profession, and supporting the advancement of nursingโ€™s future."

Erica Rossitto, MBA/HCM, BSN, RN, NEA-BC

Senior Vice President and Chief Nurse Executive

HCA Healthcare

If growth and continued learning is important to you, we encourage you to apply for our RN Case Manager opening. Our team will promptly review your application. Highly qualified candidates will be contacted for interviews. Unlock the possibilities apply today!

We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

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