Utilization Review/Case Manager-Partial Hospitalization Program Department: Lanham Partial Hospitalization Reports To: Director- Clinical Director Behavioral Health Lanham Cost Center/Job Code: 41000 ...
Utilization Review/Case Manager-Partial Hospitalization Program Department: Lanham Partial Hospitalization Reports To: Director- Clinical Director Behavioral Health Lanham Cost Center/Job Code: 41000 ...
Case Manager
$19.25 - $24.75/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
$19.25 - $24.75/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
Washington, DC · On-site
$25/hr
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
Case Manager
Washington, DC · On-site
$25/hr
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
Case Manager
Washington, DC · On-site
$25/hr
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
Case Manager
Washington, DC · On-site
$25/hr
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
Case Manager
Washington, DC · On-site
$25/hr
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
Case Manager
Washington, DC · On-site
$25/hr
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
Case Manager
Washington, DC · On-site
$25/hr
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
Case Manager
Washington, DC · On-site
$25/hr
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
Case Manager
Washington, DC · On-site
$25/hr
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
Case Manager
Washington, DC · On-site
$25/hr
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
Case Manager
Washington, DC · On-site
$25/hr
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
Case Manager
Washington, DC · On-site
$25/hr
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
Case Manager
Washington, DC · On-site
$25/hr
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
Case Manager
Washington, DC · On-site
$25/hr
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
Case Manager
Washington, DC · On-site
$25/hr
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
Case Manager
Washington, DC · On-site
$25/hr
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
Case Manager
Washington, DC · On-site
$25/hr
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
Case Manager
Washington, DC · On-site
$25/hr
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
Case Manager
Washington, DC · On-site
$25/hr
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
Case Manager
Washington, DC · On-site
$25/hr
What You'll Do The Case Manager for the Washington, DC Temporary Assistance for Needy Families ... Facilitate the successful utilization of job readiness training, rapid job searching, job retention ...
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?
| 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.
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 job categories do people searching Utilization Case Manager jobs in Washington look for?
The top searched job categories for Utilization Case Manager jobs in Washington are:
What cities in Washington are hiring for Utilization Case Manager jobs?
Cities in Washington with the most Utilization Case Manager job openings:
Full-time
Posted 7 days ago
Luminis Health rating
7.9
Based on 54 frontline employees who took The Breakroom Quiz
106th of 894 rated healthcare providers
Job description
Luminis Health
Title: Utilization Review/Case Manager-Partial Hospitalization Program
Department: Lanham Partial Hospitalization
Reports To: Director- Clinical Director Behavioral Health Lanham
Cost Center/Job Code: 41000-42002-001148
FLSA Status: Exempt
Position Objective:
Performs and monitors integrated, concurrent utilization review and case referrals on patients, consistent with the approved Utilization Review Plans. Works with medical and professional staff to obtain appropriate clinical documentation for review and optimal patient placement. Maintains contact with Managed Care and other third party payors to assure appropriate case management.
Essential Job Duties:
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions
- Performs duties according to established standards for age groups adolescence through geriatric.
- Assesses data reflective of the patients status and interprets the appropriate information needed to identify each patients requirements relative to his or her age-specific needs. Maintains monthly statistical data and reports data to Clinical Director.
- Identifies status of physical, social and psychological needs of the patient, family and significant others.
- Evaluates data obtained in the bio-psychosocial and nursing history and assesses patients and their families to determine by interview, appropriateness for admission or referral.
- Determines the medical necessity and appropriateness of admission, using established criteria and standards.
- Verifies that pre-admission assessment is performed, and pre-authorizes patients as applicable.
- Monitors medical records for medical necessity and appropriateness of continued stay in accordance with established and approved norms.
- Verifies prior authorization data and performs concurrent reviews with external review agents on a daily basis in order to provide medical necessity and intensity of service information for continued stay approvals.
- Consolidates, tracks and reports performance on completed utilization review forms for all clinical areas and relays information to the multi-disciplinary treatment team.
- Resolves matters on outliers and initiates/follows up on appeals for determination at variance with program norm.
Educational/Experience Requirements:
- BA/BS
- Two years of experience performing utilization review or utilization management.
RequiredLicense/Certifications:
Working Conditions, Equipment, Physical Demands:
There is a reasonable expectation that employees in this position will not be exposed to blood-borne pathogens.
Physical Demands -
Light work. Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects. If the use of arm and/or leg controls requires exertion of forces greater than that for sedentary work and the worker sits most of the time, the job is rated for light work.
The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act.
The above job description is an overview of the functions and requirements for this position. This document is not intended to be an exhaustive list encompassing every duty and requirement of this position; your supervisor may assign other duties as deemed necessary.
What Luminis Health employees say
Pay
Benefits
Hours and flexibility
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About Luminis Health
Sourced by ZipRecruiter
Industry
Health care and social assistance
Company size
5,001 - 10,000 Employees
Headquarters location
Annapolis, MD, US
Year founded
2019