ZipRecruiter

Log In

1

Utilization Case Manager Jobs in Washington (NOW HIRING)

MedStar Health

Director Case Management

Columbia, MD · On-site

The Director of Case Management (DCM) oversees case management activities that may include behavioral health utilization management and care management functions and serves as a liaison to government ...

Inova

Manager Case Management

Falls Church, VA

$21.25 - $27.50/hr

Three (3) years of experience in case management or relevant nursing experience to include utilization review, discharge planning, outcomes management, transitional planning, assessment, care ...

MedStar Health

Field RN Case Manager

Washington, DC · On-site

$89K - $113K/yr

Provides Case Management for designated member population to include support for self-direction nursing home transition transition of care and Utilization Management (UM) activities. Completes field ...

MedStar Health

Field RN Case Manager

Washington, DC · On-site

$88K - $112K/yr

Provides Case Management for designated member population to include support for self-direction nursing home transition transition of care and Utilization Management (UM) activities. Completes field ...

previous page

Showing results 41-60

All JobsUtilization Case JobsUtilization Case Manager JobsUtilization Case Manager Jobs in Washington

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 Washington? For Utilization Case Manager jobs in Washington, the most frequently searched job titles are:
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:
Utilization Case Manager jobs near you

Nurse Case Manager-NOVA, VA

Sentara Healthcare

Manassas, VA • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 13 days ago

Sentara Health rating

6.8

Company rating: 6.8 out of 10

Based on 398 frontline employees who took The Breakroom Quiz

492nd of 887 rated healthcare providers

Job description

City/State
Manassas, VA
Work Shift
First (Days)
Overview:
Sentara Healthcare is currently hiring an Integrated Nurse Case Manager for Northern Virginia, VA
This is a Full Time position with day shift hours and great benefits!
Requires travel to conduct face-to-face home visits in members' homes or other locations throughout the Northern Virginia Region, VA (including Arlington, Manassas, Bristow, Haymarket, Woodbridge, Front Royal, and Warrenton).
Preferred residence locations include:
  • Manassas, VA
  • Bristow, VA
  • Haymarket, VA
  • Prince William County area
  • Warrenton, VA / Fauquier County area (also considered)

Primary responsibilities include:
  • Responsible for case management services within the scope of licensure; develops, monitors, evaluates, and revises the member's care plan to meet the member's needs, with the goal of optimizing member health care across the care continuum
  • Performs telephonic or face-to-face clinical assessments for the identification, evaluation, coordination and management of member's needs, including physical and behavioral health, social services and long-term services
  • Identifies members for high-risk complications and coordinates care in conjunction with the member and health care team
  • Manages chronic illnesses, co-morbidities, and/or disabilities ensuring cost effective and efficient utilization of health benefits; conducts gap in care management for quality programs
  • Assists with the implementation of member care plans by facilitating authorizations/referrals within benefits structure or extra-contractual arrangements, as permissible
  • Interfaces with Medical Directors, Physician Advisors and/or Inter-Disciplinary Teams on care management treatment plans
  • Presents cases at case conferences for multidisciplinary focus. Ensures compliance with regulatory, accrediting and company policies and procedures
  • May assist in problem solving with provider, claims or service issues

Education
  • Associates or Bachelors Degree in Nursing

Certification/Licensure
  • Registered Nurse License (RN) - Nursing License - Compact/Multi-State License required.

Experience
  • 3 years experience in Nursing
  • Discharge planning experience preferred
  • Managed Care experience preferred
  • Preferred: Private duty nursing and knowledgeable with ventilators in a facility or home

Keywords: Care Coordination, Case Management, Human Services, Community Health, Health Education, RN Case Manager, Registered Nurse, BSN, ADN, Private Duty, Ventilator, LinkedIn, Talroo-Nursing ,Manassas, Bristow, Haymarket, Prince William County ,Warrenton, VA , Fauquier County area
Benefits: Caring For Your Family and Your Career
• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to 10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance - 5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down - 10,000
• Reimbursement for certifications and free access to complete CEUs and professional development
• Pet Insurance
• Legal Resources Plan
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.
Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
In support of our mission "to improve health every day," this is a tobacco-free environment.
For positions that are available as remote work, Sentara Health employs associates in the following states:
Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

What Sentara Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply