Must have utilization management, utilization review or case management experience for 24 recent consecutive months * Certified/certification eligible in relevant specialty, such as Certified Managed ...
Must have utilization management, utilization review or case management experience for 24 recent consecutive months * Certified/certification eligible in relevant specialty, such as Certified Managed ...
Must have utilization management, utilization review or case management experience for 24 recent consecutive months * Certified/certification eligible in relevant specialty, such as Certified Managed ...
Must have utilization management, utilization review or case management experience for 24 recent consecutive months * Certified/certification eligible in relevant specialty, such as Certified Managed ...
Uses utilization management techniques to determine the medical necessity, appropriateness and ... Registered Nurse Case Manager 2 Job Responsibilities: * Develops, implements and evaluates patient ...
New
Uses utilization management techniques to determine the medical necessity, appropriateness and ... Registered Nurse Case Manager 2 Job Responsibilities: * Develops, implements and evaluates patient ...
New
Their primary focus is optimizing resource utilization while ensuring effective discharge planning and patient advocacy. * Department: Case Management Shift: Monday to Friday, 08:00 - 16:30 (40 hours ...
Their primary focus is optimizing resource utilization while ensuring effective discharge planning and patient advocacy. * Department: Case Management Shift: Monday to Friday, 08:00 - 16:30 (40 hours ...
Registered Nurse (RN) Case Manager 2
Fairfax, VA · On-site
$92K - $151K/yr
Uses utilization management techniques to determine the medical necessity, appropriateness and ... Registered Nurse Case Manager 2 Job Responsibilities: * Develops, implements and evaluates patient ...
Registered Nurse (RN) Case Manager 2
Fairfax, VA · On-site
$92K - $151K/yr
Uses utilization management techniques to determine the medical necessity, appropriateness and ... Registered Nurse Case Manager 2 Job Responsibilities: * Develops, implements and evaluates patient ...
Uses utilization management techniques to determine the medical necessity, appropriateness and ... Registered Nurse Case Manager 2 Job Responsibilities: * Develops, implements and evaluates patient ...
New
Uses utilization management techniques to determine the medical necessity, appropriateness and ... Registered Nurse Case Manager 2 Job Responsibilities: * Develops, implements and evaluates patient ...
New
Uses utilization management techniques to determine the medical necessity, appropriateness and ... Registered Nurse Case Manager 2 Job Responsibilities: * Develops, implements and evaluates patient ...
New
Uses utilization management techniques to determine the medical necessity, appropriateness and ... Registered Nurse Case Manager 2 Job Responsibilities: * Develops, implements and evaluates patient ...
New
HSCPC RN Case Manager
Washington, DC · On-site
$80K - $115K/yr
Job Title: HSCPC RN Case Manager Location: Washington DC Compensation: $80,000 - $115,000 ... Monitor KPIs related to utilization, length of stay, and discharge efficiency * Participate in ...
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HSCPC RN Case Manager
Washington, DC · On-site
$80K - $115K/yr
Job Title: HSCPC RN Case Manager Location: Washington DC Compensation: $80,000 - $115,000 ... Monitor KPIs related to utilization, length of stay, and discharge efficiency * Participate in ...
Nurse Case Manager Contract guarantee hours: 72 hours biweekly on all assignments - these ... Their functions include concurrent and retrospective review to ensure appropriate utilization ...
Nurse Case Manager Contract guarantee hours: 72 hours biweekly on all assignments - these ... Their functions include concurrent and retrospective review to ensure appropriate utilization ...
Uses clinical expertise and utilization management techniques to determine the medical necessity ... Collaborates/communicates with internal and external case managers. Understands pre-acute and post ...
Uses clinical expertise and utilization management techniques to determine the medical necessity ... Collaborates/communicates with internal and external case managers. Understands pre-acute and post ...
Special Operations Nurse Case Manager / Case Manager Part-Time (National Capital Region)
Washington, DC · On-site
Knowledge and skill in using pre-established utilization review criteria recognize and report ... Commission for Case Management Certification, American Case Manager Association, or American Nurse ...
Special Operations Nurse Case Manager / Case Manager Part-Time (National Capital Region)
Washington, DC · On-site
Knowledge and skill in using pre-established utilization review criteria recognize and report ... Commission for Case Management Certification, American Case Manager Association, or American Nurse ...
Knowledge and skill in using pre-established utilization review criteria recognize and report ... Commission for Case Management Certification, American Case Manager Association, or American Nurse ...
Knowledge and skill in using pre-established utilization review criteria recognize and report ... Commission for Case Management Certification, American Case Manager Association, or American Nurse ...
Uses utilization management techniques to determine the medical necessity, appropriateness and ... Discusses payer criteria and issues on a case by case basis with clinical staff and follows-up to ...
Uses utilization management techniques to determine the medical necessity, appropriateness and ... Discusses payer criteria and issues on a case by case basis with clinical staff and follows-up to ...
Case Management - Travel RN
Lanham, MD · On-site
$2.0K/wk
Case Management RN Contract Position Stability HealthCare is looking for a Case Management RN ... Utilization Review
New
Case Management - Travel RN
Lanham, MD · On-site
$2.0K/wk
Case Management RN Contract Position Stability HealthCare is looking for a Case Management RN ... Utilization Review
New
RN Inpatient Case Manager Part-Time ( Emergency Dept )
Olney, MD · On-site
$89K - $162K/yr
Case Management Team Member ... Work days are set for Wednesdays and Thursdays each week, experienced utilization review candidates ...
RN Inpatient Case Manager Part-Time ( Emergency Dept )
Olney, MD · On-site
$89K - $162K/yr
Case Management Team Member ... Work days are set for Wednesdays and Thursdays each week, experienced utilization review candidates ...
Nurse Case Manager-NOVA, VA
Manassas, VA · On-site
$10K/mo
Responsible for case management services within the scope of licensure; develops, monitors ... efficient utilization of health benefits; conducts gap in care management for quality programs
Nurse Case Manager-NOVA, VA
Manassas, VA · On-site
$10K/mo
Responsible for case management services within the scope of licensure; develops, monitors ... efficient utilization of health benefits; conducts gap in care management for quality programs
Responsible for case management services within the scope of licensure; develops, monitors ... efficient utilization of health benefits; conducts gap in care management for quality programs
Responsible for case management services within the scope of licensure; develops, monitors ... efficient utilization of health benefits; conducts gap in care management for quality programs
Integrated Case Manager- Registered Nurse
Woodbridge, VA · On-site +1
The Integrated Case Manager is responsible for case management services within the scope of ... efficient utilization of health benefits; conducts gap in care management for quality programs.
Integrated Case Manager- Registered Nurse
Woodbridge, VA · On-site +1
The Integrated Case Manager is responsible for case management services within the scope of ... efficient utilization of health benefits; conducts gap in care management for quality programs.
Nurse Case Manager-NOVA, VA
Manassas, VA · On-site +1
Responsible for case management services within the scope of licensure; develops, monitors ... efficient utilization of health benefits; conducts gap in care management for quality programs
Nurse Case Manager-NOVA, VA
Manassas, VA · On-site +1
Responsible for case management services within the scope of licensure; develops, monitors ... efficient utilization of health benefits; conducts gap in care management for quality programs
Knowledge and skill in using pre-established utilization review criteria recognize and report ... Skill in management of information systems and technology in order to manage individual or ...
Knowledge and skill in using pre-established utilization review criteria recognize and report ... Skill in management of information systems and technology in order to manage individual or ...
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?
| 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 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:
Full-time
Posted 17 days ago
Job description
Spectrum Healthcare Resources has an opportunity for a Registered Nurse Utilization Management (UMRN) working at Joint Base Andrews in Washington, D.C.
Requirements:
- Associates Degree of Nursing
- Current, full, active, and unrestricted license to practice as a Registered Nurse (Any State)
- Must have at least 36 months of total nursing experience in direct patient care clinical setting. Must have utilization management, utilization review or case management experience for 24 recent consecutive months
- Certified/certification eligible in relevant specialty, such as Certified Managed Care Nurse through the American Board of Managed Care Nurses, or Certified Informatics Nursing, Ambulatory Care Nursing, Medical-Surgical Nursing, or Nursing Case Management through the American Nurses Credentialing Center.
- Highly organized, self-directed worker able to function in a high-volume environment without distractions.
- Strong verbal and written communication skills.
- Proficient level of experience with Microsoft Office applications and strong technical aptitude.
Work Schedule:
- Monday - Friday
- No nights and weekends
- 8 hours a day
Company Overview:
Spectrum Healthcare Resources (SHR) was established in 1988 to deliver systems and processes designed to meet the unique needs of Military and VA Health Systems. SHR is a leading organization that provides physician and clinical staffing and management services to United States Military Treatment Facilities, VA clinics and other Federal Agencies through various contracting vehicles. A Joint Commission Health Care Staffing Services firm, SHR is the military staffing division of TeamHealth, a Nationwide organization that serves 850 civilian and military hospitals with a team of 9,600 affiliated health care professionals.
EOE/Disabled/Veterans
Joseph Day
Recruiter
Direct: (314) 744-4138
424 S Woods Mill Rd | Suite 205 | Town & Country, MO 63017
US-MD-Camp Springs
Joseph Day
314-744-4138
joseph_day@spectrumhealth.com
About Spectrum Healthcare Resources
Sourced by ZipRecruiter
Spectrum is a leading organization that provides program management and physician and clinical staffing services to United States Military Treatment Facilities, VA Clinics and Federal Agencies. We are dedicated to the markets we serve, leading our organization’s experience for almost three decades.
Industry
Health care and social assistance
Company size
1,001 - 5,000 Employees
Headquarters location
Saint Louis, MO, US
Year founded
1988