Utilization Review / Case Manager (RN) Chicago, Illinois Reports To: Clinical Director, Behavioral Health Services Term: Permanent, Full-time General Summary The Utilization Review/Case Manager ...
Utilization Review / Case Manager (RN) Chicago, Illinois Reports To: Clinical Director, Behavioral Health Services Term: Permanent, Full-time General Summary The Utilization Review/Case Manager ...
Case Manager
Libertyville, IL ยท On-site
$19.50 - $25/hr
Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications โข License or ...
Case Manager
Libertyville, IL ยท On-site
$19.50 - $25/hr
Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications โข License or ...
Case Manager
$19.50 - $25/hr
Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications License or Certification:
Case Manager
$19.50 - $25/hr
Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications License or Certification:
Case Manager
$19.50 - $25/hr
Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications License or Certification:
Case Manager
$19.50 - $25/hr
Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications License or Certification:
Remote RN Case Manager - Metro Chicago
Downers Grove, IL ยท On-site +1
Utilization Management, Utilization Review, Managed Care, or Cost Containment experience * CCM (Certified Case Manager), CIRS, or similar Case Management certification (preferred) * Ability to travel ...
Remote RN Case Manager - Metro Chicago
Downers Grove, IL ยท On-site +1
Utilization Management, Utilization Review, Managed Care, or Cost Containment experience * CCM (Certified Case Manager), CIRS, or similar Case Management certification (preferred) * Ability to travel ...
Lead Utilization Management Nurse
Oak Brook, IL ยท On-site +1
We have an innovative organization looking to add a Lead Utilization Management Nurse to its team ... Certified Case Manager (CCM) preferred * Knowledge/experience in Medicare/Medicaid and HEDIS ...
Quick apply
Lead Utilization Management Nurse
Oak Brook, IL ยท On-site +1
We have an innovative organization looking to add a Lead Utilization Management Nurse to its team ... Certified Case Manager (CCM) preferred * Knowledge/experience in Medicare/Medicaid and HEDIS ...
The Case Manager is responsible for increasing efficient utilization of health care services; identifying chronic or catastrophic cases through the case management process and initiating intensive ...
The Case Manager is responsible for increasing efficient utilization of health care services; identifying chronic or catastrophic cases through the case management process and initiating intensive ...
The Case Manager is responsible for increasing efficient utilization of health care services; identifying chronic or catastrophic cases through the case management process and initiating intensive ...
The Case Manager is responsible for increasing efficient utilization of health care services; identifying chronic or catastrophic cases through the case management process and initiating intensive ...
Conducts routine utilization reviews to ensure patients have access to appropriate cost-effective care. * Configures the case management system to organize cases dealing with disease management and ...
Conducts routine utilization reviews to ensure patients have access to appropriate cost-effective care. * Configures the case management system to organize cases dealing with disease management and ...
Case Manager - Family Resource Center
$61K - $63K/yr
The Case Manager acts as an advocate for Maryville residents, supporting the residents in ... Assists the residents in the utilization of available resources by providing linkage to appropriate ...
Case Manager - Family Resource Center
$61K - $63K/yr
The Case Manager acts as an advocate for Maryville residents, supporting the residents in ... Assists the residents in the utilization of available resources by providing linkage to appropriate ...
Conducts routine utilization reviews to ensure patients have access to appropriate cost-effective care. * Configures the case management system to organize cases dealing with disease management and ...
Conducts routine utilization reviews to ensure patients have access to appropriate cost-effective care. * Configures the case management system to organize cases dealing with disease management and ...
The complex care case manager will provide comprehensive and quality telephonic case management for ... Perform Utilization Review activities prospectively, concurrently or retrospectively in accordance ...
The complex care case manager will provide comprehensive and quality telephonic case management for ... Perform Utilization Review activities prospectively, concurrently or retrospectively in accordance ...
Medical Case Manager II
$66K - $101K/yr
As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and ... A cost containment background, such as utilization review or managed care is helpful * Strong ...
Quick apply
Medical Case Manager II
$66K - $101K/yr
As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and ... A cost containment background, such as utilization review or managed care is helpful * Strong ...
RN Case Manager
Elmhurst, IL ยท On-site
$38.16 - $59.15/hr
The RN Case Manager helps optimize patient outcomes, improve resource utilization, and enhance the overall quality of care. What you will do: * Conduct thorough assessments of patients' medical ...
RN Case Manager
Elmhurst, IL ยท On-site
$38.16 - $59.15/hr
The RN Case Manager helps optimize patient outcomes, improve resource utilization, and enhance the overall quality of care. What you will do: * Conduct thorough assessments of patients' medical ...
Medical Case Manager II
$65K - $98K/yr
As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and ... A cost containment background, such as utilization review or managed care is helpful * Strong ...
Quick apply
Medical Case Manager II
$65K - $98K/yr
As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and ... A cost containment background, such as utilization review or managed care is helpful * Strong ...
Medical Case Manager II
Downers Grove, IL ยท On-site
$65K - $98K/yr
As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and ... A cost containment background, such as utilization review or managed care is helpful * Strong ...
Medical Case Manager II
Downers Grove, IL ยท On-site
$65K - $98K/yr
As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and ... A cost containment background, such as utilization review or managed care is helpful * Strong ...
Medical Case Manager II
$65K - $98K/yr
As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and ... A cost containment background, such as utilization review or managed care is helpful * Strong ...
Medical Case Manager II
$65K - $98K/yr
As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and ... A cost containment background, such as utilization review or managed care is helpful * Strong ...
Medical Case Manager II
$66K - $101K/yr
As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and ... A cost containment background, such as utilization review or managed care is helpful * Strong ...
Medical Case Manager II
$66K - $101K/yr
As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and ... A cost containment background, such as utilization review or managed care is helpful * Strong ...
Medical Case Manager II - Field
$66K - $101K/yr
As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and ... A cost containment background, such as utilization review or managed care is helpful * Strong ...
Medical Case Manager II - Field
$66K - $101K/yr
As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and ... A cost containment background, such as utilization review or managed care is helpful * Strong ...
Bilingual Medical Case Manager II
$65K - $98K/yr
As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and ... A cost containment background, such as utilization review or managed care is helpful. * Strong ...
Quick apply
Bilingual Medical Case Manager II
$65K - $98K/yr
As a Medical Case Manager you will make a meaningful difference in the lives of injured workers and ... A cost containment background, such as utilization review or managed care is helpful. * Strong ...
Utilization Case Manager information
See Elgin, IL salary details
$16.40 - $20.31
3% of jobs
$20.31 - $24.22
1% of jobs
$24.22 - $28.13
6% of jobs
$30.01 is the 25th percentile. Wages below this are outliers.
$28.13 - $32.04
30% of jobs
The median wage is $33.44 / hr.
$32.04 - $35.95
26% of jobs
$37.44 is the 75th percentile. Wages above this are outliers.
$35.95 - $39.86
22% of jobs
$39.86 - $43.77
3% of jobs
$43.77 - $47.68
0% of jobs
$47.68 - $51.59
5% of jobs
$51.59 - $55.50
2% of jobs
$55.50 - $59.41
1% of jobs
$16
$36
$59
How much do utilization case manager jobs pay per hour?
What is a Utilization Case Manager?
What does a utilization case manager do?
How does a Utilization Case Manager typically collaborate with healthcare providers and insurance companies?
What jobs pay 4000 a week without a degree?
What is the highest paid case manager?
Is being a MOA a good entry level job?
What are the key skills and qualifications needed to thrive as a Utilization Case Manager, and why are they important?
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.
Job description
Chicago, Illinois
Reports To: Clinical Director, Behavioral Health Services
Term: Permanent, Full-time
General Summary
The Utilization Review/Case Manager facilitates appropriate use of hospital resources by ensuring that patients meet acute inpatient criteria and anticipates discharge needs in a timely manner. The role acts as a central communicator with external and internal customers, collaborating with social workers, case managers, vendors, payers, and community agencies.
Key Responsibilities
Utilization Management
- Perform inpatient utilization management per plan, payer requirements, and standards.
- Collaborate with physicians and healthcare team members for timely and appropriate patient management.
- Collect and document clinical data to support admission and continued hospitalization.
- Provide accurate clinical information to payers as required.
- Support DRG Assurance Program with accurate data collection and assignment.
- Perform non-acute profiling, collect data on avoidable days, and refer cases to Physician Advisor when needed.
- Participate in family meetings and care conferences.
- Ensure timely referrals for discharge planning and use of regional/community resources.
- Refer complex cases to Social Services as appropriate.
- Ensure psychological needs of patients are met via direct intervention or referral.
- Act as a central communicator with patients, families, vendors, payers, and hospital staff.
- Provide continuity of care by leveraging community resources and maintaining updated resource manuals.
- Refer cases not meeting criteria to Physician Advisor in a timely manner.
- Follow up with Medical Director/Physician Advisor on unresolved issues.
- Maintain safe patient care environment and infection control compliance.
- Manage departmental operations (phones, supplies, data tracking).
- Attend in-service presentations and complete all mandatory education.
- Perform other duties as assigned.
Knowledge, Skills & Abilities
- Graduate of an accredited school of nursing (Required)
- Current RN License in Illinois (Required)
- 2+ years relevant clinical experience (Preferred)
- Utilization management experience (Preferred)
- Knowledge of Medicare/Medicaid, Managed Care, and Commercial insurance processes (Preferred)
- Strong written/oral communication skills with appropriate grammar and vocabulary
- Proficiency in Microsoft Word and Excel (Required)
- Ability to provide excellent customer service at all times
- Ability to anticipate and coordinate multiple functions effectively
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