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Utilization Case Manager Jobs in Lancaster, PA (NOW HIRING)

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Utilization Case Manager information

See Lancaster, PA salary details

$16

$35

$58

How much do utilization case manager jobs pay per hour?

As of Aug 28, 2026, the average hourly pay for utilization case manager in Lancaster, PA is $35.46, according to ZipRecruiter salary data. Most workers in this role earn between $28.75 and $37.36 per hour, depending on experience, location, and employer.

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?

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 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 are popular job titles related to Utilization Case Manager jobs in Lancaster, PA?

For Utilization Case Manager jobs in Lancaster, PA, the most frequently searched job titles are:

What job categories do people searching Utilization Case Manager jobs in Lancaster, PA look for?

The top searched job categories for Utilization Case Manager jobs in Lancaster, PA are:

What cities near Lancaster, PA are hiring for Utilization Case Manager jobs?

Cities near Lancaster, PA with the most Utilization Case Manager job openings:

Utilization Case Manager jobs near you
Infographic showing various Utilization Case Manager job openings in Lancaster, PA as of August 2026, with employment types broken down into 83% Full Time, 16% Part Time, and 1% Contract. Highlights an 79% Physical, 3% Hybrid, and 18% Remote job distribution, with an average salary of $73,754 per year, or $35.5 per hour.

Case Manager

Encompass Health Rehabilitation Hospital of Mechanicsburg

East York, PA • On-site

$19.75 - $25.25/hr

Other

Medical, Dental, Vision, Retirement, PTO

Re-posted 21 days ago

Job description

Case Manager Career Opportunity

Recognized for your abilities as a Case Manager

Are you ready for a Case Management role that brings your career closer to home and heart? Join Encompass Health, where being a Case Manager goes beyond just a job; it positions you as a vital link between exceptional care and the transformative impact on each patient's journey. As the leading provider of rehabilitation care in the nation, this opportunity allows you to leverage your clinical expertise while contributing to the well-being of individuals in your community. Manage resources, coordinate patient care from admission to post-discharge, and oversee interdisciplinary plan-of-care decisions. This is more than a career move; it's a chance to shape a future where care and compassion converge for truly meaningful outcomes.


A Glimpse into Our World

At Encompass Health, you'll experience the difference the moment you become a part of our team. Working with us means aligning with a rapidly growing national inpatient rehabilitation leader. We take pride in the growth opportunities we offer and how our team unites for the greater good of our patients. Our achievements include being named one of the "World's Most Admired Companies" and receiving the Fortune 100 Best Companies to Work For® Award, among other accolades, which is nothing short of amazing.

Starting Perks and Benefits

At Encompass Health, we are committed to creating a supportive, inclusive, and caring environment where you can thrive. From day one, you will have access to:

  • Affordable medical, dental, and vision plans for both full-time and part-time employees and their families.
  • Generous paid time off that accrues over time.
  • Opportunities for tuition reimbursement and continuous education.
  • Company-matching 401(k) and employee stock purchase plans.
  • Flexible spending and health savings accounts.
  • A vibrant community of individuals passionate about the work they do!

Become the Case Manager you always wanted to be

  • Work with interdisciplinary team, guiding treatment plans based on patient needs and preferences.
  • Coordinate with interdisciplinary team to establish tentative discharge plan and contingency plans.
  • Participate in planning for and the execution of patient discharge experience.
  • Monitor patient experience: quality/timeliness/service appropriateness/payors/expectations.
  • Facilitate team conferences weekly and coordinate all treatment plan modifications.
  • Complete case management addendums and all required documentation.
  • Maintain knowledge of regulations/standards, company policies/procedures, and department operations.
  • Review/analyze case management reports, including Key Care Indicators, and plan appropriate actions.
  • Understand commercial contract levels, exclusions, payor requirements, and recertification needs.
  • Attend Acute Care Transfer (ACT) meetings to identify trends and collaboratively reduce ACTs.
  • Meet with patient/family per Patient Arrival and Initial Visit Standard within 24 hrs. of admission.
  • Perform assessment of goals and complete case management addendum within 48 hours of admission.
  • Educate patient/family on rehabilitation and Case Manager role; establish communication plan.
  • Schedule and facilitate family conferences as needed.
  • Assist patient with timely procuring/planning of resources to avoid discharge delays or issues.
  • Monitor compliance with regulations for orthotics and prosthetics ordering and payment.
  • Make appropriate/timely referrals, including documentation to post discharge providers/physician
  • Ensure accuracy of discharge and payor-related information in the patient record
  • 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:
    • Must be qualified to independently complete an assessment within the scope of practice of his/her discipline (for example, RN, SW, OT, PT, ST, and Rehabilitation Counseling).
    • If licensure is required for one's discipline within the state, individual must hold an active license.
    • Must meet eligibility requirements for CCM® or ACM™ certification upon entry into this position OR within two years of entry into the position.
    • CCM® or ACM™ certification required OR must be obtained within two years of being placed in the Case Manager II position.
  • Minimum Qualifications:
    • For Nursing, must possess minimum of an Associate Degree in Nursing, RN licensure with BSN preferred. A diploma is acceptable only in those states whose minimum requirement for licensure or certification is a diploma rather than an associate degree.
    • For all other eligible licensed or certified health care professionals, must possess a minimum of a bachelor's degree and graduate degree is preferred.
    • 2 years of rehabilitation experience preferred.


We're eagerly looking forward to meeting you, and we genuinely mean that. Join us on this remarkable journey!

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