ZipRecruiter

Log In

1

Utilization Case Manager Jobs in Manchester, KY (NOW HIRING)

Community Hospital

RN, Case Manager (Exempt)

Corbin, KY · On-site

Case Management monitors Utilization reviews and patients LOS. Direct the quality improvement activities for the department and promotes the maintenance of high-quality, safe and effective patient ...

New

All JobsUtilization Case JobsUtilization Case Manager JobsUtilization Case Manager Jobs in Manchester, KY

Utilization Case Manager information

See Manchester, KY salary details

$10

$24

$39

How much do utilization case manager jobs pay per hour?

As of Aug 6, 2026, the average hourly pay for utilization case manager in Manchester, KY is $24.17, according to ZipRecruiter salary data. Most workers in this role earn between $19.57 and $25.48 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.

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 job categories do people searching Utilization Case Manager jobs in Manchester, KY look for? The top searched job categories for Utilization Case Manager jobs in Manchester, KY are:
What cities near Manchester, KY are hiring for Utilization Case Manager jobs? Cities near Manchester, KY with the most Utilization Case Manager job openings:
Utilization Case Manager jobs near you

Emergency Department Case Manager (RN)

Baptist Health

Corbin, KY • On-site

Full-time

Medical, Dental, Vision, Life, PTO

Posted 24 days ago

Baptist Health South Florida rating

8.1

Company rating: 8.1 out of 10

Based on 99 frontline employees who took The Breakroom Quiz

1st of 24 rated health and beauty retailers

Job description

Summary
Job Description:
Case Manager RN (ED)
Full-Time, First Shift Fri - Sun 10 am - 10 pm
BHCOR-Case Management I Corbin, KY
The Case Management Department coordinates patient care across the healthcare continuum to promote quality outcomes, efficient use of resources, and a seamless patient experience. Case managers work collaboratively with physicians, nurses, social workers, patients, families, and community partners to assess patient needs, develop care plans, coordinate services, and facilitate safe transitions of care.
The Emergency Department (ED) Registered Nurse Case Manager position is responsible for an initial medical necessity review for admitted patients and transition planning. This individual will use established MCG criteria to assess both the appropriate admission status (inpatient or observation) and level of care. This position will provide ongoing support and expertise through comprehensive assessment, planning, implementation and overall evaluation of individual patient needs. A high level of communication with other members of the interdisciplinary team will be required to coordinate the continuum of care activities, ensuring optimum utilization of resources, quality outcomes related to transition of care service delivery and compliance with external review agencies' requirements. The individual in this role should support an environment of care focused on evidence-based healing and wellness.
Description:
  • Coordinates patient progression, care transitions, and discharge planning across the continuum of care.
  • Completes patient assessments, utilization reviews, and high-risk screenings to identify care needs and ensure appropriate level of care.
  • Develops, implements, and evaluates individualized plans of care in collaboration with physicians, nursing, social work, and interdisciplinary teams.
  • Arranges post-acute services including home health, hospice, skilled nursing, durable medical equipment, transportation, community resources, and follow-up care.
  • Educates patients and families on discharge planning, available resources, financial considerations, and self-management.
  • Facilitates safe, timely, and cost-effective transitions of care while promoting quality outcomes and reducing readmissions.
  • Coordinates communication among patients, families, providers, payers, and care teams to ensure continuity of care.
  • Utilizes clinical criteria, case management tools, and documentation systems to support utilization management, regulatory compliance, and quality initiatives.
  • Advocates for patients while balancing clinical, financial, and organizational goals through effective care coordination and resource utilization.
  • Performs other duties as assigned.

Requirements:
  • Associate Degree in Nursing required; Bachelor's Degree preferred.
  • Three years of nursing experience required; Case Management and Utilization Management experience preferred.
  • Current Registered Nurse (RN) license in the state of practice.
  • Basic Life Support (BLS) certification from the American Heart Association (AHA) required within 30 days of hire.

Benefits:
  • Health, Vision, Dental and Pet Insurance
  • Life Insurance
  • Short Term and Long-Term Disability and Life Insurance
  • Identity Theft Protection
  • Tuition Reimbursement up to $6,000 annually
  • Company paid Maternity and Paternity Leave
  • 5 days of Paid Time Off available upon hire
  • Bereavement Leave (includes pets)
  • PTO Sell Back Program
  • Compassionate Leave Sharing Program (PTO Donation)
  • Employee Support Fund, for employees in need of emergency financial support
  • Retirement with Company Match

Work Experience
Education
If you would like to be part of a growing family focused on supporting clinical excellence, teamwork and innovation, we urge you to apply now!
Baptist Health is an Equal Employment Opportunity employer.

What Baptist Health South Florida employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Baptist Health South Florida logo

About Baptist Health South Florida

Sourced by ZipRecruiter

Baptist Health South Florida is the largest healthcare organization in the region, with 12 hospitals, more than 27,000 employees, 4,000 physicians and 100 outpatient centers, urgent care facilities and physician practices spanning across Miami-Dade, Monroe, Broward and Palm Beach counties. Baptist Health has internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences. A not-for-profit organization supported by philanthropy and committed to its faith-based charitable mission of medical excellence, Baptist Health has been recognized by Fortune as one of the 100 Best Companies to Work For in America and by Ethisphere as one of the World's Most Ethical Companies.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Miami, FL, US

View All Baptist Health South Florida Jobs

Apply