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Utilization Case Manager Jobs in Philadelphia, PA

Encompass Health

Case Manager

Concordville, PA

$19.75 - $25.25/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 ...

Prime Staffing

Travel RN Case Manager

Doylestown, PA · On-site

Strong assessment, discharge planning, and utilization review skills Description: The RN Case Manager coordinates patient care plans and services across the continuum of care. Works closely with ...

Main Line Health

Case Manager, Per Diem

Malvern, PA · On-site

... utilization of services. As the RN Case Manager / MSW Case Manager, you will also use your effective communication skills by communicating with payor representatives and providing age-appropriate ...

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All JobsUtilization Case JobsUtilization Case Manager JobsUtilization Case Manager Jobs in Philadelphia, PA

Utilization Case Manager information

See Philadelphia, PA salary details

$16

$36

$60

How much do utilization case manager jobs pay per hour?

As of Aug 29, 2026, the average hourly pay for utilization case manager in Philadelphia, PA is $36.82, according to ZipRecruiter salary data. Most workers in this role earn between $29.86 and $38.80 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 Philadelphia, PA?

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

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

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

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

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

Utilization Case Manager jobs near you
Infographic showing various Utilization Case Manager job openings in Philadelphia, PA as of August 2026, with employment types broken down into 84% Full Time, and 16% Part Time. Highlights an 90% In-person, 5% Hybrid, and 5% Remote job distribution, with an average salary of $76,581 per year, or $36.8 per hour.

RN - Case Manager

Penn Medicine Doylestown Health

Doylestown, PA • On-site

$2.6K/wk

Other

Re-posted 23 days ago

Job description

Details
Client Name
Penn Medicine Doylestown Health
Job Type
Travel
Offering
Nursing
Profession
RN
Specialty
Case Manager
Job ID
37666174
Job Title
RN - Case Manager
Weekly Pay
$2653.0
Shift Details
Shift
8a-4p
Scheduled Hours
40
Job Order Details
Start Date
08/18/2026
End Date
11/14/2026
Duration
13 Week(s)
Job Description
About the Position
Specialty: RN Case Manager
Experience: 1+ year of recent case management or discharge planning experience preferred
License: Active State or Compact RN License
Certifications: BLS - AHA
Must-Have: Strong assessment, discharge planning, and utilization review skills
Description: The RN Case Manager coordinates patient care plans and services across the continuum of care. Works closely with providers, social workers, and external agencies to ensure timely, efficient, and effective discharge planning and transitions. Supports utilization management and ensures compliance with payer guidelines. Onboarding typically takes 2-4 weeks based on documentation and clearance processes.
Requirements
Required for Onboarding:
  • Active RN License
  • BLS

Client Details
Address
595 W State St
City
Doylestown
State
PA
Zip Code
18901

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