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Utilization Case Manager Jobs (NOW HIRING)

FMOLHS

Case Manager - RN (PRN, Days)

Lafayette, LA · On-site

The Case Manager will facilitate the interdisciplinary plan of care with a focus on evaluating the ... Performs effective utilization review techniques to work with physicians, third party payors and ...

FMOLHS

Experienced Case Manager - RN

Jackson, MS · On-site

The Case Manager directs the utilization review of patient charts, treatment plans, and discharge planning pertaining to the quality of care and treatment criteria for patients in a specific ...

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How much do utilization case manager jobs pay per hour?

As of Sep 13, 2026, the average hourly pay for utilization case manager in the United States is $36.49, according to ZipRecruiter salary data. Most workers in this role earn between $29.57 and $38.46 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).
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What states have the most Utilization Case Manager jobs?

States with the most job openings for Utilization Case Manager jobs include:

What are popular job titles related to Utilization Case Manager jobs?

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

Utilization Case Manager jobs near you
Infographic showing various Utilization Case Manager job openings in the United States as of September 2026, with employment types broken down into 86% Full Time, 13% Part Time, and 1% Contract. Highlights an 86% Physical, 2% Hybrid, and 12% Remote job distribution, with an average salary of $75,891 per year, or $36.5 per hour.

Case Manager - RN (PRN, Days)

Lafayette, LA • On-site

Franciscan Missionaries of Our Lady Health System
Hospitals • 5 - 10K employees
Learn more about Franciscan Missionaries of Our Lady Health Systemexternal

Other

Posted 17 days ago

Franciscan Missionaries of Our Lady Health System rating

7.2

Company rating: 7.2 out of 10

Based on 38 frontline employees who took The Breakroom Quiz

Job description


The Case Manager will facilitate the interdisciplinary plan of care with a focus on evaluating the appropriateness of clinical care, medical necessity, admission status, level of care, and resource management. The Case Manager will coordinate activities that promote quality outcomes and patient throughput while supporting a balance of optimal care and appropriate resource utilization. The Case Manager will identify potential barriers to patient throughput and quality outcomes. The Case Manager will facilitate appropriate discharge plans.
Responsibilities
  1. Case Management
    1. Demonstrates the ability to maximize financial outcomes of assigned patient load using the continuum of care philosophy. Assists in the development, monitoring and analysis of annual financial goals of targeted population.
    2. Performs effective utilization review techniques to work with physicians, third party payors and federal and local agencies to prevent denials of payment and days.
    3. Acts as a resource for unit personnel in the resolution of utilization/case management problems and expediently communicates identified problems to appropriate personnel in an effort to enhance departmental operating efficiency.
    4. Evaluates the quality of necessary medical services, utilizes criteria to determine medical necessity of admissions and interacts with physicians to facilitate patient assignment to appropriate alternative of care. Understands the capabilities of outside referral sources such as home health, sub-acute care and skilled nursing facilities.
    5. Understands the different types of healthcare delivery systems and the requirements for prior approval by payor for admissions, procedures and continued stay.
    6. Meets with treatment team to provide utilization review information, discusses issues pertaining to continued stay, discharge and aftercare plans, evaluates current financial resources, and discusses whether documentation reflects the need for continued stay and at what level of care is most appropriate.
    7. Provides appropriate and timely information to third party payors to facilitate financial outcomes and ensures patients are receiving appropriate level of care; includes coordinating denials/appeals.
    8. Collaborates with all members of the health care team to ensure reimbursement optimization, appropriate discharge planning and cost-effective quality care. Plays a key role in the discharge planning process assessing patients' needs for referrals and/or alternate levels of care. Appropriately tracks and report avoidable days
    9. Demonstrates ability to access and utilize community resources. Knows how to establish a client support system.
    10. Demonstrates competence in coordination and service delivery. Understands methods for assessing an individual's level of physical/mental impairment. Assesses patient clinical information and in collaboration with the healthcare team develops treatment/discharge plans.
    11. Strives to promote the quality and efficiency of his/her own performance by remaining current with the latest trends in field.
    12. Promotes concurrent DRG/documentation management via feedback and education to physicians regarding appropriated documentation that reflects patient acuity and resource utilization.
  2. Other Duties as Assigned
    1. Good interpersonal/human relations skills
    2. Good oral and written communication skills.
    3. Good problem solving and critical thinking skills.
    4. Good time management/prioritization skills.
    5. Performs other duties as assigned or requested.
    6. Consistently performs 12 organizational Service Standards focused on Values, Service and Quality.

Qualifications
Experience - Three years in general or specialty nursing practice
Education - Associate's Degree
Licensure - Current and unrestricted Louisiana State License as RN

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About Franciscan Missionaries of Our Lady Health System

Sourced by ZipRecruiter

The Franciscan Missionaries of Our Lady Health System is the leading health care innovator in Louisiana. We bring together outstanding clinicians, the most advanced technology and leading research to ensure that our patients receive the highest quality and safest care possible.

Industry

Hospitals

Company size

5,001 - 10,000 Employees

Headquarters location

Baton Rouge, LA, US

Year founded

1911

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