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Utilization Case Manager Jobs (NOW HIRING)

MedStar Health

Director of Case Management

Baltimore, MD · On-site

$58.03 - $104.12/hr

About the Job General Summary of Position Plans organizes coordinates and directs the Utilization Case Management and Discharge Planning Programs. Monitors discharge planning services and counseling ...

BronxCare Health System

Assistant Director

Bronx, NY · On-site

Overview Assists the Director to administer operations and activities of the Utilization Case Management Department in support of policies, goals and objectives established by the Hospital by ...

Focus Staff

Travel RN Case Manager

Santa Monica, CA · On-site

Minimum of three years hospital based nursing practice with experience in utilization/case management. * BLS for Healthcare Providers required within 30 days of hire Work Experience: At least 2 years ...

Focus Staff

Travel RN Case Manager

Burbank, CA · On-site

Minimum of three years hospital based nursing practice with experience in utilization/case management. * BLS for Healthcare Providers required within 30 days of hire Work Experience: At least 2 years ...

New

Focus Staff

Travel RN Case Manager

Anchorage, AK · On-site

Minimum of three years hospital based nursing practice with experience in utilization/case management. * BLS for Healthcare Providers required within 30 days of hire Work Experience: At least 2 years ...

Focus Staff

Travel RN Case Manager

Apple Valley, CA · On-site

Minimum of three years hospital based nursing practice with experience in utilization/case management. * BLS for Healthcare Providers required within 30 days of hire Work Experience: At least 2 years ...

Focus Staff

Travel RN Case Manager

Mission Viejo, CA · On-site

Minimum of three years hospital based nursing practice with experience in utilization/case management. * BLS for Healthcare Providers required within 30 days of hire Work Experience: At least 2 years ...

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Utilization Case Manager information

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How much do utilization case manager jobs pay per hour?

As of Jul 11, 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 does a utilization case manager do?

A utilization case manager reviews and authorizes healthcare services to ensure they are necessary and appropriate, often working with insurance companies and healthcare providers. They analyze patient records, coordinate care plans, and ensure compliance with policies, typically using case management software and requiring strong communication skills.

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 jobs pay 4000 a week without a degree?

Utilization Case Managers typically do not earn $4,000 weekly without relevant experience or certifications; most roles in healthcare or social services pay less. High-paying jobs that can reach this level without a degree are rare and often involve specialized skills, sales, or entrepreneurship. Generally, achieving such income without a degree requires significant experience, licensing, or working in high-demand fields like real estate or certain trades.

What is the highest paid case manager?

The highest paid case managers are often those with advanced certifications, specialized skills, or experience in high-demand fields such as healthcare or insurance. Senior or managerial roles, such as Utilization Review Managers, can earn salaries exceeding $80,000 to $100,000 annually. Compensation varies based on location, industry, and level of responsibility.

Is being a MOA a good entry level job?

A Medical Office Assistant (MOA) role is often considered an entry-level position in healthcare, requiring basic administrative and clinical skills. It provides experience with medical records, patient communication, and office procedures, which can serve as a foundation for advancing in healthcare careers. However, the job's suitability depends on individual career goals and the specific workplace environment.

What are the key skills and qualifications needed to thrive as a Utilization Case Manager, and why are they important?

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.

More about Utilization Case Manager jobs
What cities are hiring for Utilization Case Manager jobs? Cities with the most Utilization Case Manager job openings:
What states have the most Utilization Case Manager jobs? States with the most job openings for Utilization Case Manager jobs include:
What job categories do people searching Utilization Case Manager jobs look for? The top searched job categories for Utilization Case Manager jobs are:
Utilization Case Manager jobs near you
Infographic showing various Utilization Case Manager job openings in the United States as of July 2026, with employment types broken down into 2% As Needed, 78% Full Time, 17% Part Time, and 3% Contract. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $75,891 per year, or $36.5 per hour.
Director of Case Management

Director of Case Management

MedStar Health

Baltimore, MD • On-site

$58.03 - $104.12/hr

Full-time

Posted 11 days ago

Medstar Health rating

7.8

Company rating: 7.8 out of 10

Based on 238 frontline employees who took The Breakroom Quiz

133rd of 881 rated healthcare providers

Job description

About the Job
General Summary of Position
Plans organizes coordinates and directs the Utilization Case Management and Discharge Planning Programs. Monitors discharge planning services and counseling to patients and their families and consultation to medical staff regarding patient management.
Primary Duties and Responsibilities
  • Develops and contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Ensures compliance with hospital/facility policies and procedures and governmental/accreditation regulations.
  • Develops and recommends department operating budget and manages resources according to approved budget.
  • Selects trains orients and assigns department staff. Delegates tasks as appropriate. Develops standards of performance evaluates performance and conducts performance management planning. Identifies individual staff development needs and provides appropriate resources to meet needs. Initiates or makes recommendations for personnel actions. Maintains ongoing communication with subordinates to review programs provide feedback discuss new developments and exchange information.
  • Contributes to the development review revision and implementation of clinical pathways procedures and guidelines at the hospital and system level.
  • Coordinates the facilitation of patient transition from area to area in a timely cost effective manner. Assures that the hospital-based program encompasses preadmission emergency room admitting acute care discharge follow-up sub-acute and rehabilitation.
  • Directs and participates in the provision of social services in the areas of psychosocial assessment and counseling crisis intervention child abuse home health care oncology and other support groups' discharge planning.
  • Ensures the delivery of quality care to inpatients and outpatients by identifying patient needs and developing social service programs to meet those needs.
  • Monitors and evaluates the effectiveness of policies and practices with regard to length of stay and utilization of resources.
  • Oversees monthly monitoring and reporting of critical data on LOS discharges clinical and teaching outcomes denials overturned denials and other reports.
  • Provides direction and support regarding Utilization Management Case Management Discharge Planning and Social Work.
  • Serves as the hospital liaison to payers in matters pertaining to utilization of acute care services. Makes recommendations regarding third party case management contracts.
  • Participates in meetings and on committees and represents the department and business unit in community outreach efforts. Participates in multidisciplinary quality and service improvement teams and maintains effective working relationships with other departments.

Minimal Qualifications
Education
  • Master's degree in Nursing (MSN) Healthcare Administration Business Administration or related field required

Experience
  • 3-4 years 4 years progressive leadership preferred and
  • Experience in CM/SW/UR required

Licenses and Certifications
  • RN - Registered Nurse - State Licensure and/or Compact State Licensure in the State of Maryland or District of Columbia Upon Hire required and
  • CCM - Certified Case Manager within 90 Days preferred

Knowledge Skills and Abilities
  • Excellent problem-solving skills and ability to exercise independent judgment.
  • Business acumen and leadership skills.
  • Strong verbal and written communication skills with ability to effectively interact with all levels of management internal departments and external agencies.
  • Working knowledge of various computer software applications preferred.

This position has a hiring range of
USD $58.03 - USD $104.12 /Hr.

What Medstar Health employees say

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About Medstar Health

Sourced by ZipRecruiter

MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation, and research. Our team of 32,000 includes physicians, nurses, residents, fellows, and many other clinical and non-clinical associates working in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest home health provider in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar Health is dedicated not only to teaching the next generation of doctors, but also to the continuing education, professional development, and personal fulfillment of our whole team. Together, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities. It's how we treat people.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Columbia, MD, US

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