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Utilization Review Case Manager Jobs (NOW HIRING)

UHS

Utilization Review Case Manager

Olive Branch, MS · On-site

Flexible Hours The Case Manager provides utilization review services in a manner consistent with the philosophy and objectives of the facility. The Case Manager evaluates patient medical records to ...

UHS

Utilization Review Case Manager

Olive Branch, MS

Flexible Hours The Case Manager provides utilization review services in a manner consistent with the philosophy and objectives of the facility. The Case Manager evaluates patient medical records to ...

UHS

Utilization Review Case Manager

Olive Branch, MS · On-site

Flexible Hours The Case Manager provides utilization review services in a manner consistent with the philosophy and objectives of the facility. The Case Manager evaluates patient medical records to ...

Insight

ED UTILIZATION REVIEW/CASE MANAGER

Chicago, IL · On-site

$85K - $90K/yr

The ED Utilization Review/Case Manager is responsible for facilitating the appropriate use of hospital resources by ensuring that the patient meets acute inpatient criteria, and anticipates and ...

Insight

ED UTILIZATION REVIEW/CASE MANAGER

Chicago, IL · On-site

$85K - $90K/yr

The ED Utilization Review/Case Manager is responsible for facilitating the appropriate use of hospital resources by ensuring that the patient meets acute inpatient criteria, and anticipates and ...

Enterprise Engineering

Be Seen First

Concurrent Utilization Review (UR) Nurse

OR · Remote

$30 - $38/hr

Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM), or Accredited Case Manager (ACM). o Additional clinical nursing or case management certifications are a plus. · ...

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All JobsUtilization Review Case Manager Jobs

Utilization Review Case Manager information

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How much do utilization review case manager jobs pay per hour?

As of Jun 29, 2026, the average hourly pay for utilization review 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 are some common challenges Utilization Review Case Managers face when coordinating care across multiple departments?

Utilization Review Case Managers often navigate complex communication between physicians, nursing staff, insurance providers, and patients to ensure appropriate care and resource use. Balancing timely authorizations with evolving patient needs and varying documentation standards can be challenging. Additionally, staying current with changing regulations and payer requirements requires ongoing learning and adaptability. Building strong collaborative relationships and maintaining clear, concise documentation are key strategies for overcoming these hurdles.

What is a Utilization Review Case Manager?

A Utilization Review Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical treatments and services provided to patients. They review clinical information, coordinate with providers and insurance companies, and ensure that patient care aligns with established guidelines and policies. Their goal is to optimize patient outcomes while managing healthcare costs and ensuring compliance with regulations.

What is the difference between Utilization Review Case Manager vs Utilization Review Nurse?

AspectUtilization Review Case ManagerUtilization Review Nurse
CredentialsTypically requires a nursing license or relevant healthcare certificationRegistered Nurse (RN) license is required
Work EnvironmentOffice-based, insurance companies, healthcare organizationsHospital, clinic, insurance review departments
Primary FocusReviewing medical necessity, coordinating care, managing casesAssessing medical records, clinical review, patient care evaluation

Both roles involve healthcare review and require nursing credentials, but the Utilization Review Case Manager often focuses on coordinating care and managing cases, while the Utilization Review Nurse emphasizes clinical assessment and review of medical records. Understanding these differences helps in choosing the right career path or job search focus.

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

To thrive as a Utilization Review Case Manager, you need a clinical background such as an RN or LCSW license, strong knowledge of medical necessity criteria, and experience with case management. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of regulatory guidelines like Medicare and Medicaid are essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration between patients, providers, and payers. These skills ensure appropriate resource use, compliance with regulations, and high-quality patient care.
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What cities are hiring for Utilization Review Case Manager jobs? Cities with the most Utilization Review Case Manager job openings:
What states have the most Utilization Review Case Manager jobs? States with the most job openings for Utilization Review Case Manager jobs include:
What job categories do people searching Utilization Review Case Manager jobs look for? The top searched job categories for Utilization Review Case Manager jobs are:
Utilization Review Case Manager jobs near you
Infographic showing various Utilization Review Case Manager job openings in the United States as of June 2026, with employment types broken down into 88% Full Time, 8% Part Time, and 4% Contract. Highlights an 90% Physical, 2% Hybrid, and 8% Remote job distribution, with an average salary of $75,891 per year, or $36.5 per hour.

Utilization Review/Case Manager

Freedom Behavioral

Magnolia, MS • On-site

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 4 days ago

Key responsibilities

  • Complete admission and concurrent reviews, obtain insurance authorizations, and submit clinical documentation supporting medical necessity.

  • Coordinate discharge planning, including psychosocial assessments, individualized discharge plans, referrals, and follow-up appointments.

  • Maintain accurate and timely documentation to ensure compliance with payer guidelines, regulatory requirements, and hospital policies.

Job description

NOTE: this position is currently filled. However, it is the policy of Freedom Behavioral to continue to take applications so that we can ensure there is no disruption in patient care if a vacancy occurs.
Utilization Review / Case Manager
Freedom Behavioral Hospital of Magnolia
Magnolia, Mississippi
Freedom Behavioral Hospital of Magnolia is currently accepting applications for a full-time Utilization Review (UR)/Case Manager to join our behavioral health team. This position plays a vital role in ensuring patients receive appropriate, medically necessary care while coordinating discharge planning and maximizing reimbursement through effective utilization management.
The ideal candidate is organized, detail-oriented, and passionate about helping patients successfully transition through every stage of their behavioral health treatment.
Position Summary
The Utilization Review/Case Manager is responsible for coordinating all aspects of utilization management, insurance authorization, concurrent reviews, discharge planning, and continuity of care for patients admitted to the psychiatric hospital. This position serves as a liaison between physicians, insurance companies, patients, families, and community providers to ensure appropriate levels of care, timely authorizations, and safe discharge planning.
Essential Job Responsibilities
Utilization Review
  • Complete admission reviews and obtain insurance authorizations.
  • Perform concurrent reviews with commercial insurance, Medicare Advantage, Medicaid Managed Care, and other third-party payers.
  • Submit clinical documentation supporting medical necessity.
  • Coordinate peer-to-peer reviews when required.
  • Monitor authorization status and approved lengths of stay.
  • Manage denial prevention and appeal processes.
  • Maintain accurate utilization review documentation.
  • Ensure compliance with payer guidelines and regulatory requirements.
  • Track authorization dates and notify providers of pending reviews.

Case Management
  • Complete psychosocial and discharge planning assessments.
  • Coordinate interdisciplinary treatment planning.
  • Develop individualized discharge plans beginning at admission.
  • Arrange follow-up appointments with outpatient providers.
  • Coordinate referrals to:
    • Intensive Outpatient Programs (IOP)
    • Partial Hospitalization Programs (PHP)
    • Community Mental Health Centers
    • Primary Care Providers
    • Nursing Facilities
    • Assisted Living Facilities
    • Home Health Agencies
    • Substance Use Treatment Programs
  • Arrange transportation for discharge when needed.
  • Collaborate with families and caregivers throughout hospitalization.
  • Coordinate transfers to higher or lower levels of care as appropriate.

Care Coordination
  • Participate in daily treatment team meetings.
  • Collaborate with psychiatrists, nursing staff, therapists, social workers, and administration.
  • Communicate with insurance case managers and payer representatives.
  • Ensure continuity of care following discharge.
  • Facilitate patient and family meetings as needed.

Documentation
  • Maintain complete, accurate, and timely documentation within the electronic medical record.
  • Document utilization reviews, discharge planning activities, and communications with payers.
  • Maintain records supporting medical necessity and reimbursement.
  • Ensure documentation meets CMS, Joint Commission, and Mississippi Department of Health requirements.

Regulatory Compliance
  • Maintain compliance with:
    • CMS Conditions of Participation
    • Joint Commission standards
    • HIPAA
    • Mississippi Department of Health regulations
    • Hospital policies and procedures
  • Participate in quality improvement and survey readiness activities.

Qualifications
Required
  • Minimum of two years of experience in behavioral health, case management, utilization review, or discharge planning.
  • Strong knowledge of behavioral health levels of care and medical necessity criteria.
  • Excellent communication and organizational skills.
  • Computer proficiency and experience with electronic medical records.

Preferred
  • Behavioral Health or Psychiatric Hospital experience.
  • Experience with Medicare, Medicaid, and commercial insurance authorizations.
  • Knowledge of InterQual® or MCG® medical necessity criteria.
  • Experience with utilization review and denial management.
  • Discharge planning and community resource coordination.

Benefits
Freedom Behavioral Hospital offers a competitive compensation and benefits package, including:
  • Competitive salary
  • Medical, dental, and vision insurance
  • Paid Time Off (PTO)
  • Paid holidays
  • Retirement plan
  • Continuing education opportunities
  • Supportive team environment
  • Professional growth and advancement opportunities

Freedom Behavioral provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

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