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Utilization Review Case Manager Jobs (NOW HIRING)

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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

$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 ...

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Utilization Review Case Manager information

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

As of Jun 8, 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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Utilization Review Case Manager jobs near you
Infographic showing various Utilization Review Case Manager job openings in the United States as of May 2026, with employment types broken down into 2% As Needed, 64% Full Time, 32% Part Time, and 2% Temporary. Highlights an 94% Physical, 2% Hybrid, and 4% Remote job distribution, with an average salary of $75,891 per year, or $36.5 per hour.

Utilization Review/Case Manager

Freedom Behavioral Hospital of Monroe

West Monroe, LA • On-site

Full-time

Medical, Dental, Vision, Life, Retirement

Posted 3 days ago

Job description

Salary: $18-$22 - Depending on Experience

The Utilization Review/Case Manager is responsible for coordinating patient care services and managing utilization review functions to ensure appropriate level of care, timely insurance authorization, and effective discharge planning. This role serves as the primary liaison between the hospital, payor sources, patients, families, and referral partners to support optimal clinical and financial outcomes.

In accordance with The Joint Commission standards, federal and state regulations, and Freedoms mission, policies, and Performance Improvement (PI) program, the Case Manager facilitates the continuum of care from admission through discharge.

Key Responsibilities:

  • Coordinates with Admissions and Clinical staff to ensure patient treatment needs are identified and met throughout the stay
  • Conducts utilization review activities, including securing initial and continued stay authorizations from insurance providers
  • Serves as the primary point of contact with payors, communicating medical necessity, level of care, and continued stay criteria
  • Develops, implements, and manages discharge plans to ensure safe and appropriate transitions of care
  • Communicates effectively with patients, families, and referral sources to support positive treatment outcomes
  • Gathers and presents clinical information to the multidisciplinary treatment team; actively participates in treatment team meetings
  • Maintains consistent communication with physicians, nursing, social services, and other disciplines to ensure coordinated care delivery
  • Documents all utilization review and discharge planning activities accurately and timely in the medical record, supporting intensity of service and medical necessity
  • Collaborates with external agencies and providers to coordinate aftercare services and continuity of care
  • Ensures patient rights, ethical standards, and confidentiality are upheld at all times
  • Participates in Performance Improvement (PI) and Quality Management (QM) activities, including data collection and process improvement initiatives

Qualifications & Skills:

  • Strong understanding of behavioral health levels of care, medical necessity criteria, and insurance authorization processes
  • Ability to effectively communicate with multidisciplinary teams, payors, patients, and families in a professional manner
  • Excellent organizational, documentation, and time management skills
  • Knowledge of regulatory and accreditation standards related to case management and utilization review
  • Ability to manage multiple priorities while maintaining accuracy and compliance


Excellent Benefit Package Offered for Full-Time Employees:

Medical

Dental

Vision

401k

Life and Disability


Freedom Behavioral Hospital of Monroe 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.