... case management, revenue cycle, and IT to optimize care delivery and reimbursement. Essential Functions: 1. Manage the day-to-day operations of the utilization review staff, including training ...
... case management, revenue cycle, and IT to optimize care delivery and reimbursement. Essential Functions: 1. Manage the day-to-day operations of the utilization review staff, including training ...
... case management, revenue cycle, and IT to optimize care delivery and reimbursement. Essential Functions: 1. Manage the day-to-day operations of the utilization review staff, including training ...
... case management, revenue cycle, and IT to optimize care delivery and reimbursement. Essential Functions: 1. Manage the day-to-day operations of the utilization review staff, including training ...
... case management, revenue cycle, and IT to optimize care delivery and reimbursement. Essential Functions: 1. Manage the day-to-day operations of the utilization review staff, including training ...
... case management, revenue cycle, and IT to optimize care delivery and reimbursement. Essential Functions: 1. Manage the day-to-day operations of the utilization review staff, including training ...
Case Manager II
Louisville, KY · On-site
... case management ... utilization review and management, and discharge planning. Essential Functions Care Coordination
New
Case Manager II
Louisville, KY · On-site
... case management ... utilization review and management, and discharge planning. Essential Functions Care Coordination
New
Oversee case management operations, including care coordination, utilization review, and discharge planning processes. Ensure effective collaboration between case managers, physicians, nursing teams ...
Quick apply
Oversee case management operations, including care coordination, utilization review, and discharge planning processes. Ensure effective collaboration between case managers, physicians, nursing teams ...
Case Manager
Louisville, KY · On-site
$18.25 - $23.50/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 ...
Case Manager
Louisville, KY · On-site
$18.25 - $23.50/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 ...
Case Manager
Lexington, KY · On-site
$20 - $25.50/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 ...
Case Manager
Lexington, KY · On-site
$20 - $25.50/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 ...
Case Manager
Louisville, KY · On-site
$19.25 - $24.75/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 ...
Case Manager
Louisville, KY · On-site
$19.25 - $24.75/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 ...
Case Manager
Lexington, KY · On-site
$17.50 - $22.75/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 ...
Case Manager
Lexington, KY · On-site
$17.50 - $22.75/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 ...
Case Management | Work Hours: 1930 - 0330 | Weekend Requirements: N/A | 1.0 FTE Job Summary ... Conducts initial and concurrent reviews of clinical documentation for medical necessity and ...
Case Management | Work Hours: 1930 - 0330 | Weekend Requirements: N/A | 1.0 FTE Job Summary ... Conducts initial and concurrent reviews of clinical documentation for medical necessity and ...
Case Management | Work Hours: 1930 - 0330 | Weekend Requirements: N/A | 1.0 FTE Job Summary ... Conducts initial and concurrent reviews of clinical documentation for medical necessity and ...
Case Management | Work Hours: 1930 - 0330 | Weekend Requirements: N/A | 1.0 FTE Job Summary ... Conducts initial and concurrent reviews of clinical documentation for medical necessity and ...
One (1) year of professional experience practicing as a Registered Nurse (RN) in home health or similar setting; previous case management/utilization review experience preferred. OASIS experience ...
One (1) year of professional experience practicing as a Registered Nurse (RN) in home health or similar setting; previous case management/utilization review experience preferred. OASIS experience ...
One (1) year of professional experience practicing as a Registered Nurse (RN) in home health or similar setting; previous case management/utilization review experience preferred. OASIS experience ...
One (1) year of professional experience practicing as a Registered Nurse (RN) in home health or similar setting; previous case management/utilization review experience preferred. OASIS experience ...
One (1) year of professional experience practicing as a Registered Nurse (RN) in home health or similar setting; previous case management/utilization review experience preferred. OASIS experience ...
One (1) year of professional experience practicing as a Registered Nurse (RN) in home health or similar setting; previous case management/utilization review experience preferred. OASIS experience ...
Director of Case Management -- Registered Nurse (RN)
Mayfield, KY · On-site
$95K - $125K/yr
Oversee daily case management operations, driving clinical care coordination, utilization review, and discharge planning. * Strategic Planning: Develop and implement departmental goals, policies, and ...
Quick apply
Director of Case Management -- Registered Nurse (RN)
Mayfield, KY · On-site
$95K - $125K/yr
Oversee daily case management operations, driving clinical care coordination, utilization review, and discharge planning. * Strategic Planning: Develop and implement departmental goals, policies, and ...
Case Manager II PRN
Louisville, KY · On-site
... case management, psychosocial and legal issues that affect patients and providers of care ... Utilization Management Conducts medical necessity review for appropriate utilization of services ...
New
Case Manager II PRN
Louisville, KY · On-site
... case management, psychosocial and legal issues that affect patients and providers of care ... Utilization Management Conducts medical necessity review for appropriate utilization of services ...
New
Summary Case Manager RN (ED) Full-Time, First Shift Fri - Sun 10 am - 10 pm BHCOR-Case Management I ... Completes patient assessments, utilization reviews, and high-risk screenings to identify care needs ...
Summary Case Manager RN (ED) Full-Time, First Shift Fri - Sun 10 am - 10 pm BHCOR-Case Management I ... Completes patient assessments, utilization reviews, and high-risk screenings to identify care needs ...
Experience with utilization review * Experience with behavioral change, health promotion, coaching and wellness * Certification in Case Management (CCM) * Experience with Medicaid and Medicare ...
Experience with utilization review * Experience with behavioral change, health promotion, coaching and wellness * Certification in Case Management (CCM) * Experience with Medicaid and Medicare ...
... case management/utilization review experience preferred. · OASIS experience preferred. · Practical trach and/or ventilator experience preferred, not required. At Interim HealthCare, we know that ...
... case management/utilization review experience preferred. · OASIS experience preferred. · Practical trach and/or ventilator experience preferred, not required. At Interim HealthCare, we know that ...
... utilization review experience preferred. • OASIS experience preferred. • Practical trach and/or ventilator experience preferred, not required. At Interim HealthCare, we know that being our best ...
... utilization review experience preferred. • OASIS experience preferred. • Practical trach and/or ventilator experience preferred, not required. At Interim HealthCare, we know that being our best ...
Utilization Review Case Manager information
See Kentucky salary details
$14.41 - $17.84
3% of jobs
$17.84 - $21.28
1% of jobs
$21.28 - $24.71
6% of jobs
$26.37 is the 25th percentile. Wages below this are outliers.
$24.71 - $28.15
30% of jobs
The median wage is $29.38 / hr.
$28.15 - $31.58
26% of jobs
$32.89 is the 75th percentile. Wages above this are outliers.
$31.58 - $35.02
22% of jobs
$35.02 - $38.45
3% of jobs
$38.45 - $41.89
0% of jobs
$41.89 - $45.32
5% of jobs
$45.32 - $48.76
2% of jobs
$48.76 - $52.19
1% of jobs
$14
$31
$52
How much do utilization review case manager jobs pay per hour?
As of Aug 11, 2026, the average hourly pay for utilization review case manager in Kentucky is $31.69, according to ZipRecruiter salary data. Most workers in this role earn between $25.67 and $33.41 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?
| Aspect | Utilization Review Case Manager | Utilization Review Nurse |
|---|---|---|
| Credentials | Typically requires a nursing license or relevant healthcare certification | Registered Nurse (RN) license is required |
| Work Environment | Office-based, insurance companies, healthcare organizations | Hospital, clinic, insurance review departments |
| Primary Focus | Reviewing medical necessity, coordinating care, managing cases | Assessing 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.
What are popular job titles related to Utilization Review Case Manager jobs in Kentucky? For Utilization Review Case Manager jobs in Kentucky, the most frequently searched job titles are:
- Utilization Management
- Evening Optum Health Utilization Review
- Temporary Utilization Review Nurse
- Work From Home Nurse Case Management
- Flex Schedule Remote Utilization Review Nurse
- Manager Utilization Management
- Registered Nurse Utilization Review
- Commission Cvs Health Utilization Management
- Flexible Cvs Utilization Management Nurse
- Utilization Review Nurse
What job categories do people searching Utilization Review Case Manager jobs in Kentucky look for? The top searched job categories for Utilization Review Case Manager jobs in Kentucky are:
- Manager Case Management
- Case Manager Utilization Review Nurse
- Utilization Review
- Flex Schedule Utilization Review
- Director Optum Utilization Review
- Commission Authorization Utilization Review Bcba
- Rn Field Case Manager
- Therapy Utilization Review
- From Home Anthem Utilization Review Nurse
- Authorization Utilization Review
What cities in Kentucky are hiring for Utilization Review Case Manager jobs? Cities in Kentucky with the most Utilization Review Case Manager job openings:
Full-time
Posted 5 days ago
Job description
Primary Location:
Peace - Louisville
Address:
2020 Newburg Rd.Louisville, KY 40205
Shift:
First Shift (United States of America)
Job Description Summary:
About UofL Health:
UofL Health is a fully integrated regional academic health system with five hospitals, four medical centers, nearly 200 physician practice locations, more than 700 providers, the Frazier Rehabilitation Institute and Brown Cancer Center.
With more than 12,000 team members-physicians, surgeons, nurses, pharmacists and other highly skilled health care professionals-UofL Health is focused on one mission: delivering patient-centered care to each and every patient each and every day.
Job Description:
Position Summary and Purpose
The Manager of Utilization Management (UM) leads the strategic and operational oversight of utilization review and management across the academic healthcare system. This role ensures appropriate resource utilization, regulatory compliance, and alignment with clinical and financial goals. The Manager collaborates with medical staff, case management, revenue cycle, and IT to optimize care delivery and reimbursement.
Essential Functions:
1. Manage the day-to-day operations of the utilization review staff, including training, performance evaluation, and setting performance standards.
2. Create, implement, and maintain policies and procedures for the UM program, ensuring they align with regulations and organizational goals
3. Analyze UM metrics, identify trends, and prepare reports for senior management or quality improvement committees to guide decision-making and demonstrate the impact of the program.
4. Monitor the clinical review process to ensure patient care is appropriate, effective, and timely, and collaborate with physicians, case management and other professionals to improve utilization.
5. Identify opportunities to enhance the efficiency and accuracy of UM processes, often by working with physician advisors, case management, nursing leadership, and revenue cycle.
6. Ensure the department complies with all applicable state and federal guidelines and manage audits from regulatory agencies or health plans.
7. Provide mentorship, training and performance evaluations.
8. Ensure accurate documentation and data capture for billing and compliance.
9. Facilitate secondary reviews and appeals processes.
10. Performs other duties as assigned.
Other Functions:
• Participate in UM system-wide UM committees and initiatives.
• Analyze utilization trends and recommend process improvements.
• Coordinate certified training programs (e.g., InterQual, MCG).
• Partner with IT to optimize UM-related systems (e.g., EMR, InterQual).
Additional Job Description:
Job Requirements
(Education, Experience, Licensure and Certification)
Education: Bachelor's degree in nursing or related field, master's degree preferred.
License: Active RN license or LCSW required to practice in the state of Kentucky.
Certification: Case/Utilization Management (e.g., ACM, CCM, CMAC).
Experience: Minimum seven years of UM/Case Management experience in an acute care of academic health system. Minimum 4 years leadership experience.
Job Competency:
Knowledge, Skills, and Abilities critical to this role:
• Strategic thinking
• Deep understanding of clinical workflows and regulatory requirements.
• Strong communication and stakeholder engagement skills.
• Data-driven decision-making and continuous improvement mindset.
UofL Health Core Expectation:
At UofL Health, we expect all our employees to live the values of honesty, integrity and compassion and demonstrate these values in their interactions with others and as they deliver excellent patient care by:
• Honoring and caring for the dignity of all persons
• Ensuring the highest quality of care for those we serve
• Working together as a team to achieve our goals
• Improving continuously by listening, and asking for and responding to feedback
• Seeking new and better ways to meet the needs of those we serve
• Using our resources wisely
• Understanding how each of our roles contributes to the success of UofL Health
Peace - Louisville
Address:
2020 Newburg Rd.Louisville, KY 40205
Shift:
First Shift (United States of America)
Job Description Summary:
About UofL Health:
UofL Health is a fully integrated regional academic health system with five hospitals, four medical centers, nearly 200 physician practice locations, more than 700 providers, the Frazier Rehabilitation Institute and Brown Cancer Center.
With more than 12,000 team members-physicians, surgeons, nurses, pharmacists and other highly skilled health care professionals-UofL Health is focused on one mission: delivering patient-centered care to each and every patient each and every day.
Job Description:
Position Summary and Purpose
The Manager of Utilization Management (UM) leads the strategic and operational oversight of utilization review and management across the academic healthcare system. This role ensures appropriate resource utilization, regulatory compliance, and alignment with clinical and financial goals. The Manager collaborates with medical staff, case management, revenue cycle, and IT to optimize care delivery and reimbursement.
Essential Functions:
1. Manage the day-to-day operations of the utilization review staff, including training, performance evaluation, and setting performance standards.
2. Create, implement, and maintain policies and procedures for the UM program, ensuring they align with regulations and organizational goals
3. Analyze UM metrics, identify trends, and prepare reports for senior management or quality improvement committees to guide decision-making and demonstrate the impact of the program.
4. Monitor the clinical review process to ensure patient care is appropriate, effective, and timely, and collaborate with physicians, case management and other professionals to improve utilization.
5. Identify opportunities to enhance the efficiency and accuracy of UM processes, often by working with physician advisors, case management, nursing leadership, and revenue cycle.
6. Ensure the department complies with all applicable state and federal guidelines and manage audits from regulatory agencies or health plans.
7. Provide mentorship, training and performance evaluations.
8. Ensure accurate documentation and data capture for billing and compliance.
9. Facilitate secondary reviews and appeals processes.
10. Performs other duties as assigned.
Other Functions:
• Participate in UM system-wide UM committees and initiatives.
• Analyze utilization trends and recommend process improvements.
• Coordinate certified training programs (e.g., InterQual, MCG).
• Partner with IT to optimize UM-related systems (e.g., EMR, InterQual).
Additional Job Description:
Job Requirements
(Education, Experience, Licensure and Certification)
Education: Bachelor's degree in nursing or related field, master's degree preferred.
License: Active RN license or LCSW required to practice in the state of Kentucky.
Certification: Case/Utilization Management (e.g., ACM, CCM, CMAC).
Experience: Minimum seven years of UM/Case Management experience in an acute care of academic health system. Minimum 4 years leadership experience.
Job Competency:
Knowledge, Skills, and Abilities critical to this role:
• Strategic thinking
• Deep understanding of clinical workflows and regulatory requirements.
• Strong communication and stakeholder engagement skills.
• Data-driven decision-making and continuous improvement mindset.
UofL Health Core Expectation:
At UofL Health, we expect all our employees to live the values of honesty, integrity and compassion and demonstrate these values in their interactions with others and as they deliver excellent patient care by:
• Honoring and caring for the dignity of all persons
• Ensuring the highest quality of care for those we serve
• Working together as a team to achieve our goals
• Improving continuously by listening, and asking for and responding to feedback
• Seeking new and better ways to meet the needs of those we serve
• Using our resources wisely
• Understanding how each of our roles contributes to the success of UofL Health