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Utilization Review Case Manager Jobs in Missouri

genex

Telephonic Case Manager (RN)

Saint Louis, MO · On-site

Currently seeking a Telephonic Nurse Case Manager. The qualified individual will need to be located ... Responsible for the performance of Utilization Review services, including pre-admission ...

genex

Telephonic Case Manager (RN)

Saint Louis, MO · On-site

Currently seeking a Telephonic Nurse Case Manager. The qualified individual will need to be located ... Responsible for the performance of Utilization Review services, including pre-admission ...

Genex

Telephonic Case Manager (RN)

Saint Louis, MO · On-site

Responsible for the performance of Utilization Review services, including pre-admission ... case management process. Works as an intermediary between carriers, attorneys, medical care ...

Genex Services

Utilization Reviewer 2

Saint Louis, MO · On-site

$52K - $76K/yr

Prior review experience in healthcare, insurance, utilization management, quality assurance, or other applicable capacity. * Prior experience in the workers' compensations field. Benefits We're ...

Enlyte

Utilization Reviewer 2

Saint Louis, MO · On-site

$52K - $76K/yr

Prior review experience in healthcare, insurance, utilization management, quality assurance, or other applicable capacity. * Prior experience in the workers' compensations field. Benefits We're ...

Enlyte

Utilization Reviewer 2

Saint Louis, MO

$52K - $76K/yr

Prior review experience in healthcare, insurance, utilization management, quality assurance, or other applicable capacity. * Prior experience in the workers' compensations field. Benefits We're ...

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All JobsUtilization Review Case JobsUtilization Review Case Manager JobsUtilization Review Case Manager Jobs in Missouri

Utilization Review Case Manager information

See Missouri salary details

$15

$34

$56

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

As of Aug 29, 2026, the average hourly pay for utilization review case manager in Missouri is $34.22, according to ZipRecruiter salary data. Most workers in this role earn between $27.74 and $36.06 per hour, depending on experience, location, and employer.

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 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 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 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 popular job titles related to Utilization Review Case Manager jobs in Missouri?

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

What job categories do people searching Utilization Review Case Manager jobs in Missouri look for?

The top searched job categories for Utilization Review Case Manager jobs in Missouri are:

What cities in Missouri are hiring for Utilization Review Case Manager jobs?

Cities in Missouri with the most Utilization Review Case Manager job openings:

Utilization Review Case Manager jobs near you
Infographic showing various Utilization Review Case Manager job openings in Missouri as of August 2026, with employment types broken down into 94% Full Time, 4% Part Time, and 2% Contract. Highlights an 96% In-person, 2% Hybrid, and 2% Remote job distribution, with an average salary of $71,186 per year, or $34.2 per hour.

RN, Utilization Case Manager - Archimedes

Archimedes

Earth City, MO • On-site

Other

Medical, Dental, Vision, Retirement, PTO

Posted 26 days ago

Job description

Job Title

RN, Utilization Case Manager

Job Description

The RN, Utilization Case Manager will coordinate care between physicians, patients, and pharmacies, facilitating access to specialty medications for patients with complex disease states.

Responsibilities

How do I make an impact on my team?

  • Review chart notes and perform utilization management on patient/drug specific case basis.
  • Coordinate facilitation of patients' specialty drug treatment, ensuring timely delivery to the appropriate site of care.
  • Handle case assignments, review case progress, properly document case notes, and determine case closure.
  • Follow established procedures, processes, and standards for production, productivity, quality, and customer service. Meet performance targets for speed, efficiency, and quality.
  • Complete care management clinical escalations. Escalate to account management as appropriate.
  • Ensure all external and internal customers receive the level of customer service required by Archimedes and serve as a representative of Archimedes to all external customers.
  • Participate in, adhere to, and support compliance, people and culture, and learning programs.
  • Perform other duties as assigned.
Qualifications

What our team expects from you?

  • Education: Associate's degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN) required; BSN preferred. Master of Science in Nursing (MSN) a plus.
  • Certification/Licenses: Current, active Registered Nurse (RN) license in good standing with the applicable State Board of Nursing is required.
  • Experience:
    • Utilization and Case management experience required.
    • Experience in an infusion setting, physician office or pharmacy required.
    • Experience with managing specialty medications for patients with chronic illness is highly preferred.
    • Expert at Microsoft Office Suite.
Benefits

What can you expect from Archimedes?

  • Top of the industry benefits for Health, Dental, and Vision insurance
  • 20 days paid time off
  • 4 weeks paid parental leave
  • 9 paid holidays
  • 401K company match of up to 5% - No vesting requirement
  • Adoption Assistance Program
  • Flexible Spending Account
  • Educational Assistance Plan and Professional Membership assistance
Location

502 Earth City Expy STE 300, Earth City, MO 63045, US

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