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Utilization Review Case Manager Jobs in Tennessee

Sedgwick

RN Utilization Review

Knoxville, TN · On-site

$63K - $65K/yr

To provide timely, evidence-based utilization review services to maximize quality care and cost ... Certification in case management, pharmacy, rehabilitation nursing or a related specialty is highly ...

Sedgwick

RN Utilization Review

Memphis, TN · On-site

$63K - $65K/yr

To provide timely, evidence-based utilization review services to maximize quality care and cost ... Certification in case management, pharmacy, rehabilitation nursing or a related specialty is highly ...

Sedgwick

RN Utilization Review

Nashville, TN · On-site

$63K - $65K/yr

To provide timely, evidence-based utilization review services to maximize quality care and cost ... Certification in case management, pharmacy, rehabilitation nursing or a related specialty is highly ...

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All JobsUtilization Review Case JobsUtilization Review Case Manager JobsUtilization Review Case Manager Jobs in Tennessee

Utilization Review Case Manager information

See Tennessee salary details

$15

$33

$54

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

As of Aug 9, 2026, the average hourly pay for utilization review case manager in Tennessee is $33.12, according to ZipRecruiter salary data. Most workers in this role earn between $26.83 and $34.90 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.
What are popular job titles related to Utilization Review Case Manager jobs in Tennessee? For Utilization Review Case Manager jobs in Tennessee, the most frequently searched job titles are:
What job categories do people searching Utilization Review Case Manager jobs in Tennessee look for? The top searched job categories for Utilization Review Case Manager jobs in Tennessee are:
What cities in Tennessee are hiring for Utilization Review Case Manager jobs? Cities in Tennessee 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 Tennessee as of August 2026, with employment types broken down into 88% Full Time, 11% Part Time, and 1% Contract. Highlights an 84% Physical, 3% Hybrid, and 13% Remote job distribution, with an average salary of $68,880 per year, or $33.1 per hour.

RN-Utilization Review

Baptist Memorial Health Care Corporation

Memphis, TN • On-site

Full-time

Re-posted 13 days ago

Baptist Memorial Health Care rating

7.3

Company rating: 7.3 out of 10

Based on 113 frontline employees who took The Breakroom Quiz

304th of 887 rated healthcare providers

Job description

Description
Job Summary
Manages the care for a specific population; facilitates the safe transition of patients throughout the continuum of care for appropriate utilization of resources, service delivery and compliance with federal and other payer requirements. Provides early assessment of transitional needs identified during their hospitalization, illness, and/or life situation. Performs other duties as assigned.
Responsibilities
  • Utilization Review
  • Discharge planning
  • Readmission Reduction Participation
  • Payer Communication and denial reduction
  • Completes assigned goals.
Specifications
Experience
Minimum Required
  • RN with at least one (1) year of clinical experience
Preferred/Desired
  • RN with 3 years of clinical experience with Case Management experience in a hospital or payer setting
Education
Minimum Required
  • Diploma or Associate Degree in Nursing
Preferred/Desired
  • BSN or MSN
Training
Minimum Required
Preferred/Desired
  • Certified Case Manager
Special Skills
  • .
Minimum Required
  • Critical thinking skills, communication, organization, interpersonal and computer skills. Problem solving; and governmental regulations.
Preferred/Desired
  • Critical thinking skills, communication, organization, interpersonal and computer skills. Knowledge of payer requirements; problem solving; and governmental regulations.
Licensure
  • RN
Minimum Required
  • RN
Preferred/Desired
  • RN;CCM;ACM

What Baptist Memorial Health Care employees say

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About Baptist Memorial

Sourced by ZipRecruiter

Baptist Memorial, based in Memphis, TN, US, is a leading health care organization renowned in the healthcare industry. The company's official website is baptistonline.org which provides a comprehensive view of their services and operations. Baptist Memorial operates a myriad of hospitals, health clinics, and medical facilities providing expert and compassionate care. Founded in 1912, it has a rich legacy of over a hundred years of dedication to its community, offering services which include acute care, diagnostic services, and a broad range of speciality health services fulfilling various patient needs.

Industry

Hospitals

Company size

10,000+ Employees

Headquarters location

Memphis, TN, US

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