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Utilization Review Case Manager Jobs in Mount Olive, MS

Acadia Healthcare

Utilization Specialist

Magee, MS · On-site

Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...

Acadia Healthcare

Utilization Specialist

Magee, MS · On-site

PURPOSE STATEMENT: Proactively monitor utilization of services for patients to optimize ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...

Harboroaks

Utilization Specialist

Magee, MS · On-site

$48 - $72/hr

Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...

New

Millcreek of Magee

Utilization Specialist

Magee, MS

Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...

Linde

Safety, Health & Environmental Manager

Ellisville, MS · On-site

$70K - $95K/yr

Support medical case management, return-to-work activities, and occupational health programs * Lead EHS reviews for new equipment, engineering projects, process changes, and management of change ...

Linde

Safety, Health & Environmental Manager

Ellisville, MS · On-site

$70K - $95K/yr

Support medical case management, return-to-work activities, and occupational health programs * Lead EHS reviews for new equipment, engineering projects, process changes, and management of change ...

TheraPeds

Physical Therapist

Bay Springs, MS · On-site

$55 - $65/hr

Providing case management services, as assigned * Providing appropriate supervision and direction ... Reviewing PTA documentation and student progress and modifying plans of care as appropriate

TheraPeds

Physical Therapist

Bay Springs, MS · On-site

$76 - $90/hr

Providing case management services, as assigned * Providing appropriate supervision and direction ... Reviewing PTA documentation and student progress and modifying plans of care as appropriate

Linde

Engineering Technician

Ellisville, MS · On-site

You will also support Total Preventive Maintenance (TPM) efforts to increase machine utilization ... and support design reviews with safety and ergonomic focus on plant systems and production ...

All JobsUtilization Review Case JobsUtilization Review Case Manager JobsUtilization Review Case Manager Jobs in Mount Olive, MS

Utilization Review Case Manager information

See Mount Olive, MS salary details

$13

$29

$48

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

As of Sep 4, 2026, the average hourly pay for utilization review case manager in Mount Olive, MS is $29.29, according to ZipRecruiter salary data. Most workers in this role earn between $23.75 and $30.87 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 cities near Mount Olive, MS are hiring for Utilization Review Case Manager jobs?

Cities near Mount Olive, MS 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 Mount Olive, MS as of August 2026, with employment types broken down into 50% Full Time, and 50% Contract. Highlights an 100% In-person job distribution, with an average salary of $60,915 per year, or $29.3 per hour.

BMH Rankin: RN-Case Manager

Baptist Memorial Health Care Corporation

Brandon, MS • On-site

Full-time

Posted 17 hours ago

Posted today

Baptist Memorial Health Care rating

7.3

Company rating: 7.3 out of 10

Based on 115 frontline employees who took The Breakroom Quiz

305th of 898 rated healthcare providers

Job description

Job Summary

Case Managers will apply systems, science, incentives, and information to improve healthcare practice and assist patients and their support systems to become engaged in a collaborative process designed to manage medical/social/mental health conditions more effectively. The case manager's objective is to achieve an optimal level of wellness for patients and improve coordination of care while providing cost effective, non-duplicative services. Performs all other duties as assigned.

Responsibilities

  • Assess and document the clinical, psychosocial and financial needs of patients including availability of care support, risk for readmission and safe environment upon discharge/transition and payor benefits. Findings are collected by interviewing patients, caregivers and members of the interdisciplinary team. Aspects of this assessment obtained from the patient record or previous case manager assessment are validated, updated and influence the plan of care. Assess and document the patient's care management and potential discharge needs. 20 %
  • Apply InterQual to determine/validate Level of Service and Intensity of Care. Utilize InterQual criteria within the first 24 hours of arrival to complete an initial review. Collaborate with physicians, Manager of Case Management and physician advisors to resolve conflicts. Coordinate with bed control to attain proper placement. Perform concurrent reviews of medical records to ensure continued appropriateness and make recommendations based on the needs of the patient. Escalate and facilitate resolution of unjustifiable aspects of care that vary from InterQual guidelines. 20 %
  • With the physician, identify the plan of care, estimated length of stay and transition/discharge plan. Meet with patients and families to engage them in the plan and obtain agreement. Incorporate all processes and procedures into the plan to ensure safe discharge/transition. Coordinate with physician and nurse to make plan adjustments as patient condition indicates. Use best practices and available pathways to anticipate the course of care through discharge/transition. Incorporate ancillary services as needed. Work in collaboration with social work for complex postacute placement and community service resources. 20 %
  • In coordination with nursing, ancillary departments, social work, and the physician, monitor and ensure the treatment plan and steps to prepare for transition or discharge are completed as planned, gaps in care are avoided as well as duplicative or unnecessary services. 10 %
  • Ensure that patients are discharged/transitioned timely and appropriately and that variances from the plan or target discharge/transition date are documented. 10 %
  • Escalate concerns and barriers to appropriate treatment or transition as outlined by the department. 10 %
  • Maintain a working knowledge of facilities and resources available to patients and caregivers. 10 %

Specifications

Experience

Minimum Required

  • 3 years Healthcare/Medical-Acute Care Required.

Preferred/Desired

  • Healthcare/Medical-Case Manager Preferred, or Healthcare/Medical - Utilization Review Preferred.

Education

Minimum Required

  • Graduate of School of Nursing-Accredited Required.

Preferred/Desired

  • Bachelor's Degree Nursing Preferred, or Bachelor's Degree Allied Health Preferred.

Training

Minimum Required

Preferred/Desired

Special Skills

Minimum Required

  • Must be able to work with acutely & chronically ill patients of all ages and their caregivers. Must have excellent interpersonal communication, multi-tasking, prioritizing & organizational skills. Demonstrated ability to work effectively with teams in a collaborative manner and escalate issues appropriately. Ability to work weekends and flexible hours per the department staffing plan.

Preferred/Desired

Licensure

Minimum Required

  • License/Certification/Registries (valid for the State of MS): Registered Nurse (RN) by the State Board of Nursing Required.

Preferred/Desired

  • Certification by the Case Management Society of America Preferred, or Equivalent Certification Preferred.

What Baptist Memorial Health Care employees say

Pay

Benefits

Hours and flexibility

Workplace

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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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