ZipRecruiter

Log In

1

Utilization Review Case Manager Jobs in Reno, NV

Renown Health

Utilization Management RN-Acute

Reno, NV · On-site

... and case manager) as needed to ensure the appropriate and timely disposition of the client. The Utilization Management RN, documents all chart and phone reviews, identifies and communicates ...

Renown Health

Utilization Management RN-Acute

Reno, NV · On-site

... and case manager) as needed to ensure the appropriate and timely disposition of the client. The Utilization Management RN, documents all chart and phone reviews, identifies and communicates ...

Renown Health

Utilization Management RN-Acute

Reno, NV · On-site

$38.22 - $57.32/hr

... and case manager) as needed to ensure the appropriate and timely disposition of the client. The Utilization Management RN, documents all chart and phone reviews, identifies and communicates ...

Nevada Health Centers I

RN COMPLEX CASE MANAGER

Reno, NV · On-site

... utilization, improved quality of care and cost-effective outcomes. * Ability to monitor and assure ... Generates case management logs and submits them in a timely manner. * Responsible for developing a ...

Nevada Health Centers I

RN COMPLEX CASE MANAGER

Reno, NV · On-site

... utilization, improved quality of care and cost-effective outcomes. * Ability to monitor and assure ... Generates case management logs and submits them in a timely manner. * Responsible for developing a ...

Reliable Healthcare Services

Psychiatrist

Sparks, NV · On-site

$155/hr

Facilitate safe and timely discharge planning in collaboration with social services, nursing, case management, and utilization review staff. * Coordinate ongoing medical maintenance care, collaborate ...

next page

Showing results 1-20

All JobsUtilization Review Case JobsUtilization Review Case Manager JobsUtilization Review Case Manager Jobs in Reno, NV

Utilization Review Case Manager information

See Reno, NV salary details

$16

$36

$59

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

As of Jul 16, 2026, the average hourly pay for utilization review case manager in Reno, NV is $36.38, according to ZipRecruiter salary data. Most workers in this role earn between $29.47 and $38.37 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 Reno, NV? For Utilization Review Case Manager jobs in Reno, NV, the most frequently searched job titles are:
What job categories do people searching Utilization Review Case Manager jobs in Reno, NV look for? The top searched job categories for Utilization Review Case Manager jobs in Reno, NV are:
What cities near Reno, NV are hiring for Utilization Review Case Manager jobs? Cities near Reno, NV with the most Utilization Review Case Manager job openings:
Utilization Review Case Manager jobs near you
Utilization Management RN-Acute

Utilization Management RN-Acute

Renown Health

Reno, NV • On-site

Full-time

Posted 8 days ago

Renown Health rating

7.5

Company rating: 7.5 out of 10

Based on 97 frontline employees who took The Breakroom Quiz

233rd of 886 rated healthcare providers

Job description

Position Purpose

Under the supervision Hospital Care Management, incumbent promotes appropriate utilization, high quality care and cost effective outcomes. Incumbent is also responsible for utilization review, coordination of acute inpatient denials, performs admission and concurrent reviews and communication with physicians and payers regarding the medical necessity for services.

Nature and Scope

Conduct medical certification review for medical necessity for acute care facility and services. Use nationally recognized, evidence-based guidelines approved by medical staff to recommend level of care to the physician and serve as a resource to the medical staff on issues related to admission qualifications, resource utilization, national and local coverage determinations, and documentation improvement opportunities. 

This position also provides information (certified LOS and reimbursement issues) to the care team (RN, physicians, and case manager) as needed to ensure the appropriate and timely disposition of the client.

The Utilization Management RN, documents all chart and phone reviews, identifies and communicates potentially avoidable/non-reimbursed days, quality indicators (such as readmissions). Delivers non-covered letters as set forth by payer and/or regulatory compliance.

This position will be required to work a flexible schedule that may include evenings and weekends to provide coverage for the department as needed. This position participates in Quality Improvement initiatives. 

Knowledge, Skills & Abilities

1. Strong interpersonal communication skills both verbal and written.

2. Knowledge of applicable regulatory requirements and community resources

3. Knowledge of continuous quality improvement process. 

4. Philosophy consistent with the strategic plan of Renown Health

5. The ability to understand and resolve complex problems in a timely and effective manner using critical thinking skills. 

6. The ability to keep current with new developments and acquire the needed knowledge for the position in order to keep skill sets up to date. 

7. The ability to work under stress and to meet deadlines.  

This position does not provide patient care. 

Disclaimer

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

Minimum Qualifications
Requirements - Required and/or Preferred

Name

Description

Education:

Must have working-level knowledge of the English language, including reading, writing and speaking English. English.  Appropriate education to obtain and maintain Registered Nursing licensure in the State of Nevada.

Experience:

Applicants with 1 year previous managed care and/or case management experience including acute hospital case management is preferred. Minimum of one-year in hospital setting required.

License(s):

Ability to obtain and maintain State of Nevada Registered Nurse license.

Certification(s):

Utilization or Case Management Certification preferred. Certification in Case Management (CCM), Certified Managed Care Nurse (CMCN), or ABQAURP HCQM is preferred.

Computer / Typing:

Must possess, or be able to obtain within 90 days, the computers skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.

What Renown Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Renown Health logo

About Renown Health

Sourced by ZipRecruiter

Renown Health is a leading and respected player in the healthcare industry, based in Reno, NV, US. Established in 1862, the company has a deep-rooted history in providing high-quality healthcare services to the community. Renown Health offers a wide array of services including urgent care centers, lab services, x-ray and imaging services, primary care doctors and specialists. Its central values include excellence in quality and service, caring for people first, being proactive in the community, fiscal responsibility, integrity, and respecting every person.

Industry

Health care and social assistance

Company size

5,001 - 10,000 Employees

Headquarters location

Reno, NV, US

Year founded

1862

Social media

FacebookTwitter

View All Renown Health Jobs

Apply