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Utilization Review Case Manager Jobs in Reno, NV

The Case Manager/Social Worker reviews care for level of care criteria, quality and efficacy of care and treatment, core measure interventions, and other criteria as requested. Collaborates with all ...

The Case Manager/Social Worker reviews care for level of care criteria, quality and efficacy of care and treatment, core measure interventions, and other criteria as requested. Collaborates with all ...

RN CASE MANAGER or SOCIAL WORKER, Full Time

Reno, NV ยท On-site

$21.75 - $28.50/hr

The Case Manager/Social Worker reviews care for level of care criteria, quality and efficacy of care and treatment, core measure interventions, and other criteria as requested. Collaborates with all ...

The Case Manager/Social Worker reviews care for level of care criteria, quality and efficacy of care and treatment, core measure interventions, and other criteria as requested. Collaborates with all ...

RN Care Manager (Clinic)

Reno, NV ยท On-site

$69K - $103K/yr

... Case Management. The In-Clinic Care Management (CM) Model establishes a fully integrated, clinic-embedded approach designed to enhance care coordination, reduce avoidable utilization, and improve ...

... Case Management. The In-Clinic Care Management (CM) Model establishes a fully integrated, clinic-embedded approach designed to enhance care coordination, reduce avoidable utilization, and improve ...

... Case Management. The In-Clinic Care Management (CM) Model establishes a fully integrated, clinic-embedded approach designed to enhance care coordination, reduce avoidable utilization, and improve ...

RN Care Manager (Clinic)

Reno, NV ยท On-site

$81K - $112K/yr

... Case Management. The In-Clinic Care Management (CM) Model establishes a fully integrated, clinic-embedded approach designed to enhance care coordination, reduce avoidable utilization, and improve ...

Care Manager - CA

Truckee, CA ยท On-site

$26 - $43.81/hr

... optimize resource utilization within the care continuum. Minimum Qualifications: * Bachelor ... Certified Case Manager (CCM) credential or equivalent certification. * Experience working with ...

Care Manager - CA

Truckee, CA ยท On-site

$26 - $43.81/hr

... optimize resource utilization within the care continuum. Minimum Qualifications: * Bachelor ... Certified Case Manager (CCM) credential or equivalent certification. * Experience working with ...

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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:
RN CASE MANAGER or SOCIAL WORKER, Full Time

RN CASE MANAGER or SOCIAL WORKER, Full Time

Northern Nevada Health System

Spanish Springs, NV โ€ข On-site

Other

Medical, Dental, Vision, Retirement, PTO

Posted 8 days ago


Job description

Responsibilities
Sierra Medical Center is part of Northern Nevada Health System, a regional multi-facility system that has excelled at offering quality care to residents of the greater Truckee Meadows. Sierra Medical Center is a 170-bed acute care hospital offering services including 24/7 ER care, cardiology, oncology, labor and delivery, level II NICU, surgical and orthopedic services, and much more. Learn more at northernnevadahealth.com
What we at Sierra Medical Center value:
โ€ข Compassion: We treat everyone with kindness and warmth because we genuinely care about every patient, employee and physician like they are family.
โ€ข Empathy: We put ourselves in our patient's shoes and deliver clinical care with a personalized touch.
โ€ข Teamwork: We foster a caring and friendly work environment to bring the best possible outcomes in our patient's lives.
โ€ข Quality: We strive to provide excellence in clinical care.
โ€ข Ethics: We conduct our business with the highest ethical and moral standards.
โ€ข Respect: We promise to honor the dignity, individuality and rights of everyone.
โ€ข Service Excellence: We provide personalized and professional service that exceeds the expectations of those we serve.
โ€ข Innovation: We continually invest in technology and process improvements to develop new and better ways of delivering clinical care.
Learn more at northernnevadahealth.com
The RN Case Manager OR Social Worker opportunity is full time at 40 hours per week, offers full benefits and a convenient day shift schedule. This dynamic individual will be responsible for the implementation of the case management/Social Work process, which is assessment, planning, collaboration and intervention, monitoring and evaluation. Through this process, the Case Manager/Social Worker facilitates the patient's care from admission to discharge. The Case Manager/Social Worker reviews care for level of care criteria, quality and efficacy of care and treatment, core measure interventions, and other criteria as requested. Collaborates with all members of the healthcare team to facilitate discharge planning including providing patient and family education specific to disease management and follow up care.
Job Duties/Responsibilities:
* Performs the care management process to assess, plan and facilitate discharge planning on all patents. Documents initial assessment within 48 hours of admission.
* Demonstrates competency in use of Interqual criteria to determine appropriateness and level of care of admitted and continued stay patients. Provides ongoing assessment and re-evaluation and documents appropriately.
* Documents avoidable days and refers to Administration and/or Medical Director for intervention as needed.
* Demonstrates knowledge of various levels of care by insuring safe and appropriate discharge planning and post acute care services
Benefits for full and part time employees:
* Challenging and rewarding work environment
* Competitive Compensation & Generous Paid Time Off
* Excellent Medical, Dental, Vision and Prescription Drug Plans
* 401(K) with company match and discounted stock plan
* Tuition Reimbursement/Repayment Program
* Career development opportunities within UHS and its 300+ Subsidiaries!
* More information is available on our Benefits Guest Website: benefits.uhsguest.com
If you would like to learn more about the position before applying, please contact Jenn Samudio, Recruiter @ jennifer.samudio@uhsinc.com.
Universal Health Services:
One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World's Most Admired Companies by Fortune; and listed in Forbes ranking of America's Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com
Qualifications
* Current Nevada Registered Nurse or Social Worker License
* Five (5) or more years of previous experience in all aspects of nursing and two (2) or more years of UR or CM experience preferred
* Discharge Planning preferred
* Current BLS certification
EEO Statement
All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.
We believe that diversity and inclusion among our teammates is critical to our success.
Avoid and Report Recruitment Scams
At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS
and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.
If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.