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Utilization Review Case Manager Jobs (NOW HIRING)

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RN - Case Manager

Honesdale, PA

$2.5K/wk

Utilization Review / Case Manager RN Location: Honesdale, Pennsylvania 18431 Department: Case Management Pay: $2500/weekly Schedule: * 8-hour Day Shifts * Typical Hours: 7:00 AM - 3:30 PM or 8:00 AM ...

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Utilization Review Case Manager information

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

As of Jun 29, 2026, the average hourly pay for utilization review case manager in the United States is $36.49, according to ZipRecruiter salary data. Most workers in this role earn between $29.57 and $38.46 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.
More about Utilization Review Case Manager jobs
What cities are hiring for Utilization Review Case Manager jobs? Cities with the most Utilization Review Case Manager job openings:
What states have the most Utilization Review Case Manager jobs? States with the most job openings for Utilization Review Case Manager jobs include:
What job categories do people searching Utilization Review Case Manager jobs look for? The top searched job categories for Utilization Review Case Manager jobs are:
Utilization Review Case Manager jobs near you
Infographic showing various Utilization Review Case Manager job openings in the United States as of June 2026, with employment types broken down into 88% Full Time, 8% Part Time, and 4% Contract. Highlights an 90% Physical, 2% Hybrid, and 8% Remote job distribution, with an average salary of $75,891 per year, or $36.5 per hour.
RN Utilization Review Case Manager

RN Utilization Review Case Manager

Gateway Regional Medical Center

Granite City, IL • On-site

$32 - $48/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 9 days ago

Gateway Regional Medical Center rating

4.4

Company rating: 4.4 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

973rd of 1,003 rated hospitals

Job description

Utilization Review Specialist RN
Full-Time | Case Management | Gateway Regional Medical Center | Granite City, Illinois
Gateway Regional Medical Center is hiring a Utilization Review Specialist Registered Nurse (RN) to join our Case Management team.
This role is ideal for an experienced acute care nurse who is ready to move into a more analytical, process-driven role focused on appropriate utilization of services, payer compliance, and supporting high-quality, cost-effective patient care.
What You'll Do
In this role, you will support appropriate patient care utilization and financial stewardship by:
  • Completing admission and concurrent chart reviews for medical necessity
  • Working to prevent denials from all payers through timely review and documentation
  • Managing and coordinating appeals for denied or at-risk accounts
  • Collaborating with physicians, case managers, and interdisciplinary teams
  • Monitoring payer requirements and regulatory compliance standards
  • Identifying denial trends and opportunities for process improvement
  • Supporting efficient patient flow and appropriate level-of-care placement
  • Ensuring accurate and timely documentation to support reimbursement
What We're Looking For
  • Graduate of an accredited School of Nursing (RN required)
  • Current Illinois RN license
  • Current BLS certification required
  • Minimum 5 years of acute care clinical nursing experience required
  • Experience in case management, discharge planning, utilization review, or appeals preferred
  • Familiarity with InterQual and/or Milliman criteria preferred
Ideal Candidate
This role is a great fit if you:
  • Have strong critical thinking and clinical judgment skills
  • Enjoy reviewing clinical documentation and problem-solving
  • Are detail-oriented and comfortable working with payer guidelines
  • Thrive in a structured, policy-driven environment
  • Want to transition out of bedside nursing into a more administrative clinical role
Why Join Gateway?
  • Competitive pay: $32.00-$48.00/hr
  • Comprehensive medical, dental, and vision insurance
  • Paid vacation and holiday time
  • Retirement plan with employer match
  • Stable weekday schedule (no nights or weekends, if applicable you can insert)
  • Supportive case management and interdisciplinary team environment
  • Opportunity to directly impact quality metrics and hospital performance
Location
Gateway Regional Medical Center
2100 Madison Ave
Granite City, IL 62040
Compensation
Compensation is based on education, experience, certifications, and relevant skills. Final offers are determined through our compensation review process to ensure fairness and internal equity.
Join a team where your clinical expertise helps ensure patients receive the right level of care at the right time-while supporting quality, compliance, and patient outcomes. Apply today.

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