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Utilization Review Case Manager Jobs (NOW HIRING)

MTK Healthcare

RN-Case Manager

Portales, NM · On-site

$59 - $62/hr

MTK Healthcare Inc. is Hiring RN Case Manager - Utilization Review & Swing Bed | Portales, NM | Monday-Friday (8:00 AM-4:30 PM), Day Shift Position Details * Position: RN Case Manager - Utilization ...

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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 Jul 19, 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 July 2026, with employment types broken down into 2% As Needed, 78% Full Time, 17% Part Time, and 3% Contract. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $75,891 per year, or $36.5 per hour.
Utilization Review/Case Management RN

Utilization Review/Case Management RN

Pyramid Consulting

Santa Clara, CA • On-site

$75 - $85/hr

Other

Medical, Dental, Vision, Retirement

Posted 24 days ago

Job description

Immediate need for a talented Utilization Review/Case Management RN. This is a 03+ Months Contract opportunity with long-term potential and is located in Santa Clara, CA (Onsite). Please review the job description below and contact me ASAP if you are interested.
Job ID:25-96149
Pay Range: $75 - $85/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
Key Responsibilities:

  • Utilization Management:-Performs daily pre-admission, admission, and concurrent utilization reviews using guidelines, institutional policies/procedures, and other information to determine appropriate levels of care and readiness for discharge.
  • Monitors the progression of the discharge plan and facilitates discussions with the multidisciplinary teams.
  • Educates other healthcare team members on utilization and care coordination.
  • Collaborates with and provides information to patients, families, physicians, and staff regarding the discharge plans and transitions.
  • Understands and consistently applies the interpretation, and utilization of member health care benefits.
  • Conducts UM, care coordination and discharge planning activities according to all applicable regulatory requirements.
  • Discharge Planning:- Ensures continuity of care through communication in rounds and written documentation, level of care recommendations, transfer coordination, discharge planning and obtaining authorizations/approvals as needed for outside services for the patient.
  • Develops, evaluates, and coordinates a comprehensive discharge plan in conjunction with the patient/family, physician, nursing, social services, and other health care providers and agencies.
  • Regulatory:-Conducts UM, care coordination, and discharge planning activities according to all applicable regulatory requirements.
  • Shift Timings: 8:00 AM - 4:30 PM - 5 days/week including every other weekend (both Saturday & Sunday).
  • Days vary but we are looking for 2 travelers to fill the schedules below:
  • Traveler Week 1 Schedule Week 2 Schedule
  • Traveler 1 Mon, Tue, Wed, Fri, Sat Sun, Mon, Wed, Thu, Fri
  • Traveler 2 Mon, Tue, Thu, Fri, Sat Sun, Tue, Wed, Thu, Fri
Key Requirements and Technology Experience:
  • Skills-Recent hospital/acute care setting experience
  • Strong discharge planning background
  • Availability aligned with the outlined shift schedules
  • Minimum two (2) years of experience in utilization review, case management, and discharge planning.
  • Graduate of accredited school of nursing.
  • Diploma/Associate Degree in Nursing.
  • License, Certification, Registration:-Registered Nurse License (California) - Required upon hire.
  • Basic Life Support (BLS) - Required upon hire.
  • Knowledge of the Nurse Practice Act, TJC, DMHC, CMS, NCQA, HIPAA, ERISA, EMTALA & all other applicable federal/state/local laws & regulations.
  • Demonstrated strong communication and customer service skills, problem-solving, critical thinking, & clinical judgment abilities.
  • Fundamental word processing & computer navigation skills & the ability to interpret & use analytic data in day to day operations.
  • Knowledge of health care benefits associated with various business lines (Medicare/KPSA, Commercial/KFH, Medi-Cal, Federal, etc.).
  • Must be able to work in a Labor/Management Partnership environment.
  • Acute inpatient hospital-level experience.
  • Bachelor's degree in nursing or a health care related field preferred.
  • Master's degree in case management preferred.
Our client is a leading Healthcare Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.
Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
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