Experience in Utilization Review, Case Management, or similar clinical coordination role preferred * Strong understanding of medical necessity criteria and payer guidelines * Knowledge of insurance ...
Quick apply
Experience in Utilization Review, Case Management, or similar clinical coordination role preferred * Strong understanding of medical necessity criteria and payer guidelines * Knowledge of insurance ...
Duties of a Utilization Review and Appeals Case Manager may include the following but are not limited to: Conduct utilization review of inpatient, outpatient, and post-acute services to determine ...
Duties of a Utilization Review and Appeals Case Manager may include the following but are not limited to: Conduct utilization review of inpatient, outpatient, and post-acute services to determine ...
Experience in Utilization Review, Case Management, or similar clinical coordination role preferred * Strong understanding of medical necessity criteria and payer guidelines * Knowledge of insurance ...
Experience in Utilization Review, Case Management, or similar clinical coordination role preferred * Strong understanding of medical necessity criteria and payer guidelines * Knowledge of insurance ...
Experience in Utilization Review, Case Management, or similar role preferred * Strong understanding of medical necessity, payer guidelines, and clinical documentation * Knowledge of insurance ...
Quick apply
Experience in Utilization Review, Case Management, or similar role preferred * Strong understanding of medical necessity, payer guidelines, and clinical documentation * Knowledge of insurance ...
Experience in Utilization Review, Case Management, or similar role preferred * Strong understanding of medical necessity, payer guidelines, and clinical documentation * Knowledge of insurance ...
Experience in Utilization Review, Case Management, or similar role preferred * Strong understanding of medical necessity, payer guidelines, and clinical documentation * Knowledge of insurance ...
Experience in Utilization Review, Case Management, or similar clinical coordination role preferred * Strong understanding of medical necessity criteria and payer guidelines * Knowledge of insurance ...
Experience in Utilization Review, Case Management, or similar clinical coordination role preferred * Strong understanding of medical necessity criteria and payer guidelines * Knowledge of insurance ...
Experience in Utilization Review, Case Management, or similar role preferred * Strong understanding of medical necessity, payer guidelines, and clinical documentation * Knowledge of insurance ...
Experience in Utilization Review, Case Management, or similar role preferred * Strong understanding of medical necessity, payer guidelines, and clinical documentation * Knowledge of insurance ...
Duties of a Utilization Review and Appeals Case Manager may include the following but are not limited to: • Conduct utilization review of inpatient, outpatient, and post-acute services to determine ...
Duties of a Utilization Review and Appeals Case Manager may include the following but are not limited to: • Conduct utilization review of inpatient, outpatient, and post-acute services to determine ...
RN-Utilization Review/Case Manage Nurse - RFT
Gibson City, IL · On-site
$32 - $48/hr
UTILIZATION REVIEW/CASE MANAGEMENT - Nurse DEPARTMENT: CASE MANAGEMENT (QUALITY) HOURS & SHIFT REQUIREMENTS: Full time position. Hybrid (combination of in person and remote considered) GENERAL ...
RN-Utilization Review/Case Manage Nurse - RFT
Gibson City, IL · On-site
$32 - $48/hr
UTILIZATION REVIEW/CASE MANAGEMENT - Nurse DEPARTMENT: CASE MANAGEMENT (QUALITY) HOURS & SHIFT REQUIREMENTS: Full time position. Hybrid (combination of in person and remote considered) GENERAL ...
American Traveler is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Lebanon, New Hampshire. & Requirements * Specialty: Utilization Review * Discipline: RN * ...
American Traveler is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Lebanon, New Hampshire. & Requirements * Specialty: Utilization Review * Discipline: RN * ...
Utilization Review RN
$30 - $32/hr
Collaborate with primary or attending physician, case managers, patient and/or family to provide ... Provide outpatient or pharmacy services utilization review Hours for this Position: * M-F 8:00am to ...
Utilization Review RN
$30 - $32/hr
Collaborate with primary or attending physician, case managers, patient and/or family to provide ... Provide outpatient or pharmacy services utilization review Hours for this Position: * M-F 8:00am to ...
Experience in Utilization Review, Case Management, or similar role preferred * Strong understanding of medical necessity, payer guidelines, and clinical documentation * Knowledge of insurance ...
Quick apply
Experience in Utilization Review, Case Management, or similar role preferred * Strong understanding of medical necessity, payer guidelines, and clinical documentation * Knowledge of insurance ...
Experience in Utilization Review, Case Management, or similar role preferred * Strong understanding of medical necessity, payer guidelines, and clinical documentation * Knowledge of insurance ...
Experience in Utilization Review, Case Management, or similar role preferred * Strong understanding of medical necessity, payer guidelines, and clinical documentation * Knowledge of insurance ...
Experience in Utilization Review, Case Management, or similar role preferred * Strong understanding of medical necessity, payer guidelines, and clinical documentation * Knowledge of insurance ...
Quick apply
Experience in Utilization Review, Case Management, or similar role preferred * Strong understanding of medical necessity, payer guidelines, and clinical documentation * Knowledge of insurance ...
Experience in Utilization Review, Case Management, or similar role preferred * Strong understanding of medical necessity, payer guidelines, and clinical documentation * Knowledge of insurance ...
Experience in Utilization Review, Case Management, or similar role preferred * Strong understanding of medical necessity, payer guidelines, and clinical documentation * Knowledge of insurance ...
Experience in Utilization Review, Case Management, or similar role preferred * Strong understanding of medical necessity, payer guidelines, and clinical documentation * Knowledge of insurance ...
Experience in Utilization Review, Case Management, or similar role preferred * Strong understanding of medical necessity, payer guidelines, and clinical documentation * Knowledge of insurance ...
Experience in Utilization Review, Case Management, or similar role preferred * Strong understanding of medical necessity, payer guidelines, and clinical documentation * Knowledge of insurance ...
Quick apply
Experience in Utilization Review, Case Management, or similar role preferred * Strong understanding of medical necessity, payer guidelines, and clinical documentation * Knowledge of insurance ...
Utilization Review and Appeals Case Manager
Stony Brook, NY · On-site
$89.76K - $127.98K/yr
Duties of a Utilization Review and Appeals Case Manager may include the following but are not limited to: • Conduct utilization review of inpatient, outpatient, and post-acute services to determine ...
Utilization Review and Appeals Case Manager
Stony Brook, NY · On-site
$89.76K - $127.98K/yr
Duties of a Utilization Review and Appeals Case Manager may include the following but are not limited to: • Conduct utilization review of inpatient, outpatient, and post-acute services to determine ...
Duties of a Utilization Review and Appeals Case Manager may include the following but are not limited to: Conduct utilization review of inpatient, outpatient, and post-acute services to determine ...
Duties of a Utilization Review and Appeals Case Manager may include the following but are not limited to: Conduct utilization review of inpatient, outpatient, and post-acute services to determine ...
Experience in Utilization Review, Case Management, or similar role preferred * Strong understanding of medical necessity, payer guidelines, and clinical documentation * Knowledge of insurance ...
Experience in Utilization Review, Case Management, or similar role preferred * Strong understanding of medical necessity, payer guidelines, and clinical documentation * Knowledge of insurance ...
Utilization Review Case Manager information
See salary details
$16.59 - $20.54
3% of jobs
$20.54 - $24.50
1% of jobs
$24.50 - $28.45
6% of jobs
$30.36 is the 25th percentile. Wages below this are outliers.
$28.45 - $32.41
30% of jobs
The median wage is $33.83 / hr.
$32.41 - $36.36
26% of jobs
$37.87 is the 75th percentile. Wages above this are outliers.
$36.36 - $40.32
22% of jobs
$40.32 - $44.27
3% of jobs
$44.27 - $48.23
0% of jobs
$48.23 - $52.19
5% of jobs
$52.19 - $56.14
2% of jobs
$56.14 - $60.10
1% of jobs
$16
$36
$60
How much do utilization review case manager jobs pay per hour?
As of Jun 2, 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 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 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?
| Aspect | Utilization Review Case Manager | Utilization Review Nurse |
|---|---|---|
| Credentials | Typically requires a nursing license or relevant healthcare certification | Registered Nurse (RN) license is required |
| Work Environment | Office-based, insurance companies, healthcare organizations | Hospital, clinic, insurance review departments |
| Primary Focus | Reviewing medical necessity, coordinating care, managing cases | Assessing 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.
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:
$40/hr
Full-time
This job post has expired today. Applications are no longer accepted.
Job description
Job Title: Registered Nurse – Utilization Review
Location: Santa Rosa, CA
Shift Details: Day Shift | 5x8 Hours | 08:00 AM – 04:30 PM
Contract Duration: 13 Weeks
Orientation: 40 Hours (Non-Billable)
Required Qualifications
- Active Registered Nurse (RN) License required
- Minimum 1–2 years acute care experience preferred
- Experience in Utilization Review, Case Management, or similar clinical coordination role preferred
- Strong understanding of medical necessity criteria and payer guidelines
- Knowledge of insurance authorization and review processes
- Strong documentation, analytical, and communication skills
- Ability to work independently in a remote setting
- Experience with EMR systems preferred (Epic preferred)
Job Responsibilities
- Perform utilization review for inpatient and outpatient services
- Evaluate medical records for appropriate level of care and medical necessity
- Process prior authorizations and continued stay reviews
- Collaborate with physicians, case managers, and insurance payers
- Document review decisions accurately in EMR systems
- Identify cases requiring escalation to clinical reviewers or medical directors
- Support discharge planning and care coordination when needed
- Ensure compliance with regulatory, payer, and facility guidelines
- Maintain productivity and quality standards in a remote environment
For more details contact at sthakur@navitashealth.com
About Navitas Healthcare, LLC certified WBENC and one of the fastest-growing healthcare staffing firms in the US providing Medical, Clinical and Non-Clinical services to numerous hospitals. We offer the most competitive pay for every position we cater. We understand this is a partnership. You will not be blindsided and your salary will be discussed upfront.