Case Manager - Utilization Management
Lehigh Valley Health Network · United States · US
Utilization Review
Remote
physician
Nurse
Demand78
Career growth65
Healthcare fit82
Remote potential40
5-year outlook
Demand for utilization management and case management roles is likely to remain stable due to payer scrutiny and hospital resource management. Pay should be competitive for experienced RN case managers, with advancement requiring certifications, payer-side experience, or leadership responsibilities.
Clinical license
Required
Applicant reach
moderate
Seniority
mid
Employment type
full-time
Date found
2026-10-30
Intelligence details
Flexible work details
- Engagement type
- Permanent
- Hours
- Full-time
- Eligible countries
- United States
- License jurisdiction
- US
- Profession fit
- physician, Nurse
- Rate period
- Annual
Listing via Himalayas.
Eligibility, licensing, and location restrictions can change. Always confirm details on the source posting before applying.
Why this is worth applying to
Worth applying for nurses with prior utilization review or case management experience who want a hospital-based, payer-facing non-bedside role. Clinicians without utilization-review exposure may find the 2-year experience requirement a significant barrier.
Who should apply
RNs with 2+ years of utilization review experience, inpatient case managers, and nurses familiar with third-party payer requirements, patient class assignment, and clinical documentation review.
CV angle
Frame bedside nursing assessment, documentation, discharge planning, payer communication, HIPAA compliance, and quality improvement work using utilization-management language. Highlight any real experience with clinical reviews, admission criteria, denials/appeals, patient class, or payer interaction; do not claim utilization review experience you do not have.
Skills to highlight
- Utilization management
- Clinical review
- Patient class assignment
- Third-party payer requirements
- HIPAA/PHI compliance
- Discharge planning and care coordination
- Performance improvement
- Interdisciplinary collaboration
Role summary
A hospital-based utilization management case manager role focused on reviewing admissions, determining appropriate patient class, applying evidence-based criteria, supporting payer compliance, and collaborating with care management, billing, coding, appeals, and finance teams.
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