Care Management & Utilization Review Nurse

Syracuse Area Health • Syracuse, NE

3d

About The Position

The Care Manager/Utilization Review Nurse or Social Worker is responsible for coordinating patient care across the continuum, ensuring the delivery of high-quality, cost‑effective services that meet regulatory, payer, and organizational requirements. This role performs comprehensive assessments, discharge planning, care coordination, and utilization review activities to promote optimal outcomes and appropriate resource utilization. This is a benefited, full-time, day shift position, totaling 40 hours per week. No weekends and no holidays!

Requirements

• Active RN license (BSN preferred) or Licensed Clinical Social Worker (LCSW/MSW); case management certifications such as CCM or ACM preferred
• 2–5 years of clinical experience in acute care, behavioral health, care coordination, or utilization management
• Working knowledge of InterQual or MCG criteria and payer medical‑necessity guidelines
• Strong assessment, psychosocial evaluation, and critical thinking skills
• Excellent communication, negotiation, and interdisciplinary collaboration abilities
• Proficiency with EMRs and utilization management software; strong documentation and organizational skills

Nice To Haves

• BSN preferred
• case management certifications such as CCM or ACM preferred

Responsibilities

• coordinating patient care across the continuum
• ensuring the delivery of high-quality, cost‑effective services that meet regulatory, payer, and organizational requirements
• performing comprehensive assessments
• discharge planning
• care coordination
• utilization review activities to promote optimal outcomes and appropriate resource utilization

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level