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Case manager vs utilization review nurse

The differences between case managers and utilization review nurses can be seen in a few details. Each job has different responsibilities and duties. While it typically takes 2-4 years to become a case manager, becoming a utilization review nurse takes usually requires 1-2 years. Additionally, a utilization review nurse has an average salary of $65,425, which is higher than the $43,118 average annual salary of a case manager.

The top three skills for a case manager include social work, patients and community resources. The most important skills for a utilization review nurse are medical necessity, patients, and acute care.

Case manager vs utilization review nurse overview

Case ManagerUtilization Review Nurse
Yearly salary$43,118$65,425
Hourly rate$20.73$31.45
Growth rate9%6%
Number of jobs84,95929,776
Job satisfaction4.5-
Most common degreeBachelor's Degree, 64%Bachelor's Degree, 43%
Average age4544
Years of experience42

What does a case manager do?

A case manager is responsible for giving advice, handling plans for the client's recovery, and connecting with other human service professionals to ask for further options and recommendations for the client's concerns. Case managers should have excellent communication and listening skills to evaluate the client's needs, ensuring that they will have the utmost care and safety through efficient advocacy. A case manager should be able to provide a reliable support system for the client and monitor progress to achieve wellness and guarantee satisfaction.

What does a utilization review nurse do?

The primary role of an Utilization Review Nurse is to analyze the condition of each patient carefully and decide if the patient still needs to stay in the hospital or be sent home. They deal with patients' relatives, doctors, and people from insurance companies.

Case manager vs utilization review nurse salary

Case managers and utilization review nurses have different pay scales, as shown below.

Case ManagerUtilization Review Nurse
Average salary$43,118$65,425
Salary rangeBetween $30,000 And $61,000Between $47,000 And $89,000
Highest paying CityWashington, DCAlameda, CA
Highest paying stateNew HampshireRhode Island
Best paying companyWellpathMolina Healthcare
Best paying industryInsuranceHealth Care

Differences between case manager and utilization review nurse education

There are a few differences between a case manager and a utilization review nurse in terms of educational background:

Case ManagerUtilization Review Nurse
Most common degreeBachelor's Degree, 64%Bachelor's Degree, 43%
Most common majorPsychologyNursing
Most common collegeCalifornia State University - Long BeachDuke University

Case manager vs utilization review nurse demographics

Here are the differences between case managers' and utilization review nurses' demographics:

Case ManagerUtilization Review Nurse
Average age4544
Gender ratioMale, 23.4% Female, 76.6%Male, 8.5% Female, 91.5%
Race ratioBlack or African American, 7.9% Unknown, 6.2% Hispanic or Latino, 7.9% Asian, 3.1% White, 74.2% American Indian and Alaska Native, 0.6%Black or African American, 12.0% Unknown, 4.3% Hispanic or Latino, 9.1% Asian, 8.9% White, 65.3% American Indian and Alaska Native, 0.4%
LGBT Percentage15%9%

Differences between case manager and utilization review nurse duties and responsibilities

Case manager example responsibilities.

  • Manage all programs operations in accordance with HRA and industry regulations, agency policies and HIPAA guidelines.
  • Manage the care of patients with tuberculosis (TB) during their hospitalization and their discharge follow-up care.
  • Provide clients support with basic ADL's (shopping, payee services, budgets, managing and attending appointments).
  • Practice cognitive behavioral, DBT, motivational enhancement and structural family therapy.
  • Practice excellent customer service and build meaningful, professional relationships with families and patients.
  • Facilitate vocational rehabilitation and relate community services.
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Utilization review nurse example responsibilities.

  • Monitor patients' status during surgery (circulate in operating room) and manage patients in PACU.
  • Case management for acute patients refer to LTC
  • Advise insurance carriers on recommend reimbursement for charges following automate bill audit utilizing ICD-9 and CPT codes.
  • Provide caregiver oversight relate to care, medication administration and emergency situations.
  • Identify inappropriate utilization of services/settings through the application of establish clinical criteria using InterQual and CMS guidelines for medical necessity.
  • Direct contact with IPA providers.
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Case manager vs utilization review nurse skills

Common case manager skills
  • Social Work, 17%
  • Patients, 14%
  • Community Resources, 7%
  • Substance Abuse, 6%
  • Crisis Intervention, 5%
  • Rehabilitation, 5%
Common utilization review nurse skills
  • Medical Necessity, 9%
  • Patients, 7%
  • Acute Care, 7%
  • Discharge Planning, 7%
  • Utilization Management, 6%
  • Utilization Review, 6%

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