Case Manager - Utilization Management

Clinical Careers Page(1 month ago)

RemoteFull TimeMedior$93,376 - $125,454 (estimated)Admission Case Management

About this role

Performs clinical reviews of hospital admissions to ensure appropriate use of resources and correct patient class assignment in accordance with third-party payer requirements. The role supports compliance and reimbursement by evaluating admissions against evidence-based criteria and coordinating with care teams and revenue cycle departments. Works within Lehigh Valley Health Network to support utilization management processes and quality outcomes.

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Required Skills

Utilization Review
Patient Classification
Clinical Review
Care Management
Evidence-Based
HIPAA Compliance
Documentation
Queue Management

Qualifications

Specialized Diploma in Nursing
RN License (Pennsylvania)
Bachelor's Degree in Nursing
Accredited Case Manager (ACM)
Certified Case Manager (CCM)
Certified Managed Care Nurse (CMCN)

About Clinical Careers Page

lvhn.org

Lehigh Valley Health Network (LVHN) is a not‑for‑profit, integrated medical organization that provides comprehensive health care services to the Lehigh Valley and surrounding regions. LVHN operates hospitals, outpatient and urgent care centers, primary care and specialty practices, and offers advanced programs in areas such as cardiology, oncology, and behavioral health, alongside telehealth and rehabilitation services. The system combines clinical care with research, medical education, and community health initiatives to improve population health across its service area. Patients and partners rely on LVHN for coordinated, patient‑centered care and regional clinical expertise.

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