FREE ACCESS
5,000–10,000 jobs/day
See all jobs on JobTailor
Search thousands of fresh jobs every day.
Discover
- Fresh listings
- Fast filters
- No subscription required
Create a free account and start exploring right away.
Utilization Specialist, Case Management
MSKUtilization Specialist in Case Management at Memorial Sloan Kettering Cancer Center ensuring effective healthcare resource utilization. Collaborating with interdisciplinary partners to support high-quality patient care.
Posted 7/21/2026full-timeNew York City • New York • 🇺🇸 United StatesJuniorMid-Level💰 $77,100 - $119,400 per yearWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Utilization Review and Case Management, ensuring compliance with state and federal regulations while effectively collaborating with healthcare providers and insurance companies to optimize patient care and operational efficiency.
Highest-signal resume keywords
Licensed Practical Nurse (LPN) or Registered Nurse (RN)Utilization Review ExperienceCase Management ExperienceInterQual Software KnowledgeMCG Medical Necessity Criteria Knowledge
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Medical Necessity DeterminationClinical DocumentationPayer CommunicationDischarge PlanningQuality Concern Identification
Soft Skills
CollaborationGuidance on Case Management ProcessesProcess Improvement Participation
Tools & Technologies
InterQual SoftwareMCG Medical Necessity Criteria Software
Certifications & Qualifications
InterQual CertificationMCG Certification
Industry Keywords
Healthcare SystemInsurance OrganizationState and Federal RegulationsUtilization Management
About the role
Key responsibilities & impact- Perform admission, concurrent, retrospective, and Medicare reviews to determine medical necessity and support appropriate levels of care
- Collaborate with Case Managers, providers, and insurance companies to support treatment plans, authorization reviews, denial prevention, and discharge planning
- Document clinical reviews, payer communications, treatment delays, avoidable days, and other case management activities in accordance with departmental and regulatory requirements
- Maintain accurate records and databases, organize clinical information, and support concurrent and retrospective utilization reviews
- Identify quality concerns, report potential issues, and provide guidance on case management processes and payer requirements
- Participate in departmental initiatives, process improvement efforts, and ongoing learning to support operational excellence and high-quality patient care
Requirements
What you’ll need- Licensed Practical Nurse (LPN) or Registered Nurse (RN) with a current, active state license required
- Minimum 2 years of Utilization Review and/or Case Management experience within a healthcare system or insurance organization required
- Knowledge of InterQual software and/or MCG Medical Necessity criteria software; InterQual or MCG Certification highly preferred
- Knowledge of state and federal regulations governing health insurance coverage and utilization management
Benefits
Comp & perks- Health insurance
- Retirement plans
- Paid time off
- Flexible work arrangements
- Professional development