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Case Manager Utilization Review Nurse Jobs in Decatur, GA

Oscar Health

Utilization Review Nurse

Atlanta, GA · Remote

$35 - $45.94/hr

You will perform frequent case reviews, check medical records and speak with care providers ... Previous experience conducting concurrent or inpatient reviews for a managed care plan This is an ...

Alliant Health Group

Review Nurse-PA/UM

Atlanta, GA · On-site

Alliant is recruiting a Hybrid Review Nurse for its Prior Authorization and Utilization Management ... case which a nurse cannot approve * Consult with the Manager, Supervisor PA/UM, or Medical ...

Lancesoft INC

Utilization Review RN

Atlanta, GA · On-site

$3.0K - $3.1K/wk

Utilization Review Shift: 09:30 AM to 08:00 PM 13 weeks contract Description: * Utilization Review RN - Target Review * Health Plan Insurance (no acute care) * BLS (AHA) * RN state license Company ...

Bestica Healthcare

RN Case Manager

Atlanta, GA · On-site

Acute Hospital * Long Term Acute Care/Rehab/Skilled Nursing Case Management/Utilization Review: * Admission Criteria * Care coordination * Discharge Planning * Utilize InterQual Criteria * Utilize ...

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Case Manager Utilization Review Nurse information

See Decatur, GA salary details

$18

$46

$78

How much do case manager utilization review nurse jobs pay per hour?

As of Aug 6, 2026, the average hourly pay for case manager utilization review nurse in Decatur, GA is $46.41, according to ZipRecruiter salary data. Most workers in this role earn between $34.52 and $56.11 per hour, depending on experience, location, and employer.

What is the difference between Case Manager Utilization Review Nurse vs Case Manager?

AspectCase Manager Utilization Review NurseCase Manager
CredentialsRN license, certification in utilization review (e.g., URAC)RN license, case management certification (e.g., CCM)
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community health, insurance providers
Primary FocusReviewing medical necessity and appropriateness of careCoordinating patient care and discharge planning

While both roles involve patient care coordination, the Case Manager Utilization Review Nurse primarily focuses on reviewing medical necessity and insurance approvals, whereas the Case Manager handles broader patient care coordination and discharge planning. Both roles require nursing credentials and are vital in healthcare settings, but their specific responsibilities differ.

How does a case manager utilization review nurse typically collaborate with physicians and other healthcare providers?

Case Manager Utilization Review Nurses regularly work with physicians, social workers, and other healthcare professionals to ensure patients receive appropriate care while managing resource utilization. They often participate in interdisciplinary team meetings to discuss care plans, review patient progress, and address any barriers to discharge. Building strong communication channels and maintaining up-to-date clinical knowledge are essential, as nurses must advocate for patients while also supporting evidence-based practices and regulatory compliance. This collaborative environment helps streamline patient care and optimize outcomes.

What is a case manager utilization review nurse?

A Case Manager Utilization Review Nurse is a registered nurse who evaluates the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, coordinate with healthcare providers, and ensure that treatments meet established guidelines and insurance requirements. Their goal is to optimize patient outcomes while controlling healthcare costs and ensuring compliance with regulations. These nurses also help facilitate communication between patients, providers, and payers to support effective care management.

What are the key skills and qualifications needed to thrive as a case manager utilization review nurse, and why are they important?

To excel as a Case Manager Utilization Review Nurse, you need a solid background in nursing, strong clinical assessment skills, and a valid RN license, often with case management certification. Familiarity with utilization review software, electronic health record (EHR) systems, and knowledge of insurance and regulatory guidelines is essential. Exceptional communication, critical thinking, and negotiation abilities set top performers apart in this role. These qualifications ensure effective patient advocacy, cost-effective care, and compliance with healthcare standards.

What does a case manager utilization review nurse do?

A case manager utilization review nurse evaluates medical cases to determine the necessity, appropriateness, and efficiency of healthcare services. They review patient records, collaborate with healthcare providers, and ensure treatment plans comply with insurance and regulatory guidelines, often using electronic health record systems. This role requires clinical nursing experience and knowledge of healthcare policies.
What are popular job titles related to Case Manager Utilization Review Nurse jobs in Decatur, GA? For Case Manager Utilization Review Nurse jobs in Decatur, GA, the most frequently searched job titles are:
What job categories do people searching Case Manager Utilization Review Nurse jobs in Decatur, GA look for? The top searched job categories for Case Manager Utilization Review Nurse jobs in Decatur, GA are:
What cities near Decatur, GA are hiring for Case Manager Utilization Review Nurse jobs? Cities near Decatur, GA with the most Case Manager Utilization Review Nurse job openings:
Case Manager Utilization Review Nurse jobs near you

Utilization Review Nurse

Oscar Health

Atlanta, GA • Remote

$35 - $45.94/hr

Full-time

Posted 14 days ago

Oscar Health rating

6.9

Company rating: 6.9 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

251st of 301 rated insurance

Job description

Hi, we're Oscar. We're hiring a Utilization Review Nurse to join our Utilization Review team.

About the role:

You will perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed. You will make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions.

You will report into the Supervisor, Utilization Review.

Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois; Iowa; Kansas; Michigan; Missouri; Nebraska; New Jersey; North Carolina; Ohio; Oklahoma; Pennsylvania; South Carolina; Tennessee; Texas; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events.

Pay Transparency: The base pay for this role is: $35.00 - $45.94 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Responsibilities:

  • Complete medical necessity reviews and level of care reviews for requested services using clinical judgment and Oscar Clinical Guidelines, Milliman Care Guidelines
  • Obtain the information necessary (via telephone and fax) to assess a member's clinical condition, and apply the appropriate evidence-based guidelines
  • Meet required decision-making SLAs
  • Refer members for further care engagement when needed
  • Compliance with all applicable laws and regulations
  • Other duties as assigned

Requirements:

  • Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)
  • Associate Degree - Nursing or Graduate of Accredited School of Nursing Or Successful completion of Nursing Diploma Program in Accredited School of Nursing
  • Ability to obtain additional state licenses to meet business needs
  • 1+ year of utilization review experience in a managed care setting
  • Strong experience utilizating MCG (Milliman Care Gudielines)
  • 1+ years of clinical experience (including at least 1+ year clinical practice in an acute care setting, i.e., ER or hospital)
  • Weekend availability is required; all applicants must be able to work at least one weekend day (Saturday or Sunday) each week.

Bonus points:

  • BSN
  • Previous experience conducting concurrent or inpatient reviews for a managed care plan

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

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