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Case Manager Utilization Review Nurse Jobs in Decatur, IL

RN - New Graduate

Lincoln, IL · On-site

$30.23 - $48.37/hr

The New Graduate Registered Nurse will receive support from their Nurse Manager, Preceptor, Mentor ... To review Memorial's Benefits click here: Benefits - Memorial HR Qualifications Licensure ...

The New Graduate Registered Nurse will receive support from their Nurse Manager, Preceptor, Mentor ... To review Memorial's Benefits click here: Benefits - Memorial HR Licensure/Certification/Registry:

RN - New Graduate

Lincoln, IL · On-site

$30.23 - $48.37/hr

The New Graduate Registered Nurse will receive support from their Nurse Manager, Preceptor, Mentor ... To review Memorial's Benefits click here: Benefits - Memorial HR Qualifications Licensure ...

Training Specialist

Decatur, IL · On-site

$20.05/hr

... utilization of the kitchen. * Documents data/information pertaining to each person's IVP/IPP in ... case manager for inclusion in monthly reviews and IPP according to established time frames. NON ...

Training Specialist

Decatur, IL · On-site

$20.05/hr

... utilization of the kitchen. * Documents data/information pertaining to each person's IVP/IPP in ... case manager for inclusion in monthly reviews and IPP according to established time frames. NON ...

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Case Manager Utilization Review Nurse information

See Decatur, IL salary details

$18

$46

$77

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

As of Jul 13, 2026, the average hourly pay for case manager utilization review nurse in Decatur, IL is $46.11, according to ZipRecruiter salary data. Most workers in this role earn between $34.28 and $55.72 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 do Case Manager Utilization Review Nurses 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 are popular job titles related to Case Manager Utilization Review Nurse jobs in Decatur, IL? For Case Manager Utilization Review Nurse jobs in Decatur, IL, the most frequently searched job titles are:
What job categories do people searching Case Manager Utilization Review Nurse jobs in Decatur, IL look for? The top searched job categories for Case Manager Utilization Review Nurse jobs in Decatur, IL are:
What cities near Decatur, IL are hiring for Case Manager Utilization Review Nurse jobs? Cities near Decatur, IL with the most Case Manager Utilization Review Nurse job openings:
Case Manager, Registered Nurse - Field- Sangamon, Macon, Logan and surrounding counties

Case Manager, Registered Nurse - Field- Sangamon, Macon, Logan and surrounding counties

CVS Health

Lincoln, IL • On-site

$66K - $142K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 12 days ago


CVS Health rating

5.8

Company rating: 5.8 out of 10

Based on 4,278 frontline employees who took The Breakroom Quiz

80th of 104 rated pharmacies


Job description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Program Overview:

Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country.

Position Summary
The Case Management Coordinator utilizes critical thinking and judgment to collaborate and inform the case management process. The Case Management Coordinator facilitates appropriate healthcare outcomes for members by providing assistance with appointment scheduling, identifying and assisting with accessing benefits and education for members through the use of care management tools and resources

Remote Work Expectations

  • This is a remote/field role; candidates must have a dedicated workspace free of interruptions

  • Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.


Required Qualifications

• Must reside in the state of Illinois

•Must possess reliable transportation and be willing and able to travel up to 75% of the time from home location in and around Sangamon, Macon and Logan Counties, IL. Mileage is reimbursed per our company expense reimbursement policy
• Minimum 3-5 years clinical practical experience
• Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually
• Excellent analytical and problem-solving skills
• Effective communications, organizational, and interpersonal skills.
• Ability to work independently
• Effective computer skills including navigating multiple systems and keyboarding
• Demonstrates proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint, as well as some special proprietary applications

Preferred Qualifications

• 2-3 years Care Management, discharge planning and/or home health care coordination experience

• Certified Case Manager
•Bilingual


Education

Associate's degree required, along with active and unencumbered Registered Nurse license in the state of Illinois

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$66,575.00 - $142,576.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.


Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 07/17/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.


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