ZipRecruiter

Log In

1

Case Manager Utilization Review Nurse Jobs in Rochester, MN

next page

Showing results 1-20

All JobsCase Utilization Review Nurse JobsCase Manager Utilization Review Nurse JobsCase Manager Utilization Review Nurse Jobs in Rochester, MN

Case Manager Utilization Review Nurse information

See Rochester, MN salary details

$19

$48

$81

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

As of Aug 25, 2026, the average hourly pay for case manager utilization review nurse in Rochester, MN is $48.32, according to ZipRecruiter salary data. Most workers in this role earn between $35.91 and $58.41 per hour, depending on experience, location, and employer.

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.

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 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 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.

What are popular job titles related to Case Manager Utilization Review Nurse jobs in Rochester, MN?

For Case Manager Utilization Review Nurse jobs in Rochester, MN, the most frequently searched job titles are:

What job categories do people searching Case Manager Utilization Review Nurse jobs in Rochester, MN look for?

The top searched job categories for Case Manager Utilization Review Nurse jobs in Rochester, MN are:

What cities near Rochester, MN are hiring for Case Manager Utilization Review Nurse jobs?

Cities near Rochester, MN with the most Case Manager Utilization Review Nurse job openings:

Case Manager Utilization Review Nurse jobs near you
Infographic showing various Case Manager Utilization Review Nurse job openings in Rochester, MN as of July 2026, with employment types broken down into 82% Full Time, 17% Part Time, and 1% Contract. Highlights an 82% Physical, 2% Hybrid, and 16% Remote job distribution, with an average salary of $100,499 per year, or $48.3 per hour.

Clinical Appeals Specialist II-Hybrid

Rochester, MN • On-site

Mayo Clinic
Hospitals • 10K+ employees

7.8

Company rating: 7.8 out of 10

Based on 699 frontline employees who took The Breakroom Quiz

128th of 893 rated healthcare providers

People enjoy working here

Good employer

Recommended by students

Learn more about Mayo Clinicexternal

Full-time

Medical, Dental, Vision, Retirement

Posted 26 days ago

Job description


This is a hybrid position and must be located within 100 miles of any of the Mayo Clinic campuses for on-site expectations based on business needs.
Primary duties may include, but are not limited to, responsibility for reviewing assigned clinically related denials, payer audits, and payer correspondence as well as preparation of relevant appeal submission or audit responses. Utilizes clinical expertise and critical thinking in the evaluation of medical records against appropriate criteria and contract requirements and utilizes appropriate communication style to appeal or defend medically denied claims. Is a liaison and resource to revenue cycle, case management and practice stakeholders in defending clinically denied claims and providing relevant feedback to key stakeholders on denial prevention opportunities.
Qualifications
Minimum Education: Associates Degree
Minimum Experience: 3 years of relevant nursing experience
Current active unrestricted RN license.
The preferred applicant will have the following experience: Advanced knowledge of ICD-10-CM/PCS coding conventions, DRG reimbursement methodology, and clinical validation principles, with demonstrated ability to interpret Coding Clinic guidance and Medicare IPPS regulations to support accurate DRG assignment and defend coding-related denials.
Healthcare Financial Management Association (HFMA) Certification Preferred.
CCDS or CDIP Certification Preferred.
Experience in utilization review, case management, denials and appeals, revenue cycle, or prior authorization preferred. Knowledge and use of discharge planning, case management, utilization review, and levels of care criteria. Familiarity with Medicaid and Medicare claims denials and appeals processing and regulatory requirements. Knowledge and use of payer medical policy and Medicare LCD/NCD criteria. Knowledge of billing and coding requirements. Experience utilizing Milliman Care Guidelines and InterQual Criteria. Knowledge of current NCQA/URAC standards. Knowledge and experience applying 2-Midnight Rule Criteria. Knowledge and experience in Epic. Must have the ability to effectively utilize Microsoft Office Suite and possess basic data entry skills. Must possess excellent verbal, written and interpersonal communication skills, and able to balance multiple demands and respond to time constraints. Must have high-level skills in organization as well as problem solving and analytical skills.
**This vacancy is not eligible for sponsorship / we will not sponsor or transfer visas for this position.
About Us
Why Mayo Clinic
Mayo Clinic is top-ranked in more specialties than any other care provider according to U.S. News & World Report. As we work together to put the needs of the patient first, we are also dedicated to our employees, investing in competitive compensation and comprehensive benefit plans - to take care of you and your family, now and in the future. And with continuing education and advancement opportunities at every turn, you can build a long, successful career with Mayo Clinic.
Benefits Highlights
  • Medical: Multiple plan options.
  • Dental: Delta Dental or reimbursement account for flexible coverage.
  • Vision: Affordable plan with national network.
  • Pre-Tax Savings: HSA and FSAs for eligible expenses.
  • Retirement: Competitive retirement package to secure your future.

About the Team
Just as our reputation has spread beyond our Minnesota roots, so have our locations. Today, our employees are located at our three major campuses in Phoenix/Scottsdale, Arizona, Jacksonville, Florida, Rochester, Minnesota, and at Mayo Clinic Health System campuses throughout Midwestern communities, and at our international locations. Each Mayo Clinic location is a special place where our employees thrive in both their work and personal lives. Learn more about what each unique Mayo Clinic campus has to offer, and where your best fit is.
Equal Opportunity
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, protected veteran status or disability status. Learn more about the "EOE is the Law". Mayo Clinic participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization.
Mayo Clinic logo

About Mayo Clinic

Sourced by ZipRecruiter

Mayo Clinic is the largest integrated, not-for-profit medical group practice in the world. We're building the future, one where the best possible care is available to everyone — and more people can heal at home. Our relentless research turns into earlier diagnoses and new cures. That's how we inspire hope in those who need it most. At Mayo Clinic, experts work together to solve the most challenging unmet needs of patients. Our history of innovation dates back almost 150 years, when brothers Will and Charlie Mayo pioneered an integrated, team-based approach to medicine. Today, that trailblazing spirit drives innovations like Mayo Clinic Platform — which powers new technologies to change how care is delivered to all.

Industry

Hospitals

Company size

10,000+ Employees

Headquarters location

Rochester, MN, US

Year founded

1919

View All Mayo Clinic Jobs

What Mayo Clinic employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply