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Case Manager Utilization Review Nurse Jobs in Springfield, GA

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Hospice RN Nurse Case Manager

Bluffton, SC · On-site

The role of the Nurse Case Manager position is a critical part of the patient's care team. The ... Review medical records. * Complete consents with patients. * Enroll patients in Care Management, if ...

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Case Manager Utilization Review Nurse information

See Springfield, GA salary details

$15

$39

$66

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

As of Sep 6, 2026, the average hourly pay for case manager utilization review nurse in Springfield, GA is $39.27, according to ZipRecruiter salary data. Most workers in this role earn between $29.18 and $47.45 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 Springfield, GA?

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

What cities near Springfield, GA are hiring for Case Manager Utilization Review Nurse jobs?

Cities near Springfield, GA 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 Springfield, GA as of August 2026, with employment types broken down into 76% Full Time, 13% Part Time, and 11% Contract. Highlights an 89% In-person, and 11% Remote job distribution, with an average salary of $81,672 per year, or $39.3 per hour.

Clinical Case Manager / MDS

Resorts at Pooler

Pooler, GA • On-site

Full-time

Posted 3 days ago

New

Job description

Job Title: Clinical Case Manager – Utilization Review

Role Overview:
We are seeking a highly organized and detail-oriented Case Manager/MDS to manage the intersection of clinical care and financial reimbursement. This role is primarily focused on managing insurance authorizations, coordinating with the interdisciplinary care team, and ensuring that our billing office has the precise information needed for seamless revenue cycles.

Key Responsibilities

  • Insurance Authorization Management:

    • Work with admissions department to proactively obtain and track initial and ongoing authorizations for all insurance plan.

    • Monitor "next review dates" and submit timely clinical updates to payers to prevent denials.

    • Serve as the primary point of contact for insurance case managers.

  • Care Team Coordination:

    • Participate in weekly meetings with nursing, therapy, and social work to ensure plans of care align with insurance requirements.

    • Attain necessary clinical documentation from team to track progress and submit  to plans as required.

  • Billing & Financial Liaison:

    • Work closely with the Business Office Manager and billing department to verify coverage and resolve technical denials.

    • Maintain a systematic log of all authorizations, appeals, and clinical reviews to ensure the billing office has real-time data.

  • Administrative Oversight:

    • Manage a high volume of digital files, ensuring all physician orders and therapy notes are organized and accessible.

    • Maintain meticulous records of phone conversations and email correspondence with payers.

    • Track all necessary information on each case for timely and efficient billing.

Required Qualifications & Skills

  • Systematic Organization: You must have a proven ability to manage multiple deadlines and track complex data points without items falling through the cracks.

  • Technical Proficiency: Computer skills are essential, including experience with Electronic Medical Records (EMR) and Microsoft Excel/Google Sheets.

  • Professional Communication: Excellent phone etiquette and the ability to advocate firmly but professionally with insurance companies.

  • Clinical Knowledge: A background in long-term care, skilled nursing setting is required. A Nurse or a Social Worker (LSW) with heavy experience in utilization review and medical terminology is preferred.

Why You’ll Excel in This Role

You enjoy "putting the puzzle pieces together." You find satisfaction in keeping a clean, organized digital workspace and ensuring that the hard work of the clinical team is accurately reflected in the facility’s financial health as you advocate for your residents.