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Entry Level Utilization Management Nurse Jobs (NOW HIRING)

Humana

Utilization Management Nurse

As a Utilization Management (UM) Nurse, you will play a vital role in improving the health and well-being of Illinois Medicaid members by reviewing and authorizing Long-Term Services and Supports ...

Cottingham & Butler

Utilization Management Nurse

Utilization Management Nurse We are looking for a nurse just like you - a nurse that thrives in a fast-paced environment, enjoys making a difference for patients, and prefers working in a ...

Humana

Utilization Management Nurse

As a Utilization Management (UM) Nurse, you will play a vital role in improving the health and well-being of Illinois Medicaid members by reviewing and authorizing Long-Term Services and Supports ...

Medical University of South Carolina

... Nurse required. Prior leadership experience preferred. One year of case management and/or utilization management work experience preferred. Staff hired prior to July 1, 2013 will be grandfathered in ...

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Entry Level Utilization Management Nurse information

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$39K

$89.5K

$163K

How much do entry level utilization management nurse jobs pay per year?

As of Aug 21, 2026, the average yearly pay for entry level utilization management nurse in the United States is $89,483.00, according to ZipRecruiter salary data. Most workers in this role earn between $64,500.00 and $104,500.00 per year, depending on experience, location, and employer.

What is an entry level utilization management nurse?

An Entry Level Utilization Management Nurse is a registered nurse who works within healthcare organizations or insurance companies to review medical cases and ensure that patients receive appropriate, cost-effective care. They assess treatment plans, evaluate the necessity of medical procedures, and help coordinate services to avoid unnecessary hospitalizations. These nurses use clinical guidelines and their medical knowledge to make recommendations, often working closely with physicians, healthcare providers, and insurance representatives. The position is typically suited for nurses who are early in their careers and interested in the intersection of clinical practice and healthcare administration.

What are the key skills and qualifications needed to thrive as an entry level utilization management nurse?

To thrive as an Entry Level Utilization Management Nurse, you need an active RN license, a solid understanding of clinical guidelines, and a basic knowledge of healthcare regulations such as Medicare and Medicaid. Familiarity with utilization review software, electronic health records (EHRs), and clinical documentation systems is typically required. Strong analytical thinking, attention to detail, effective communication, and the ability to collaborate with healthcare teams are essential soft skills in this role. These skills and qualifications ensure accurate patient care reviews, compliance with regulations, and the delivery of cost-effective, quality healthcare.

What are some common challenges faced by entry level utilization management nurses during their first year on the job?

Entry Level Utilization Management Nurses often encounter challenges such as adapting to the fast-paced decision-making required in assessing medical necessity, interpreting insurance policies, and learning to communicate effectively with both providers and insurance representatives. Navigating complex healthcare regulations and documentation requirements can also be overwhelming at first. However, most organizations provide thorough onboarding, mentorship, and ongoing training to help new nurses build confidence and proficiency in these areas.

What is the difference between Entry Level Utilization Management Nurse vs Utilization Review Nurse?

AspectEntry Level Utilization Management NurseUtilization Review Nurse
CertificationsRN license, possibly some utilization management trainingRN license, often additional certifications like CCM or URAC
Work EnvironmentHospitals, insurance companies, healthcare organizationsInsurance companies, healthcare facilities, third-party review organizations
Job FocusAssessing patient needs for appropriate care, initial reviewReviewing medical necessity, approving or denying services

While both roles involve reviewing healthcare services, the Entry Level Utilization Management Nurse typically focuses on initial assessments and coordinating patient care, whereas the Utilization Review Nurse often concentrates on detailed reviews for approval or denial of services, often requiring additional certifications.

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Entry Level Utilization Management Nurse jobs near you

Utilization Management Nurse

HealthCheck360

Dubuque, IA • On-site

Full-time

Re-posted 6 days ago

Job description

Utilization Management Nurse

Location: Onsite in Dubuque, IA. Also accepting remote applicants.

We are looking for a nurse just like you - a nurse that thrives in a fast-paced environment, enjoys making a difference for patients, and prefers working in a professional office setting with daytime office hours and weekends/holidays off.

This position is responsible for working telephonically with providers to evaluate and pre-certify requests such as hospital stays, outpatient surgeries, outpatient tests, care, etc. Review requests and match up to an evidence-based guideline to ensure proper care and ensure the right service is happening at the right time and is medically necessary. In this position you will be handling multiple provider phone calls at any given time and need to be able to handle a very fast paced environment. You will also work closely with participants for referrals to case management and condition management services according to referral criteria and health plan guidelines.

Qualified candidates will have strong multitasking skills, RN and clinical experience, preferably in ER, ICU, mental health, orthopedics, and/or pain management. Bilingual is also preferred.

Full-Time Benefits - Most benefits start day 1

  • Medical, Dental, Vision Insurance
  • Flex Spending or HSA
  • 401(k) with company match
  • Profit-Sharing/Defined Contribution (1-year waiting period)
  • PTO/Paid Holidays
  • Company-paid ST and LT Disability
  • Maternity Leave/Parental Leave
  • Subsidized Parking
  • Company-paid Term Life/Accidental Death Insurance