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Home Utilization Management Nurse Jobs (NOW HIRING)

HealthONE

Utilization Management Nurse

Dalton, GA · On-site

Job Title Utilization Management Nurse Our mission is to enhance well-being by connecting individuals with vital health resources through a compassionate workforce that embodies the spirit of ...

INTUS INC

Contract Utilization Management Nurse

$42/hr

Role Overview The Contract Utilization Management Nurse plays a critical role in ensuring high-quality, cost-effective, and compliant care for PACE participants supported by IntusCare. This ...

UMR

Utilization Management Nurse | Square, |

$60K - $107K/yr

Utilization Management Nurse Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly ...

Oak St. Health

Utilization Management Nurse Consultant

$26.01 - $62.32/hr

Utilization Management Nurse Consultant Clinical Precertification RN (Medicare) Remote | Full-Time | Weekday Schedule Are you a Registered Nurse ready to make an impact beyond the bedside? Join our ...

Oak St. Health

Utilization Management Nurse Consultant

$26.01 - $56.14/hr

... N licensure in state of residence Utilization Management is a 24/7 operation and work schedules ... Work-from-Home colleagues are required to work within the state and city where they have confirmed ...

CVS Health

MI · On-site

$29.10 - $62.32/hr

Utilization Management is a 24/7 operation and work schedule may include weekends, holidays, and ... UM Nurse Consultant Fully Remote- WFH Schedule: Monday, Tuesday, Thursday, Friday and Saturday 8:00 ...

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Home Utilization Management Nurse information

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$39K

$89.5K

$163K

How much do home utilization management nurse jobs pay per year?

As of Sep 11, 2026, the average yearly pay for home 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.

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Utilization Management Nurse

Dalton, GA • On-site

HealthONE
Health Care and Social Assistance • 10K+ employees
Learn more about HealthONEexternal

Other

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 21 days ago

Job description

Job Title

Utilization Management Nurse

Job Description

Our mission is to enhance well-being by connecting individuals with vital health resources through a compassionate workforce that embodies the spirit of neighbors helping neighbors.

HealthOne is guided by a cultural framework that embodies our values and drives our decisions. Our purpose is to care for people by connecting them to resources that help protect them in health related situations. To fulfill our purpose, we align our priorities to ensure each decision we make is ethical, empathetic, economical, and efficient. We care for people by being welcoming, authentic, truthful, consistent and humble. We are continuously looking for ways to improve our process and how we get things done.

HealthOne seeks individuals with integrity and heart to embody our values. Whether you're starting your career or looking to develop additional skills to reach your full potential, HealthOne provides the means to help you achieve your goals.

Job Purpose

The Utilization Management Nurse performs comprehensive clinical reviews of requested services utilizing clinical criteria, received through various mechanisms.

Essential Job Duties

• Initiate referrals to ensure appropriate coordination of care.
• Seek the advice of the Medical Director when appropriate, according to policy.
• Assists non-clinical staff in performance of administrative reviews
• Performing comprehensive provider and member appeals, denial interpretation for letters, retrospective claim review, special review requests, and UM pre-certifications and appeals, utilizing medical appropriateness criteria, clinical judgement, and contractual eligibility.
• Regular and predictable attendance
• Consistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practice
• Works to encourage and promote Company culture throughout the organization
• Other duties as may be assigned

Qualifications

• 3 years Clinical experience preferred
• 1-2 years of Utilization Review preferred
• Proficient in Microsoft Office (Outlook, Word, Excel)
• Working knowledge of NCQA preferred
• Must be able to work in an independent and creative manner.
• Ability to manage multiple projects and priorities
• Adaptive to high pace and changing environment
• Customer service oriented
• Proficient in interpreting benefits, contract language and medical policy/medical review criteria
• Current, active Compact State license in Nursing (RN).

Physical Requirements

Prolonged periods of sitting at a desk and working on a computer. Moderate to significant amount of stress in meeting deadlines and dealing with day-to-day responsibilities. Must be able to drive a vehicle and daytime/overnight travel as required.

Benefits

401K (4% Match, Immediate Vesting)
Accident insurance
Competitive salary
Critical Illness Insurance
Dental Insurance
Employee Assistance Program
Flexible Spending Account
Health & Wellness Program
Health Savings Account
Life & AD&D Insurance
Long Term Disability
Medical Insurance
Paid Time Off
Pet Insurance
Short Term Disability
Vision Insurance

Pre-Employment Screening

Drug Screen and Background Check Required

HealthOne Statement

HealthOne is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, disability, sex, age, ethnic or national origin, marital status, sexual orientation, gender identity or presentation, pregnancy, genetics, veteran status, or any other status protected by state or federal law.

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