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No Experience Utilization Management Nurse Jobs (NOW HIRING)

Humana

Utilization Management Nurse

Licensed Registered Nurse (RN) in the state of Ohio with no disciplinary action. * At least 3 years ... Previous experience in utilization management. * Prior clinical experience preferably in an acute ...

Humana

Utilization Management Nurse

Licensed Registered Nurse (RN) in the state of Ohio with no disciplinary action. * At least 3 years ... Previous experience in utilization management. * Prior clinical experience preferably in an acute ...

Access Dubuque

Utilization Management Nurse

Dubuque, IA · On-site

Utilization Management Nurse Cottingham & Butler/ SISCO 1 Positions ID: 4627707008 Posted On 07/01 ... Qualified candidates will have strong multitasking skills, RN and clinical experience, preferably ...

Solis Health Plans

Utilization Management Nurse

Miami, FL · On-site

$60K - $70K/yr

Solis was born out of a desire to provide a more personal experience throughout all levels of the ... Under the supervision of the Health Services Director, the Utilization Management Nurse (LPN or RN) ...

HealthCheck360

Utilization Management Nurse

Dubuque, IA · On-site

Utilization Management Nurse Location : Onsite in Dubuque, IA. Also accepting remote applicants. We ... Qualified candidates will have strong multitasking skills, RN and clinical experience, preferably ...

HealthCheck360

Utilization Management Nurse

Dubuque, IA · On-site

Utilization Management Nurse Location : Onsite in Dubuque, IA. Also accepting remote applicants. We ... Qualified candidates will have strong multitasking skills, RN and clinical experience, preferably ...

HealthCheck360

Utilization Management Nurse

Dubuque, IA · On-site

Utilization Management Nurse Location : Onsite in Dubuque, IA. Also accepting remote applicants. We ... Qualified candidates will have strong multitasking skills, RN and clinical experience, preferably ...

Humana

Utilization Management Nurse

Licensed Registered Nurse (RN) in Illinois with no disciplinary action. * 1+ years of experience in utilization management/LTSS service authorization. * 2+ years of clinical experience, preferably in ...

Humana

Utilization Management Nurse

Licensed Registered Nurse (RN) in Illinois with no disciplinary action. * 1+ years of experience in utilization management/LTSS service authorization. * 2+ years of clinical experience, preferably in ...

Oak St. Health

Utilization Management Nurse Consultant

$32.01 - $68.55/hr

Registered Nurse (RN) - Utilization Management Are you an experienced RN looking to leverage your clinical expertise in a non-bedside role? Join our Utilization Management team and help ensure ...

Medical University of South Carolina

... Nurse required ... Prior leadership experience preferred. One year of case management and/or utilization management ...

CVS Health

Utilization Management Nurse Consultant

$29.10 - $62.32/hr

Managed Care experience, particularly Utilization Management * Reside in the Eastern Time Zone ... N who thrives in a fast-paced environment and enjoys combining clinical expertise with care ...

CVS Health

Utilization Management Nurse Consultant

$32.01 - $68.55/hr

Utilizes clinical experience and skills in a collaborative process to assess, plan, implement ... N licensure in state of residence - Utilization Management is a 24/7 operation and work schedules ...

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How much do no experience utilization management nurse jobs pay per year?

As of Aug 24, 2026, the average yearly pay for no experience 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 a no experience utilization management nurse?

A No Experience Utilization Management Nurse job is an entry-level role for registered nurses (RNs) transitioning into utilization management without prior experience in the field. These nurses review medical records, evaluate the necessity of treatments, and coordinate care to ensure patients receive appropriate services while managing healthcare costs. They typically work for insurance companies, hospitals, or healthcare organizations, often in remote or office-based settings. Training and mentorship are usually provided to help new nurses develop the required skills for the role.

What are the key skills and qualifications needed to thrive as a no experience utilization management nurse?

To thrive as a No Experience Utilization Management Nurse, you generally need a current RN license, a strong understanding of clinical nursing concepts, and a willingness to learn about healthcare review processes. Familiarity with electronic health records (EHRs), utilization management software, and standard coding systems like ICD-10 is advantageous, though training is often provided for entry-level candidates. Attention to detail, critical thinking, strong organizational skills, and clear communication are important soft skills in this field. These qualifications ensure you can accurately review patient cases, coordinate effectively with healthcare teams, and make appropriate coverage determinations based on clinical criteria.

What types of training and support can I expect as a no experience utilization management nurse?

As a No Experience Utilization Management Nurse, you'll typically receive comprehensive onboarding and training focused on utilization review protocols, clinical documentation requirements, and the use of review software tools. Many employers pair new nurses with mentors or experienced team members to guide you through the early learning curve and help you get comfortable with non-bedside aspects of nursing. Regular team meetings and ongoing education opportunities are common, allowing you to build expertise in reviewing medical necessity, insurance guidelines, and collaboration with physicians and case managers. This supportive environment is designed to help you confidently transition into the field and grow your skills in utilization management nursing.

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No Experience Utilization Management Nurse jobs near you
Infographic showing various No Experience Utilization Management Nurse job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 76% Full Time, 19% Part Time, and 4% Contract. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $89,483 per year, or $43 per hour.

Utilization Management Nurse

Nashville, TN • On-site

ArchWell Health
Outpatient Health Care • 11 - 50 employees

8.0

Company rating: 8.0 out of 10

Based on 20 frontline employees who took The Breakroom Quiz

3rd of 243 rated social care providers

Great coworkers

People enjoy working here

Good employer

Learn more about ArchWell Healthexternal

Other

Re-posted 14 days ago

Job description

Utilization Management Nurse

Reporting to the Director of Utilization Management, the Utilization Management Nurse is responsible for ensuring that patients receive appropriate, cost-effective care by reviewing and evaluating medical services, treatments, and procedures. This role identifies trends for opportunities to educate and collaborate with healthcare providers, patients, and specialists to optimize resource utilization and improve patient outcomes.

Duties/Responsibilities
  • Conducts prospective, concurrent, and retrospective utilization reviews for medical necessity to ensure treatment and services are appropriate and necessary by reviewing medical records and treatment plans.
  • Works collaboratively with healthcare providers and Medical Directors to provide guidance on approvals or requests for health plan determination reviews as applicable utilizing CMS clinical guidelines and insurance policies.
  • Maintains accurate and detailed records of reviews, interventions, and communications to ensure adherence to health plan requirements and organizational policies.
  • Analyze utilization trends to ensure progress towards organizational goals
  • Educates healthcare providers and patients regarding appropriate levels of care and service criteria and guidelines.
  • Collaborates with Network and specialists to identify opportunities to educate on value-based care, resolve specialty gaps by markets, improve cost-effectiveness and coordination of care to meet patient needs.
Required Skills/Abilities
  • Strong knowledge of utilization management functions in value-based care, including data analysis, claims review, reimbursement practices, and medical records reviews.
  • Thorough, in-depth knowledge of evidence-based practice, legal rules and regulations and best practices in healthcare
  • Ability to effectively leverage business and organizational knowledge within and across functional areas
  • Must possess a high degree of emotional intelligence and integrity, driven and focused work ethic
  • Continuous desire to learn and embrace new methods; ability to adapt and be resilient.
  • Self-starter with the ability to think creatively and work effectively
  • Ability to build a relationship and work effectively with various seniorities and diverse populations.
  • Excellent critical reasoning, decision-making, and problem-solving skills to make informed decisions and ensure effective resource utilization while maintaining quality patient care.
  • Willingness and ability to travel, up to 20%
Education and Experience
  • AA/AS degree in Nursing required; BA/BS degree in Nursing (BSN) or Healthcare Administration preferred
  • A valid, active Registered Nurse (RN) license in state(s) of employment required
  • A minimum of 3 years', current direct utilization management required
  • Work in an acute care facility, community-based clinic, public health department or specialization with the senior population preferred
  • Proficient PC skills
  • Fluency in Spanish or other languages spoken by people in the communities we serve is desirable, but not required

ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.

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About ArchWell Health

Sourced by ZipRecruiter

At ArchWell Health, we help our members lead healthier lives through superior senior primary care and stronger patient-to-doctor relationships. You’ll find plenty of reasons to love being an ArchWell Health member. You’ll also discover that they add up to something huge—a healthier and happier you.

Industry

Outpatient health care

Company size

11 - 50 Employees

Headquarters location

Nashville, TN, US

Year founded

2020

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