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Optum Utilization Review Nurse Jobs in Decatur, GA

Oscar Health

Sr. Quality of Care Review Nurse

Atlanta, GA · Remote

$83K - $109K/yr

We're hiring a Sr. Quality of Care Review Nurse to join our Quality team. Oscar is the first health ... Health plan utilization management experience or case management experience. * Experience in health ...

Pharmacy Careers

Remote Clinical Review Pharmacist

Atlanta, GA · On-site

$114K - $136K/yr

Remote Clinical Review Pharmacist - Work From Home | Evidence-Based Decisions | Flexible Schedule ... Collaborate with physicians, nurses, and utilization-management teams on complex cases. * Document ...

New

Bestica Healthcare

RN Case Manager

Atlanta, GA · On-site

Acute Hospital * Long Term Acute Care/Rehab/Skilled Nursing Case Management/Utilization Review: * Admission Criteria * Care coordination * Discharge Planning * Utilize InterQual Criteria * Utilize ...

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Optum Utilization Review Nurse information

See Decatur, GA salary details

$20

$41

$67

How much do optum utilization review nurse jobs pay per hour?

As of Aug 10, 2026, the average hourly pay for optum utilization review nurse in Decatur, GA is $41.28, according to ZipRecruiter salary data. Most workers in this role earn between $32.64 and $47.40 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as an Optum Utilization Review Nurse?

To thrive as an Optum Utilization Review Nurse, you need strong clinical assessment skills, a current RN license, and experience in case management or utilization review. Familiarity with clinical documentation systems, InterQual or Milliman Care Guidelines, and managed care regulations is typically required. Attention to detail, critical thinking, and effective communication are crucial soft skills for this role. These competencies are vital to ensure appropriate care decisions, regulatory compliance, and collaboration with interdisciplinary teams for optimal patient outcomes.

What is the difference between Optum Utilization Review Nurse vs Optum Case Manager?

AspectOptum Utilization Review NurseOptum Case Manager
CredentialsRN license, certifications in case management or utilization review often preferredRN license, case management certification often preferred
Work EnvironmentReviewing medical records, assessing insurance claims, working in healthcare or insurance settingsCoordinating patient care, managing cases, working in healthcare or insurance settings
Employer & IndustryHealth insurance companies, healthcare providers, utilization review departmentsHealth insurance companies, healthcare organizations, patient advocacy

Optum Utilization Review Nurses primarily evaluate medical necessity and approve or deny insurance claims, focusing on utilization review. In contrast, Optum Case Managers coordinate patient care, develop treatment plans, and support patient needs. Both roles require nursing credentials and work within healthcare or insurance environments, but their core responsibilities differ in focus and scope.

How does an Optum Utilization Review Nurse typically collaborate with physicians and other healthcare professionals during the review process?

As an Optum Utilization Review Nurse, you will frequently interact with physicians, case managers, and other healthcare providers to assess the medical necessity and appropriateness of patient care. This collaboration often involves reviewing clinical documentation, participating in multidisciplinary meetings, and communicating findings or recommendations to ensure quality and cost-effective care. Building strong professional relationships and maintaining clear, respectful communication are key to facilitating smooth care transitions and achieving optimal patient outcomes. This collaborative approach helps ensure that all parties are aligned with evidence-based guidelines and organizational policies.

What does an Optum Utilization Review Nurse do?

An Optum Utilization Review Nurse is responsible for reviewing medical records and patient cases to ensure that healthcare services provided are medically necessary and compliant with insurance guidelines. They evaluate treatment plans, collaborate with healthcare providers, and help determine coverage decisions for patients. By assessing the appropriateness of care, they help manage healthcare costs and improve patient outcomes. Their work involves communication with physicians, patients, and insurance representatives to ensure efficient and effective care delivery.
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What cities near Decatur, GA are hiring for Optum Utilization Review Nurse jobs? Cities near Decatur, GA with the most Optum Utilization Review Nurse job openings:
Optum Utilization Review Nurse jobs near you

Travel Nurse RN - Case Manager, Utilization Review

AMN Healthcare Revenue Cycle

Atlanta, GA • On-site

$1.8K - $2.7K/wk

Contractor

Medical, Dental, Vision, Life, Retirement

This job post has expired today. Applications are no longer accepted.

Job description

AMN Healthcare Revenue Cycle is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Atlanta, Georgia.

Job Description & Requirements
  • Specialty: Utilization Review
  • Discipline: RN
  • Start Date: ASAP
  • Duration: 13 weeks
  • 36 hours per week
  • Shift: 12 hours
  • Employment Type: Travel

Job Description & Requirements
RN Case Manager
StartDate: 8/10/2026 Pay Rate: $1800.00 - $2700.00
POSITION SUMMARY RN Case Manager Unit: Population Management -Diabetes
POSITION DUTIES 

    • Responsibilities include, but are not limited to, comprehensive patient assessment, symptom management, data analysis, care planning, case management, implementation of interventions, and evaluation of outcomes for patients with past, current, or suspected chronic diagnoses.
    • Chronic Conditions management, focused on outreach and management of the disease state (renal, respiratory as example), disease management specifically in diabetes, respiratory, or renal care.
    • Develop and facilitate individualized plans of care in collaboration with treating physicians, patients, their support networks, and family members. Coordinate and modify plans of care as needed to ensure seamless, patient-centered care across inpatient, outpatient, home, and other supportive care settings.
    • Perform clinical assessments and triage of new and established patients (including patients enrolled in clinical research studies) by telephone, in clinic, or in collaboration with the interdisciplinary healthcare team. Coordinate appointments for specialty consults, procedures, diagnostic testing, and support services within established service lines.
    • Deliver ongoing patient and caregiver education related to diagnoses, treatment plans, medications, symptom management, self-injection techniques, specialty-specific devices, and disease self-management. Monitor treatment response, identify side effects or dose-limiting toxicities, communicate findings to treating providers, and implement timely interventions.
    • Maintain collaborative relationships with physicians, primary care providers, specialty services, diagnostics, laboratory, radiology, inpatient teams, and other key stakeholders to ensure coordinated care, continuity of services, and optimal patient outcomes.
    • Support clinical quality and professional practice by identifying quality indicators, conducting systematic reviews, maintaining specialty-specific databases, reviewing policies, implementing evidence-based practice improvements, and ensuring compliance with clinical standards, protocols, and quality requirements. 
  • Float department (if needed): Supporting different specialties- renal, respiratory, and diabetes—all in the same location

MINIMUM REQUIRED QUALIFICATIONS GA or Compact RN License in hand
PREFERRED QUALIFICATIONS Kaiser Exp (not req)
LENGTH OF ASSIGNMENT 13 weeks 
SHIFT / HOURS PER WEEK 8:00am - 5:00pm (NO WEEKENDS)
SYSTEMS EPIC
START DATE 08/10/26
Facility Location
With its alluring charm and energetic buzz, Atlanta beckons newcomers from near and far. Part Southern belle, part economic powerhouse, the capital of Georgia is a favorite destination for travel nurses in search of career-boosting assignments, while the city’s numerous entertainment options and warm Southern hospitality make it a great place to call home.
Job Benefits
Becoming an AMN Healthcare professional gives you the incredible opportunity to gain critical career experience, work with new people, and earn a highly competitive salary—but the perks don't stop there. There are many additional benefits to enjoy, including:
  • Medical, dental and vision benefits
  • Earned time off and paid holidays
  • Paid continuing education time
  • 401(K) retirement planning
  • Short-term disability, life insurance, paid jury duty
  • Access to the largest network of facilities and providers in the country
  • Industry experienced workforce management team
  • Licensure and certification reimbursement

About the Company
At AMN Healthcare, we strive to be recognized as the most trusted, innovative, and influential force in helping healthcare organizations provide quality patient care that continually evolves to make healthcare more human, more effective, and more achievable.

AMN Healthcare Revenue Cycle Job ID #3546849. Pay package is based on 12 hour shifts and 36 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: RN Case Manager

About AMN Healthcare Revenue Cycle

AMN Healthcare is a leading force in the healthcare industry, committed to being the most trusted, innovative, and influential partner for healthcare organizations. With a focus on providing quality patient care, AMN Healthcare offers holistic solutions that reduce costs, streamline processes, and improve efficiencies. The company boasts over 30 years of experience and takes pride in staffing leading healthcare facilities with the nation's best travelers. As an industry leader, AMN Healthcare offers a diverse team dedicated to supporting healthcare workers and facilities, ensuring a personalized and supportive experience for both clients and candidates.

Benefits
  • Medical benefits
  • Dental benefits
  • Company provided housing options
  • Continuing Education

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