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Part Time Utilization Management Nurse Jobs (NOW HIRING)

Genesis HealthCare

Utilization Management Overview of Position: Acts as part of a multidisciplinary team including ... Works with admitting department, bed coordinator and nursing campus supervisor to facilitate proper ...

FROEDTERT HEALTH

RN DENIALS MANAGEMENT HOURLY

Milwaukee, WI · On-site

$36.38 - $56.39/hr

Prior utilization management, insurance background, and denial management experience is preferred. EDUCATION DESCRIPTION: Bachelor's degree is required. Professional knowledge of nursing theory and ...

Froedtert

RN DENIALS MANAGEMENT HOURLY

Milwaukee, WI · On-site

$36.38 - $56.39/hr

Prior utilization management, insurance background, and denial management experience is preferred. EDUCATION DESCRIPTION: Bachelor's degree is required. Professional knowledge of nursing theory and ...

CommonSpirit Health

Your ability to manage charts, apply criteria precisely, and communicate effectively with ... Employment Type: Part Time

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How much do part time utilization management nurse jobs pay per year?

As of Jun 9, 2026, the average yearly pay for part time 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 are the key skills and qualifications needed to thrive in the Part Time Utilization Management Nurse position, and why are they important?

A Part Time Utilization Management Nurse needs an active RN license, strong clinical assessment abilities, and a solid understanding of medical necessity criteria. Familiarity with utilization review software, medical coding, and knowledge of insurance guidelines or programs such as InterQual or Milliman is often required. Excellent critical thinking, attention to detail, and professional communication skills help nurses collaborate effectively with providers and payers. These competencies ensure appropriate care delivery, resource management, and compliance with healthcare regulations in a dynamic environment.

What is a Part Time Utilization Management Nurse job?

A Part Time Utilization Management Nurse evaluates the medical necessity, efficiency, and appropriateness of healthcare services for patients. They review patient records, collaborate with healthcare providers, and ensure treatments align with clinical guidelines and insurance policies. Working part-time, they may focus on prior authorizations, case reviews, or appeals. This role helps optimize resource use while ensuring quality patient care and compliance with regulations.

What are the typical responsibilities of a Part Time Utilization Management Nurse on a weekly basis?

As a Part Time Utilization Management Nurse, you are responsible for reviewing patient records, assessing medical necessity, and determining the appropriateness of hospital admissions or continued stays according to established guidelines. You’ll routinely interact with physicians, case managers, and insurance representatives to advocate for patients and ensure cost-effective care. Your weekly duties may involve detailed documentation, participation in interdisciplinary meetings, and responding to authorization requests in a timely manner. By balancing clinical judgment with regulatory requirements, you play a key role in optimizing patient outcomes while managing healthcare resources efficiently.

More about Part Time Utilization Management Nurse jobs
What cities are hiring for Part Time Utilization Management Nurse jobs? Cities with the most Part Time Utilization Management Nurse job openings:
What are the most commonly searched types of Utilization Management Nurse jobs? The most popular types of Utilization Management Nurse jobs are:
What states have the most Part Time Utilization Management Nurse jobs? States with the most job openings for Part Time Utilization Management Nurse jobs include:
What job categories do people searching Part Time Utilization Management Nurse jobs look for? The top searched job categories for Part Time Utilization Management Nurse jobs are:
Part Time Utilization Management Nurse jobs near you
Infographic showing various Part Time Utilization Management Nurse job openings in the United States as of May 2026, with employment types broken down into 100% Part Time. Highlights an 94% In-person, and 6% Remote job distribution, with an average salary of $89,483 per year, or $43 per hour.
Behavioral Health UM Care Manager (RN) - Part Time

Behavioral Health UM Care Manager (RN) - Part Time

UPMC - Pittsburgh Medical Center

Pittsburgh, PA • Remote

Part-time

Posted 12 days ago

Job description

UPMC Health Plan is hiring a part-time UM Care Manager to join the UM Clinical Operations team. This role will work remotely, with scheduled hours falling between 8:00 AM and 4:30 PM EST, Monday through Friday.

The Utilization Management (UM) Care Manager is responsible for utilization review of health plan services and assessment of member's barriers to care, as well as actively working with providers and assessing members to ensure a safe and coordinated discharge from an inpatient setting. Interacts daily with facility clinicians, physicians, and UPMC Health Plan care managers and Medical Directors as part of the member treatment team. Facilitates transitions in care for skilled nursing, rehabilitation, long term acute care, as needed. Coordinates with Health Plan case managers or health management staff members to follow-up after discharge from an inpatient setting. Provides guidance and assistance to providers and members to ensure that health care needs are met through the delivery of covered services in the most appropriate setting and cost - effective manner.
Responsibilities:
 

  • Review and document clinical information from health care providers including clinical history, home environment, support system, available caregiver, cognitive and psychological status. Conduct clinical reviews for authorization requests using established criteria including Interqual, Mahalik, and health plan policy and procedures for inpatient, outpatient, Durable Medical Equipment (DME), Behavioral Health, and Private Duty Nursing.
  • Work closely with peers and other departments to determine discharge needs including necessary referrals to health plan care management for short or long term interventions.
  • Obtain documentation to support requested level of care within the defined health plan regulatory timeframes and provide verbal and/or written notification to providers as applicable. Consult with health plan medical director to discuss medical necessity for requested service.
  • Maintain communication with health care providers regarding health plan determinations.
  • Participate in health plan interdisciplinary team conferences and collaborative case reviews to discuss complex cases and determine appropriate discharge plan or level of service. Consult with health plan medical director on an as needed basis to discuss medical necessity for requested service.
  • Identify potential quality of care concerns and never events and refers to health plan quality management department.
  • Document all activities in the Health Plan's care management tracking system following Health Plan and internal department standards and identify trends and opportunities for improvement based on information obtained from interaction with members and providers.
  • Minimum of 2 years of experience in a clinical and/or case management nursing required. 
  • BSN or MSN strongly preferred. 
  • Prior UM experience strongly preferred
  • Prior psych experience strongly preferred. 
  • PA RN license strongly preferred. 
  • Work experience of 1 year discharge planning preferred. 
  • BSN preferred. 
  • Strong organizational, task prioritization and problem-solving skills. 
  • Ability to construct grammatically correct reviews using standard medical terminology. 
  • Computer proficiency required.
    Licensure, Certifications, and Clearances:
     
  • Case management certification or approved clinical certification preferred
  • Registered Nurse (RN)
  • Act 34

*Current licensure either in the state where the facility is located or, if the facility is in a state covered by the multistate Nursing Licensure Compact (NLC) agreement, a multistate license issued by a participating NLC state. Hires and current employees working on an out-of-state NLC license who later change their residency to the state where the facility is also located will have 60 days upon changing their residency to apply for licensure within that state.
UPMC is an Equal Opportunity Employer/Disability/Veteran

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