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Rn Utilization Management Jobs (NOW HIRING)

talent4health

RN - Utilization Review

Cleveland, OH · On-site

$2.2K/wk

... Offering Nursing Profession RN Specialty Utilization Review Job ID 18807560 Job Title RN - ... Previous Care Management, Case Management, or Utilization Management Experience. * Experience with ...

Oak St. Health

Utilization Management Nurse Consultant

$32.01 - $68.55/hr

Registered Nurse (RN) - Utilization Management Join a dynamic healthcare team and make an impact on patient care from wherever you work. We are seeking an experienced Registered Nurse (RN) to support ...

Christiana Care Health Services

$85K - $137K/yr

Job Details Registered Nurse (RN) - Utilization ManagementFT Day Shift (Hrs.: 8a-4:30p) - On-site Newark, DE ChristianaCare Hospital in Newark, DE, is seeking a Utilization Management Nurse (RN) with ...

Guthrie

RN - Utilization Management - FT

Binghamton, NY · On-site

Up To $25,000 Sign On Bonus For Qualified RNs! Summary The Registered Nurse (RN) Utilization Management (UM) in collaboration with Care Coordination, Guthrie Clinic offices, other physician offices ...

Guthrie

RN - Utilization Management - FT

Binghamton, NY · On-site

Up To $25,000 Sign On Bonus For Qualified RNs! Summary The Registered Nurse (RN) Utilization Management (UM) in collaboration with Care Coordination, Guthrie Clinic offices, other physician offices ...

Dignity Health

Utilization Management RN

Bakersfield, CA · On-site

$57.37 - $85.33/hr

Job Summary and Responsibilities As our UM RN (Utilization Management Registered Nurse), you will be responsible for ensuring the integrity of the adverse determination processes and accuracy of ...

New

University of Rochester

$81K - $109K/yr

Utilization Management experience preferred KNOWLEDGE, SKILLS AND ABILITIES * Database experience including: Interqual, Sharepoint, eRecord, ePARC, Cobius preferred LICENSES AND CERTIFICATIONS * RN - ...

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RN Utilization Management information

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$39K

$89.5K

$163K

How much do rn utilization management jobs pay per year?

As of Aug 10, 2026, the average yearly pay for rn utilization management 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.

How does an RN Utilization Management typically collaborate with physicians and other healthcare team members?

RN Utilization Management professionals work closely with physicians, case managers, and insurance representatives to ensure patients receive appropriate, high-quality care while managing healthcare costs. They review patient records, communicate clinical findings, and may participate in interdisciplinary meetings to discuss care plans and discharge needs. Building strong relationships and maintaining open lines of communication with the care team is essential for timely authorizations and effective care coordination. This collaborative approach helps optimize patient outcomes and resource utilization.

What skills and qualifications are needed to thrive as an RN Utilization Management?

To thrive as an RN Utilization Management Nurse, you need a current RN license, strong clinical assessment skills, and experience in care coordination or case management. Familiarity with utilization review tools, electronic health records, and knowledge of insurance guidelines or InterQual/MCG criteria are typically required. Exceptional communication, critical thinking, and negotiation skills help facilitate collaboration among providers, payers, and patients. These abilities are crucial for ensuring appropriate resource use, compliance with regulations, and optimal patient outcomes.

How to get into utilization management as an RN?

To become an RN in utilization management, gain experience as a registered nurse, often in case management or clinical roles, and obtain knowledge of insurance policies and healthcare regulations. Certifications such as Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ) can enhance prospects. Strong communication skills and familiarity with electronic health records (EHR) systems are also beneficial.

What is the difference between Rn Utilization Management vs Rn Case Management?

AspectRn Utilization ManagementRn Case Management
CertificationsRN license, possibly certifications in utilization reviewRN license, case management certification often preferred
Work EnvironmentUtilization review departments, insurance companies, hospitalsCommunity clinics, hospitals, insurance companies
Primary FocusReviewing medical necessity and appropriateness of servicesCoordinating patient care and discharge planning

Both roles require an RN license, but Rn Utilization Management focuses on reviewing the necessity of services, while Rn Case Management emphasizes coordinating patient care. Understanding these differences helps professionals choose the right career path and employers.

What does a utilization management registered nurse do?

A utilization management registered nurse reviews patient cases to determine the necessity, appropriateness, and efficiency of healthcare services and treatments. They analyze medical records, collaborate with healthcare providers, and ensure compliance with insurance and regulatory guidelines, often using electronic health records and clinical judgment. Certification in case management or utilization review is commonly required for this role.

What is an RN Utilization Management?

RN Utilization Management nurses are registered nurses who specialize in reviewing healthcare services to ensure patients receive appropriate and cost-effective care. They evaluate the necessity, efficiency, and quality of medical treatments and procedures, often working with insurance companies, hospitals, or healthcare organizations. Their responsibilities include reviewing patient records, coordinating with clinical staff, making coverage recommendations, and ensuring compliance with healthcare regulations. This role helps manage healthcare costs while maintaining high standards of patient care.
More about RN Utilization Management jobs
What cities are hiring for Rn Utilization Management jobs? Cities with the most Rn Utilization Management job openings:
What states have the most Rn Utilization Management jobs? States with the most job openings for Rn Utilization Management jobs include:
What job categories do people searching Rn Utilization Management jobs look for? The top searched job categories for Rn Utilization Management jobs are:
RN Utilization Management jobs near you
Infographic showing various Rn Utilization Management job openings in the United States as of August 2026, with employment types broken down into 83% Full Time, 13% Part Time, 1% Temporary, and 3% Contract. Highlights an 88% Physical, 2% Hybrid, and 10% Remote job distribution, with an average salary of $89,483 per year, or $43 per hour.

Utilization Management RN

Dignity Health Management Services

Bakersfield, CA • Remote

$57.37 - $85.33/hr

Full-time

Posted 19 days ago

Job description


Job Summary and Responsibilities

As our UM RN (Utilization Management Registered Nurse), you will be responsible for ensuring the integrity of the adverse determination processes and accuracy of clinical decision-making, as it relates to the application of criteria and composition of compliant denial notices, to review medical records, authorize requested services, and prepare cases for physician review based on medical necessity.
Every day you will partner with both the Pre-Service and In-Patient Utilization Management teams. You will ensure to monitor and assure the appropriateness and medical necessity of care as it relates to quality, continuity, and cost-effectiveness. This involves meticulous review of medical records, application of clinical guidelines, and collaborative communication to facilitate optimal patient care while ensuring compliance and fiscal responsibility.
To be successful in your role, you will strategically ensure the integrity and accuracy of utilization management decisions, meticulously reviewing medical records and applying clinical criteria to determine medical necessity. You will demonstrate exceptional clinical judgment, partner effectively with pre-service and in-patient teams, and maintain rigorous oversight of care appropriateness, quality, continuity, and cost-effectiveness, thereby safeguarding both patient well-being and organizational resources.

As a remote employee, we will provide you with the equipment needed to work from home, including a laptop, docking station, dual monitors, and accessories.

This position is remote with a CA RN license.  PST business hours will be expected.

Potential for on-call, weekend and holiday shifts.

  • Reviews designated requests for referral authorizations either proactively, concurrently or retroactively. Gathering all information needed to make a determination and/or coordinate with the Medical Director as needed.
  • Ensure compliance with turnaround times and accuracy standards are met.
  • Ensure contracted providers are in place when authorizing.
  • Responsible to coordinate with contracting to obtain appropriate contracts as deemed appropriate.
  • Identify cases that require additional case management.
  • Work with appropriate departments and internal staff to coordinate patient care
Job Requirements

Required

  • Three (3) years recent clinical experience
  • Graduate of an accredited RN program
  • Clear and current CA Registered Nurse (RN) license
  • Knowledge of nursing theory and ability to apply or modify as appropriate
  • Knowledge of ICD-10, CPT, HCPCS coding, medical terminology and insurance benefits
  • Knowledge of legal and ethical considerations related to patient information, PHI and HIPPA regulations


Preferred

  • Bachelors of Nursing (BSN) preferred
  • Previous inpatient Utilization Management (UM) experience strongly preferred
  • Experience with MCG strongly preferred
  • EZCap experience a plus
Where You'll Work

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health's Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.

One Community. One Mission. One California 


Pay Range
$57.37 - $85.33 /hour

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