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Rn Utilization Management Jobs (NOW HIRING)

Sagility LLC

RN Utilization Management Reviewer

$35 - $40/hr

Job title: RN Utilization Management Reviewer We are currently hiring a talented RN, Utilization Management Reviewer. This role will be responsible in day-to-day timely clinical and service ...

Sagility LLC

RN Utilization Management Reviewer

$35 - $40/hr

Job title: RN Utilization Management Reviewer We are currently hiring a talented RN, Utilization Management Reviewer. This role will be responsible in day-to-day timely clinical and service ...

Sagility

RN Utilization Management Reviewer

Concord, NC · Remote

$35 - $40/hr

Job title: RN Utilization Management Reviewer We are currently hiring a talented RN, Utilization Management Reviewer. This role will be responsible in day-to-day timely clinical and service ...

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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 Jun 16, 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 professional 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.

How to make $150,000 as a nurse?

Registered nurses in utilization management can reach a $150,000 salary by gaining specialized certifications, such as Certified Case Manager (CCM), and accumulating several years of experience in the field. Working in high-demand healthcare settings, taking on leadership roles, or pursuing advanced education like a master's degree can also increase earning potential.

What does a utilization management RN do?

A utilization management RN reviews medical records and treatment plans to determine the necessity, appropriateness, and efficiency of healthcare services. They collaborate with healthcare providers and insurance companies to ensure compliance with guidelines and optimize patient care while managing costs. Certification in case management or utilization review is often required, and the role typically involves working in a healthcare or insurance setting during regular business hours.

How to make 300,000 a year as a nurse?

To earn $300,000 annually as an RN in utilization management, nurses typically need extensive experience, advanced certifications such as CCM or ANCC, and may work in high-paying settings like insurance companies or healthcare consulting firms. Combining leadership roles, overtime, or specialized skills can also increase earning potential.

What are the key skills and qualifications needed to thrive as an RN Utilization Management Nurse, and why are they important?

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.

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.

How to make an extra 2000 a month as a nurse?

Rn Utilization Management professionals can increase income by taking on overtime shifts, working in high-demand specialties, or obtaining certifications like Certified Case Manager (CCM) to qualify for higher-paying roles. Additionally, some may pursue consulting or remote work opportunities that offer flexible schedules and higher pay rates.

What are RN Utilization Management nurses?

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.
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Rn Utilization Management jobs near you
Infographic showing various Rn Utilization Management job openings in the United States as of June 2026, with employment types broken down into 3% Internship, 92% Full Time, and 5% Part Time. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $89,483 per year, or $43 per hour.
RN, Utilization Management | Utilization Management

RN, Utilization Management | Utilization Management

UF Health

Gainesville, FL

Part-time

Posted 24 days ago

Job description

Overview

RN, Utilization Management | Utilization Management 

Ensure the right care at the right time—driving quality outcomes through effective utilization and care coordination.

???? Work Style: Onsite
???? Location: Gainesville, FL 
???? FTE: Part-Time (.6)
????️ Schedule: Weekend Only (12-hour shifts)

Evaluates patient medical records to determine the medical necessity and appropriateness of healthcare services in alignment with utilization management guidelines. Collaborates with healthcare providers to support compliance, optimize treatment plans, and promote efficient resource utilization.

Communicates authorization decisions clearly and monitors patient progress to support timely discharge planning. Analyzes utilization data to identify trends and opportunities for improvement.

Partners with interdisciplinary teams to enhance care coordination, ensure accurate documentation, and maintain compliance with regulatory and organizational standards.


Responsibilities

Key Responsibilities

  • Evaluates patient medical records to ensure the necessity and appropriateness of healthcare services.
  • Coordinates with healthcare providers to ensure compliance with utilization management guidelines.
  • Supports the optimization of treatment plans to promote effective patient care and appropriate resource utilization.
  • Communicates authorization decisions clearly and supports timely discharge planning.
  • Analyzes utilization data to identify trends and opportunities to improve care coordination.
  • Collaborates with interdisciplinary teams to ensure accurate documentation and regulatory compliance.

Qualifications

Education & Experience:


Registered Nurse (RN) with a current Florida license required.

  • Three (3) years of critical care nursing experience, or
  • Five (5) years of medical-surgical nursing experience, or
  • Three (3) years of utilization review, case management, or third-party payer experience.

Qualifications

  • Active Registered Nurse (RN) license with 3+ years of experience in utilization review or case management.
  • Strong knowledge of healthcare utilization management guidelines and regulatory compliance.
  • Experience evaluating medical necessity and optimizing treatment plans.
  • Excellent communication skills with the ability to clearly convey authorization decisions.
  • Ability to analyze utilization data and support effective care coordination.
  • Strong organizational skills with the ability to manage multiple priorities simultaneously.
  • Ability to work independently and collaboratively with multidisciplinary teams.
  • Strong attention to detail and innovative problem-solving skills.
  • Flexibility to adjust work hours and days based on departmental needs.

Motor Vehicle Operator Designation:
Employees in this position will not operate vehicles for an assigned business purpose.

Note: Please indicate the appropriate operator designation on the Request for Personnel (RFP) form at the time of submission.

Licensure/Certification/Registration:

  • Registered Nurse (RN) with a current Florida license required.

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