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Rn Utilization Management Jobs in Iowa (NOW HIRING)

Virginia Gay Hospital

Utilization Tech

Vinton, IA · On-site

Would prefer candidate to have previous education and experience as an MA/RN/LPN, Utilization Review Nurse and/or have experience in physician office preauthorization and utilization review.

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Rn Utilization Management information

See Iowa salary details

$36.6K

$84K

$153.1K

How much do rn utilization management jobs pay per year?

As of Sep 11, 2026, the average yearly pay for rn utilization management in Iowa is $84,048.00, according to ZipRecruiter salary data. Most workers in this role earn between $60,600.00 and $98,200.00 per year, depending on experience, location, and employer.

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.

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 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 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 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 healthcare policies and insurance processes. 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 are popular job titles related to Rn Utilization Management jobs in Iowa?

For Rn Utilization Management jobs in Iowa, the most frequently searched job titles are:

What job categories do people searching Rn Utilization Management jobs in Iowa look for?

The top searched job categories for Rn Utilization Management jobs in Iowa are:

Rn Utilization Management jobs near you
Infographic showing various Rn Utilization Management job openings in Iowa as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 17% Part Time, and 2% Contract. Highlights an 82% Physical, 3% Hybrid, and 15% Remote job distribution, with an average salary of $84,048 per year, or $40.4 per hour.

Utilization Management Nurse

Dubuque, IA • On-site

Access Dubuque
See more jobs at Access Dubuqueexternal

Other

Medical, Dental, Life, Retirement, PTO

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

Job description

Utilization Management Nurse

Medical Associates

1 Positions

ID: ou7IAfwD

Posted On 09/01/2026

Job Overview

Description

Medical Associates is looking for a Utilization Management Nurse to join our Health Care Services team!

Schedule: Primary schedule will be Monday through Friday 8:00am to 5:00pm, 40 hours/week with flexibility. After training, there is o pportunity for work from home if desired!

Location: Training is in-person at Medical Associates Health Plans, 1605 Associates Drive, Dubuque, IA 52002

Benefits Package Includes:

  • Single or Family Health Insurance with discounted premium rates for wellness program participation.

  • 401k with immediate matching (50% on the dollar up to 7% of pay + additional annual Profit Sharing)

  • Flexible Paid Time Off Program (24 days off/year)

  • Medical and Dependent Care Flex Spending Accounts

  • Life insurance, Long Term Disability Coverage, Short Term Disability Coverage, Dental Insurance, etc.

What You Will Be Doing:

  • Review requests from providers or members for approval of procedures, medications, durable medical and/or services prior to delivery of the service.

  • Utilize established screening criteria to ensure patients get the correct treatment from the resources that are available at the most cost-effective level to meet their needs.

  • Facilitate options and services for meeting individuals’ health needs with the goal of decreasing fragmentation, duplication of care and enhancing quality, cost‑effective clinical outcomes.

  • Review of hospital and skilled admissions to justify continued care is medically necessary per Health Plan established guidelines.

Essential Functions & Responsibilities:

  1. Conduct reviews inclusive of physician referrals, medication reviews, admissions, utilization review updates, investigating alternatives to hospitalization such as home health care and durable medical equipment, utilizing the assessment process by obtaining pertinent patient history and accurate vital data, anticipating patient and family needs, working with the Health Choice Claims and Membership Services to determine benefit eligibility, facilitating crisis intervention, sharing information with co‑workers and documenting accurately. Utilize established screening criteria to determine medical necessity of requested authorizations. Refer patients to case management nurse or health coach as appropriate.

  2. Facilitate out‑of‑plan referrals, out‑of‑area urgent and emergent care for enrollees and provider offices and provide necessary information to Medical Director on specified referrals. Communicate decision to enrollees, providers, and facilities per established policies.

  3. Work collaboratively with internal and external staff, in determining extent of benefits and coverage for services being coordinated. Document authorizations, denials, cost savings and other outcome measurements.

  4. Act as a resource for the enrollee, provider offices, and other MAHP departments. Perform retrospective review to determine coverage of hospitalizations, and outpatient services. Communicate with enrollees regarding the use of managed care systems and participate in answering enrollees and providers inquiries.

  5. Assist in preparations for external review/regulatory agencies.

  6. Complete all other assigned projects and duties.

Knowledge, Skills and Abilities:

Experience - Three years to five years of similar or related experience.

Education - Valid RN nursing license is required.

Physical Aspects:

Stooping - Bending body downward and forward by bending spine at the waist. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles.

Reaching - Extending hand(s) and arm(s) in any direction.

Standing - Particularly for sustained periods of time.

Walking - Moving about on foot to accomplish tasks, particularly for long distances.

Lifting - Raising objects from a lower to a higher position or moving objects horizontally from position-to-position. This factor is important if it occurs to a considerable degree and requires the substantial use of the upper extremities and back muscles.

Fingering - Picking, pinching, typing or otherwise working, primarily with fingers rather than with the whole hand or arm as in handling.

Grasping - Applying pressure to an object with the fingers and palm.

Talking - Expressing or exchanging ideas by means of the spoken word. Those activities in which they must convey detailed or important spoken instructions to other workers accurately, loudly or quickly.

Hearing - Perceiving the nature of sound with or without correction. Ability to receive detailed information through oral communication and to make fine discriminations in sound, such as when making fine adjustments on machined parts.

Vision - 20 / 40 or better in the best eye with or without correction.

Repetitive Motions - Substantial movements (motions) of the wrists, hands and/or fingers.

Sedentary Work - Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

Environmental Conditions:

None - The worker is not substantially exposed to adverse environmental conditions (such as in typical office or administrative work).

Medical Associates Clinic & Health Plans is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, pregnancy, age, national origin, marital status, parental status, disability, veteran status, or other distinguishing characteristics of diversity and inclusion, or any other protected status.

Please view Equal Employment Opportunity Posters provided by OFCCP https://www.eeoc.gov/poster

Primary Contact

9878

Careers at Medical Associates

,

563-584-4225

Phone

Phone

Phone

Fax

[email protected]

Email

True

False

True

Job Details

Categories

Health Care

Location

Dubuque, IA

Job Type

Employee

Full/Part

Full Time

Company ID

1148

Job REQ #

ou7IAfwD

# Positions

1

Start Date

20260901

End Date

20260906

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Medical Associates

About the Company

Our mission is to provide superior healthcare and an excellent patient experience.

Medical Associates Clinic is a well-established multispecialty group practice with over 200+ providers and a staff of over 1,100+ health care professionals and support personnel. The group was founded in 1924 and is Iowa's oldest multispecialty group practice. Today, Medical Associates Clinic is the area's leading health care provider and only multispecialty group practice. Medical Associates Clinic has been recognized since 1998 as a "better performing practice" by the Medical Group Management Association.

In 1982, Medical Associates developed the Tri-State's first health maintenance organization, Medical Associates Health Plans, which offers comprehensive health benefits to over 400 employers and 45,000 members. Medical Associates Health Plans has maintained an "Excellent" rating, the highest level of accreditation possible by the National Committee for Quality Assurance, for 13 consecutive years.

Medical Associates Clinic offers several locations from which to seek medical care, including facilities at 1500 Associates Drive, 1000 Langworthy, and 4155 Pennsylvania Ave in Dubuque, Iowa; as well as facilities in Bellevue, Cascade, Dyersville, Iowa; Cuba City, Lancaster, Platteville, Wisconsin; and Galena, Illinois.

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