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Rn Utilization Management Jobs in Minnesota (NOW HIRING)

Medica

Utilization Management RN III

Minnetonka, MN · On-site

$70K - $120K/yr

... * RN license Preferred Qualifications : * Experience with appeals strongly preferred * Utilization Management experience * Knowledge surrounding regulatory requirements (i.e. CMS and NCQA) specific ...

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Rn Utilization Management information

See Minnesota salary details

$38.2K

$87.6K

$159.6K

How much do rn utilization management jobs pay per year?

As of Aug 6, 2026, the average yearly pay for rn utilization management in Minnesota is $87,640.00, according to ZipRecruiter salary data. Most workers in this role earn between $63,200.00 and $102,300.00 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.
What are popular job titles related to Rn Utilization Management jobs in Minnesota? For Rn Utilization Management jobs in Minnesota, the most frequently searched job titles are:
What job categories do people searching Rn Utilization Management jobs in Minnesota look for? The top searched job categories for Rn Utilization Management jobs in Minnesota are:
Rn Utilization Management jobs near you
Infographic showing various Rn Utilization Management job openings in Minnesota as of August 2026, with employment types broken down into 82% Full Time, 14% Part Time, 1% Temporary, and 3% Contract. Highlights an 89% Physical, 2% Hybrid, and 9% Remote job distribution, with an average salary of $87,640 per year, or $42.1 per hour.

Utilization Management RN

North Memorial Health

Robbinsdale, MN • On-site, Remote

$39.83 - $59.74/hr

Full-time, Part-time

Medical, Retirement, PTO

Posted 28 days ago

North Memorial Health rating

7.5

Company rating: 7.5 out of 10

Based on 50 frontline employees who took The Breakroom Quiz

232nd of 887 rated healthcare providers

Job description

Utilization Management RN
Robbinsdale, MN
Posting Date: Jul 10 2026
Requisition Number: 513995
Why North Memorial Health?
At North Memorial Health, you're part of an inclusive health team that is rooted in our values: Advocate Courageously, Rally Together, Respect Uniqueness and Create Impact. Empathy and care are at the heart of North's culture which is designed to actively support each team member's wellbeing and growth. Our strength lies in our diversity, and we embrace the unique contributions and experiences of each person. Together, we empower patients to achieve their best health.
Our health system encompasses two hospital locations in Robbinsdale and Maple Grove as well as a network of 23 clinics which includes 13 primary clinics, 6 specialty clinics, 4 urgent care/urgency centers and emergency care offerings covering five counties. Our Robbinsdale Hospital, established in 1954, is a 385-bed facility recognized as the top Level 1 Trauma center for 25 years, as well as serving as a Level II pediatric trauma center. Our Maple Grove Hospital was established in 2009, is a 134-bed facility recognized as a top hospital in the state for Women and Children Care, with a Level III NICU, and is the largest Family Birth Center in the state (~5,000 deliveries per year and over 60,000 babies delivered). Both have been named to the 2022 Fortune/Merative 100 Top Hospitals® list, 2023 Women's Choice Award Best Hospitals list.
Benefits the North Way!
As North Memorial Health is a non-profit organization you are eligible for the Public Student Loan Forgiveness program. Most part-time and all full-time positions are eligible for benefits.
  • Health & Welfare Benefit Packages
  • 401k Retirement Match or Pension Plan, based on workgroup eligibility
  • Generous Paid Time Off (PTO) Plans
  • Adoption Reimbursement up to $3000 per child
  • Child Care Discount Program with New Horizon 10% off weekly childcare tuition
  • Education/Tuition Reimbursement
  • 24/7 Fitness Center Access for all benefit eligible team members

Commitment to Diversity, Equity & Inclusion
At North Memorial Health we recognize that the strength of our team lies in our diversity and make every effort to embrace the unique contributions and experiences of each person on our team. We strive to ensure that everyone feels like they are a valuable part of our community, with initiatives that reinforce our belief in diversity, equity, and inclusivity, to promote a workforce that enables authenticity, as we want to be our best when providing effective services to our patients. We acknowledge and celebrate the unique traditions, backgrounds, languages, beliefs, and customs of our community, and want everyone to feel welcome. Through our DE&I initiatives we hope to dispel myths, assumptions, and acts of implicit bias.
About this position
The Utilization Management RN, under the supervision of the Utilization Management Manager, acts as a support resource to the Medical Staff of North Memorial Health (NMH) and Maple Grove Hospital (MGH) in relationship to clinical documentation of admitted customers. The UM RN assess the documented medical necessity of each bedded patient to assist the MD as needed to determine an appropriate admission status. They provide clinically based information to assist with care coordination and support the delivery of quality customer care as efficiently as possible. The RN has accountability for assisting in ensuring quality clinical outcomes, and appropriate resource management related to admission, readmission, length of stay, extended stay, avoidable days and discharge planning. They work with the medical and care teams (nursing, social services, therapies, and ancillary departments) to ensure the customer is receiving the right care, at the right level across the continuum. Additionally, they know the disease, trajectory of illness, treatment plan, standard of care for the diagnosis, expected outcome, and Length of Stay (LOS) for the case type. They work with all admissions (bedded customers) excluding any customers in the Emergency Department Finally, they UM RN actively and consistently demonstrates the mission, vision, values and guiding principles of North Memorial Health.
Requirements
Education
• Bachelor's Degree from an accredited school of nursing required.
Experience
• Three (3) to five years of previous acute care nursing experience required.
• One (1) year of direct case management experience required.
• Hospital case management and utilization management experience required. • Knowledge of nursing theory and practice and primary care principles and practices.
• Knowledge of Medicare rules and regulations.
• Knowledge of current case management principles, utilization management, length of stay management, and/or transition/discharge planning.
• Knowledge of current nursing principles, techniques and procedures.
• Demonstrated ability to deal with conflict in a positive manner. Has an awareness of, responds to, and considers the needs, feelings and capabilities of others.
• Strong communication skills with demonstrated ability to express ideas and information clearly and concisely in a manner appropriate to the audience.
Licensure/Certification
Current licensure and registration as an RN in the State of MN. - State Requirement
The North Memorial Health System is dedicated to building a diverse, inclusive, and authentic workplace, so if you're excited about this role, but your past experience doesn't perfectly align with every qualification listed, we encourage you to apply anyway. You may still be the right candidate for this or other roles.
Work Group: Non Contract
Hours per two week pay period: 80
Shift: Days 8 hours
Weekend Requirement: Every Other Weekend
Call Requirement: None
Remote or On-site: Hybrid Remote- Must live in MN or WI
FLSA Status: Exempt
Benefit Eligibility: Health insurance benefits are available for this position. North Memorial Health offers multiple health plans based on work group eligibility.
Salary Range: N23 ($39.83 - $59.74), based on experience
Shift Differential: Compensation may include shift differential pay depending on the position and shift worked.
STI Bonus Eligible: False
Employment Sponsorship: Applicants must be currently authorized to work in the United States on a full-time basis. Work visa sponsorship is not available for this position
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EEO/AA STATEMENT
North Memorial Health is an equal employment and affirmative action employer. North Memorial Health does not discriminate against any employee or applicant for employment because of race, color, religion, sex, national origin, age, disability, genetic information, marital status, veteran status, sexual orientation, gender identity, creed, status with respect to public assistance, or other protected class status. North Memorial Health provides reasonable accommodation to disabled applicants and employees and takes affirmative action to ensure that applicants are employed, and that employees are treated during employment, without regard to protected class status. If you believe that you have been treated in a way that does not conform to these statements, please contact our HR Service Center: JobApplicationAssistance@NorthMemorial.com. If you need a reasonable accommodation, due to a disability, or to assist with the application process, please contact our HR Service Center: JobApplicationAssistance@NorthMemorial.com.
INSPECTION OF AAP
North Memorial Health is a Federal government contractor or subcontractor.
As a part of our obligations under law, we must develop a written Affirmative Action Program for Individuals with Disabilities and Protected Veterans, as specified by law (AAP).
This AAP is available for inspection by applicants and employees in the Human Resources Office during normal business hours.
Link to Policy
North Memorial Health
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