UM Nurse focuses on the Gonzaba Medical Group UM Review Process. Supervisory Responsibilities: This position has no supervisory responsibilities. General Requirements: All duties performed will be ...
UM Nurse focuses on the Gonzaba Medical Group UM Review Process. Supervisory Responsibilities: This position has no supervisory responsibilities. General Requirements: All duties performed will be ...
UM Nurse
San Antonio, TX · On-site
UM Nurse Position Type Full Time Category Managed Care Description General Summary: UM Nurse focuses on the Gonzaba Medical Group UM Review Process. Supervisory Responsibilities: This position has no ...
UM Nurse
San Antonio, TX · On-site
UM Nurse Position Type Full Time Category Managed Care Description General Summary: UM Nurse focuses on the Gonzaba Medical Group UM Review Process. Supervisory Responsibilities: This position has no ...
UM Nurse
San Antonio, TX · On-site
UM Nurse focuses on the Gonzaba Medical Group UM Review Process. Supervisory Responsibilities: This position has no supervisory responsibilities. General Requirements: All duties performed will be ...
UM Nurse
San Antonio, TX · On-site
UM Nurse focuses on the Gonzaba Medical Group UM Review Process. Supervisory Responsibilities: This position has no supervisory responsibilities. General Requirements: All duties performed will be ...
UM Nurse focuses on the Gonzaba Medical Group UM Review Process. Supervisory Responsibilities: This position has no supervisory responsibilities. General Requirements: All duties performed will be ...
UM Nurse focuses on the Gonzaba Medical Group UM Review Process. Supervisory Responsibilities: This position has no supervisory responsibilities. General Requirements: All duties performed will be ...
UM Nurse (California License) - Must Be Licensed In California- Remote Opportunity The role of the UM Nurse is to promote quality, cost-effective outcomes for a population by facilitating ...
UM Nurse (California License) - Must Be Licensed In California- Remote Opportunity The role of the UM Nurse is to promote quality, cost-effective outcomes for a population by facilitating ...
UM Nurse Specialist (HYBRID)
Dallas, TX · On-site
The UM Nurse Specialist provides organizational support in the Utilization Management Department; efficiently processes Pre-Service Authorization requests within regulated turn-around times. Works ...
UM Nurse Specialist (HYBRID)
Dallas, TX · On-site
The UM Nurse Specialist provides organizational support in the Utilization Management Department; efficiently processes Pre-Service Authorization requests within regulated turn-around times. Works ...
UM Nurse Reviewer Under the guidance of the Utilization Management, the UM Nurse Reviewer will leverage expertise to conduct timely reviews of pre-certification and/or concurrent requests, aligning ...
UM Nurse Reviewer Under the guidance of the Utilization Management, the UM Nurse Reviewer will leverage expertise to conduct timely reviews of pre-certification and/or concurrent requests, aligning ...
UM Nurse Reviewer
Orange, CA · On-site
The nurse also issues timely and accurate denial, deferral, or authorization letters, manages ... Collaborate with healthcare providers, the Utilization Management (UM) team, and compliance ...
UM Nurse Reviewer
Orange, CA · On-site
The nurse also issues timely and accurate denial, deferral, or authorization letters, manages ... Collaborate with healthcare providers, the Utilization Management (UM) team, and compliance ...
UM Nurse Reviewer Under the guidance of the Utilization Management, the UM Nurse Reviewer will leverage expertise to conduct timely reviews of pre-certification and/or concurrent requests, aligning ...
UM Nurse Reviewer Under the guidance of the Utilization Management, the UM Nurse Reviewer will leverage expertise to conduct timely reviews of pre-certification and/or concurrent requests, aligning ...
UM Nurse Reviewer
$75K - $95K/yr
The nurse also issues timely and accurate denial, deferral, or authorization letters, manages ... Collaborate with healthcare providers, the Utilization Management (UM) team, and compliance ...
UM Nurse Reviewer
$75K - $95K/yr
The nurse also issues timely and accurate denial, deferral, or authorization letters, manages ... Collaborate with healthcare providers, the Utilization Management (UM) team, and compliance ...
UM Nurse Reviewer, RN - Bakersfield 1.1
Bakersfield, CA · On-site
$31 - $54.18/hr
The UM Nurse Reviewer holds responsibility for ensuring that members receive suitable care at the right time and location, all while adhering to federally and state regulated turn-around times. This ...
UM Nurse Reviewer, RN - Bakersfield 1.1
Bakersfield, CA · On-site
$31 - $54.18/hr
The UM Nurse Reviewer holds responsibility for ensuring that members receive suitable care at the right time and location, all while adhering to federally and state regulated turn-around times. This ...
UM Nurse Reviewer
Orange, CA · On-site
The nurse also issues timely and accurate denial, deferral, or authorization letters, manages ... Collaborate with healthcare providers, the Utilization Management (UM) team, and compliance ...
UM Nurse Reviewer
Orange, CA · On-site
The nurse also issues timely and accurate denial, deferral, or authorization letters, manages ... Collaborate with healthcare providers, the Utilization Management (UM) team, and compliance ...
UM Nurse Reviewer
Orange, CA · On-site
$75K - $95K/yr
The nurse also issues timely and accurate denial, deferral, or authorization letters, manages ... Collaborate with healthcare providers, the Utilization Management (UM) team, and compliance ...
UM Nurse Reviewer
Orange, CA · On-site
$75K - $95K/yr
The nurse also issues timely and accurate denial, deferral, or authorization letters, manages ... Collaborate with healthcare providers, the Utilization Management (UM) team, and compliance ...
UM Nurse Reviewer, RN - Bakersfield 1.1
Bakersfield, CA · On-site
$43.35 - $54.18/hr
The UM Nurse Reviewer holds responsibility for ensuring that members receive suitable care at the right time and location, all while adhering to federally and state regulated turn-around times. This ...
UM Nurse Reviewer, RN - Bakersfield 1.1
Bakersfield, CA · On-site
$43.35 - $54.18/hr
The UM Nurse Reviewer holds responsibility for ensuring that members receive suitable care at the right time and location, all while adhering to federally and state regulated turn-around times. This ...
UM Nurse Reviewer, RN - Bakersfield 1.1
Bakersfield, CA · On-site
$43.35 - $54.18/hr
The UM Nurse Reviewer holds responsibility for ensuring that members receive suitable care at the right time and location, all while adhering to federally and state regulated turn-around times. This ...
UM Nurse Reviewer, RN - Bakersfield 1.1
Bakersfield, CA · On-site
$43.35 - $54.18/hr
The UM Nurse Reviewer holds responsibility for ensuring that members receive suitable care at the right time and location, all while adhering to federally and state regulated turn-around times. This ...
UM Nurse Reviewer, LVN - Bakersfield 1.2
Bakersfield, CA · On-site
$43.35 - $54.18/hr
The UM Nurse Reviewer holds responsibility for ensuring that members receive suitable care at the right time and location, all while adhering to federally and state regulated turn-around times. This ...
UM Nurse Reviewer, LVN - Bakersfield 1.2
Bakersfield, CA · On-site
$43.35 - $54.18/hr
The UM Nurse Reviewer holds responsibility for ensuring that members receive suitable care at the right time and location, all while adhering to federally and state regulated turn-around times. This ...
UM Nurse Reviewer, LVN - Bakersfield 1.2
Bakersfield, CA · On-site
$31 - $54.18/hr
The UM Nurse Reviewer holds responsibility for ensuring that members receive suitable care at the right time and location, all while adhering to federally and state regulated turn-around times. This ...
UM Nurse Reviewer, LVN - Bakersfield 1.2
Bakersfield, CA · On-site
$31 - $54.18/hr
The UM Nurse Reviewer holds responsibility for ensuring that members receive suitable care at the right time and location, all while adhering to federally and state regulated turn-around times. This ...
The ideal candidate for this opening would be a current member of the One Home / Home Solutions UM Team who has been in their current position for 12+ months? * Bachelor's degree in nursing or ...
The ideal candidate for this opening would be a current member of the One Home / Home Solutions UM Team who has been in their current position for 12+ months? * Bachelor's degree in nursing or ...
The ideal candidate for this opening would be a current member of the One Home / Home Solutions UM Team who has been in their current position for 12+ months? * Bachelor's degree in nursing or ...
The ideal candidate for this opening would be a current member of the One Home / Home Solutions UM Team who has been in their current position for 12+ months? * Bachelor's degree in nursing or ...
Um Nurse information
See salary details
$39K - $50.3K
15% of jobs
$50.3K - $61.5K
8% of jobs
$63.2K is the 25th percentile. Wages below this are outliers.
$61.5K - $72.8K
15% of jobs
The median wage is $79.9K / yr.
$72.8K - $84.1K
20% of jobs
$84.1K - $95.4K
11% of jobs
$101K is the 75th percentile. Wages above this are outliers.
$95.4K - $106.6K
13% of jobs
$106.6K - $117.9K
5% of jobs
$117.9K - $129.2K
3% of jobs
$129.2K - $140.5K
4% of jobs
$140.5K - $151.7K
3% of jobs
$151.7K - $163K
3% of jobs
$39K
$89.5K
$163K
How much do um nurse jobs pay per year?
As of Aug 14, 2026, the average yearly pay for um 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 as a Utilization Management (UM) nurse?
To thrive as a UM Nurse, a current RN license, strong clinical background, and knowledge of healthcare regulations and insurance guidelines are essential. Familiarity with utilization review software, electronic medical records, and industry certifications such as CCM (Certified Case Manager) are highly valued. Exceptional critical thinking, attention to detail, and effective communication skills help UM Nurses excel in decision-making and collaboration with providers and payers. These skills ensure accurate medical necessity determinations, regulatory compliance, and optimal patient care outcomes.
What are some common challenges Utilization Management (UM) nurses face when coordinating care between providers and insurance companies?
UM Nurses often encounter challenges such as navigating differing interpretations of medical necessity between healthcare providers and insurance companies, managing tight deadlines for case reviews, and handling a high volume of cases. Effective communication and strong organizational skills are essential, as UM Nurses must ensure that all parties are informed and that patient care is not delayed. Additionally, staying updated on changing regulations and payer requirements can be demanding but is crucial for success in this role.
What is a UM nurse?
UM Nurses, or Utilization Management Nurses, are registered nurses who evaluate the necessity, appropriateness, and efficiency of healthcare services and treatments. They review patient records, coordinate with healthcare providers, and ensure that care meets established guidelines and insurance requirements. Their work helps control healthcare costs while ensuring patients receive appropriate care. UM Nurses often work for insurance companies, hospitals, or managed care organizations and play a key role in pre-authorizations, concurrent reviews, and discharge planning.
More about Um Nurse jobs
What cities are hiring for Um Nurse jobs?
Cities with the most Um Nurse job openings:
What are the most commonly searched types of Um Nurse jobs?
The most popular types of Um Nurse jobs are:
What states have the most Um Nurse jobs?
States with the most job openings for Um Nurse jobs include:
What job categories do people searching Um Nurse jobs look for?
The top searched job categories for Um Nurse jobs are:
- Temporary Aetna Utilization Review Nurse
- Overnight Dental Utilization Management
- Full Time Cigna Utilization Review
- Entry Level Remote Um Nurse
- Full Time Weekend Utilization Review
- Remote Dental Utilization Management
- Freelance International Utilization Review Nurse
- Seasonal Remote Utilization Review
- Lpn Utilization Review Nurse
- Remote Refugee Health Nurse
Job description
Job Title: UM Nurse (California License) – Must be licensed in California- Remote Opportunity
Work Hrs: (8am – 5pm PDT) would like to include evening, weekend and holiday coverage.
3 month contract plus
Remote Opportunity
Ready to Hire ASAP.
JD: The role of the UM Nurse is to promote quality, cost-effective outcomes for a population by facilitating collaboration and coordination across settings, identifying member needs, planning for care, monitoring the efficacy of interventions, and advocating to ensure members receive the services and resources required to meet desired health and social outcomes. The UM Nurse is responsible for providing patient-centered care across the care continuum.
This position is not patient facing, they will be reviewing patient records and providing recommendations.
Role and Responsibilities
- Perform prospective, retrospective, or concurrent medical necessity reviews for an assigned panel of members
- Review cases for medical necessity and apply the appropriate clinical criteria; to include, but not limited to Medicare criteria, Medicaid/Medi-cal criteria, Interqual, Milliman, or Health Plan specific guidelines
- Collaborate with the Medical Director to ensure the integrity of adverse determination notices based on the quality standards for adverse determinations
- Ensure discharge planning is timely and appropriately communicated to the transition of care teams, when applicable.
- Meet or exceed productivity targets set forth
- Serve as a resource to non-clinical team members when applicable
Qualifications and Education Requirements
- Associate's degree in Nursing, preferred
- Minimum 2 years of experience in medical management clinical functions.
- UM Reviewer in patient experience required
- Working knowledge of MCG, InterQual, and NCQA standards
About Enterprise Engineering
Sourced by ZipRecruiter
Our team is composed of architects and application experts skilled in Open Banking and Digital Transformation. Financial Data is in our DNA, and for years we have been helping our clients design, develop and deploy modern, innovative solutions bringing the greatest value to our clients and their business. If you have a constant thirst for emerging technology and a passion for pushing the needle towards excellence, you might be just like us. Life at EEI At EEI, our cultural pillars have been and continue to be a collaborative work environment that cultivates teamwork, mentoring, knowledge sharing, individual and team development. We are a humble bunch that cares for the personal and professional wellbeing of our clients and coworkers and support a healthy work life balance. Do you share our values?
Industry
It services
Company size
51 - 200 Employees
Headquarters location
NY, US
Year founded
1995