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Utilization Management Case Manager Rn Jobs (NOW HIRING)

Intermedia Group

Manager - Case Management RN

Everett, WA · On-site

$141K - $223K/yr

... planning, utilization management, social work services, and pre-admission case management. * The ... Washington Registered Nurse License upon hire * 6 years of experience in Case Management. * 2 years ...

TotalMed RN

Travel Utilization Review RN

Irvine, CA · On-site

TotalMed RN is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Irvine, California. & Requirements * Specialty: Utilization Review * Discipline: RN * Duration ...

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Utilization Management Case Manager Rn information

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How much do utilization management case manager rn jobs pay per hour?

As of Sep 14, 2026, the average hourly pay for utilization management case manager rn in the United States is $47.53, according to ZipRecruiter salary data. Most workers in this role earn between $35.34 and $57.45 per hour, depending on experience, location, and employer.

What is the difference between Utilization Management Case Manager Rn vs Utilization Review Nurse?

AspectUtilization Management Case Manager RnUtilization Review Nurse
CredentialsRN license, certification in case management (e.g., CCM)RN license, often with certification in utilization review
Work EnvironmentInsurance companies, healthcare facilities, case management teamsHospitals, insurance companies, outpatient clinics
Primary FocusCoordinating patient care, managing cases, ensuring appropriate utilizationReviewing medical necessity, approving or denying services
Common TasksAssessing patient needs, developing care plans, liaising with providersEvaluating medical records, making utilization decisions, ensuring compliance

The main difference is that the Utilization Management Case Manager Rn focuses on coordinating patient care and managing cases, while the Utilization Review Nurse primarily reviews medical records to approve or deny services. Both roles require RN licensure and related certifications, but their daily responsibilities and work environments differ slightly.

Are utilization management case managers in demand?

Utilization management case managers are in demand due to the growing need for healthcare cost control and efficient patient care coordination. Employers in healthcare organizations, insurance companies, and managed care plans seek professionals with strong clinical knowledge, certification, and experience in utilization review processes. The role offers stable employment opportunities as healthcare systems focus on cost-effective treatment management.

What cities are hiring for Utilization Management Case Manager Rn jobs?

Cities with the most Utilization Management Case Manager Rn job openings:

What states have the most Utilization Management Case Manager Rn jobs?

States with the most job openings for Utilization Management Case Manager Rn jobs include:

What are popular job titles related to Utilization Management Case Manager Rn jobs?

For Utilization Management Case Manager Rn jobs, the most frequently searched job titles are:

Infographic showing various Utilization Management Case Manager Rn job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 84% Full Time, 13% Part Time, and 2% Contract. Highlights an 83% Physical, 2% Hybrid, and 15% Remote job distribution, with an average salary of $98,869 per year, or $47.5 per hour.

RN - Utilization Management

Milford, NH • On-site

Central Business Solutions
See more jobs at Central Business Solutionsexternal

Other

Re-posted 15 days ago

Job description

Utilization Management Registered Nurse (UM RN)

We are seeking an experienced and detail-oriented Utilization Management Registered Nurse (UM RN) to join our hospital team. The UM RN is responsible for reviewing patient cases to ensure appropriate utilization of healthcare services, medical necessity, compliance with payer requirements, and optimal patient outcomes. This role collaborates closely with physicians, case managers, and interdisciplinary teams to support quality patient care while managing healthcare resources efficiently.

Key Responsibilities
  • Perform utilization review activities for inpatient and outpatient services.
  • Assess medical necessity, level of care, and appropriateness of admissions using established criteria such as InterQual or MCG guidelines.
  • Collaborate with physicians, case management, and healthcare teams regarding patient care plans and discharge planning.
  • Communicate with insurance providers and third-party payers to obtain authorizations and resolve coverage issues.
  • Monitor patient length of stay and identify opportunities to improve care efficiency.
  • Ensure compliance with hospital policies, federal regulations, and payer requirements.
  • Document utilization review findings accurately and maintain confidentiality of patient information.
  • Participate in denial prevention and appeals processes when necessary.
  • Support quality improvement initiatives and patient care coordination activities.
Qualifications
  • Active Registered Nurse (RN) license in the applicable state.
  • Bachelor of Science in Nursing (BSN) preferred.
  • Minimum 2–3 years of acute care hospital nursing experience required.
  • Prior experience in Utilization Management, Case Management, or Care Coordination preferred.
  • Strong knowledge of InterQual and/or MCG criteria.
  • Experience working with electronic medical records (EMR) systems.
  • Excellent communication, critical thinking, and organizational skills.

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