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Utilization Management Coordinator Rn Jobs (NOW HIRING)

IntePros

Utilization Management RN

Philadelphia, PA · On-site

PA RN License Required We are seeking an experienced Care Management Coordinator to join our Infusion Therapy team. This role is responsible for performing utilization management reviews to determine ...

Uloop Inc.

Utilization Management Coordinator

Miami, FL · On-site

$60 - $80/hr

Utilization Management Coordinator We are seeking a Utilization Management Coordinator to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as ...

TriHealth

Care Management Coord RN

Oxford, OH · On-site

We are looking for a Care Mgmt Coord RN at McCullough-Hyde/TriHealth Facility in Oxford, OH Make a ... Performs utilization review for patients served. Requires weekend, holiday, and off site commitment ...

TriHealth

Care Management Coord RN

Oxford, OH · On-site

We are looking for a Care Mgmt Coord RN at McCullough-Hyde/TriHealth Facility in Oxford, OH Make a ... Performs utilization review for patients served. Requires weekend, holiday, and off site commitment ...

UHS

Utilization Management Coordinator

Chicago, IL · On-site

$58K - $75K/yr

The Utilization Management Coordinato r performs timely, daily clinical reviews with all payer ... LCPC, LCSW, LPC, LSW, LMFT, RN or CADC preferred Experience: 1 or more years of experience in ...

UHS

Utilization Management Coordinator

Chicago, IL · On-site

The Utilization Management Coordinato r performs timely, daily clinical reviews with all payer ... LCPC, LCSW, LPC, LSW, LMFT, RN or CADC preferred Experience: 1 or more years of experience in ...

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Utilization Management Coordinator Rn information

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How much do utilization management coordinator rn jobs pay per hour?

As of Sep 9, 2026, the average hourly pay for utilization management coordinator rn in the United States is $29.61, according to ZipRecruiter salary data. Most workers in this role earn between $21.39 and $34.62 per hour, depending on experience, location, and employer.

What is a utilization management coordinator RN?

Utilization Management Coordinator RNs are registered nurses who review and coordinate the use of healthcare services to ensure patients receive appropriate, cost-effective care. They assess medical records, apply clinical guidelines, and collaborate with healthcare providers to determine the necessity of treatments, hospital stays, or procedures. Their goal is to optimize patient outcomes while managing healthcare resources efficiently, often working for insurance companies, hospitals, or managed care organizations.

What are the key skills and qualifications needed to thrive as a utilization management coordinator RN?

To thrive as a Utilization Management Coordinator RN, you need a current RN license, strong clinical assessment skills, and knowledge of utilization review and case management principles. Familiarity with medical management software, health insurance systems, and regulatory guidelines such as CMS and NCQA is typically required. Exceptional communication, critical thinking, and organizational skills help facilitate collaboration with healthcare providers and payers. These competencies ensure effective resource utilization, compliance, and quality patient care within healthcare organizations.

How does a utilization management coordinator RN typically collaborate with other healthcare professionals to ensure appropriate patient care?

A Utilization Management Coordinator RN works closely with physicians, case managers, social workers, and insurance representatives to review patient cases and determine the medical necessity of treatments and services. This collaboration often involves attending multidisciplinary team meetings, sharing clinical insights, and ensuring that care plans align with both patient needs and regulatory guidelines. Effective communication and relationship-building skills are essential, as the role requires balancing advocacy for the patient with adherence to utilization policies. These interactions help streamline care delivery and promote optimal outcomes for patients.

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

AspectUtilization Management Coordinator RnUtilization Review Nurse
CredentialsRN license, certifications in utilization managementRN license, certifications in utilization review
Work EnvironmentHealthcare facilities, insurance companiesHospitals, insurance companies, outpatient clinics
Job FocusCoordinating care, managing utilization processesReviewing medical necessity, approving or denying services

Both roles require an RN license and focus on utilization review processes. The Utilization Management Coordinator Rn primarily coordinates care and manages utilization workflows, while the Utilization Review Nurse concentrates on evaluating medical necessity and making approval decisions. They often work in similar settings like insurance companies and healthcare facilities, but their specific responsibilities differ slightly.

What cities are hiring for Utilization Management Coordinator Rn jobs?

Cities with the most Utilization Management Coordinator Rn job openings:

What states have the most Utilization Management Coordinator Rn jobs?

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

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

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

Utilization Management RN - Post Acute

Philadelphia, PA • On-site

IntePros
Software Development • 201 - 500 employees
Learn more about InteProsexternal

Other

Posted 15 days ago

Job description

Utilization Management RN
We're actively seeking qualified candidates for a Utilization Management Coordinator / RN opportunity supporting inpatient utilization management and care coordination.
This position is remote; however, candidates must reside in Pennsylvania, New Jersey, or Delaware to be eligible for potential conversion.
Key Requirements
  • Active Pennsylvania RN license required
  • Post-acute care experience required
  • Minimum of 3 years of acute-care clinical experience in a hospital or healthcare setting
  • Utilization management and/or discharge planning experience strongly preferred
  • Experience reviewing medical necessity, level of care, continued stay, and length of stay
  • Experience working with clinical criteria such as InterQual or similar tools preferred
Position Overview
The Utilization Management Coordinator / RN performs utilization management reviews for inpatient hospital admissions and works closely with providers, hospital case management teams, Medical Directors, members, and families to promote high-quality, cost-effective care.
This individual will evaluate medical necessity and continued stay, identify discharge planning needs, and help facilitate transitions to the most appropriate level and setting of care.
Responsibilities
  • Perform telephonic utilization management reviews for inpatient hospital admissions.
  • Evaluate medical necessity, appropriate level of care, continued stay, and length of stay using established clinical criteria.
  • Review treatment plans and collaborate with attending physicians and hospital utilization review teams regarding continued inpatient needs.
  • Identify admissions that no longer meet established criteria and escalate cases to Medical Directors for review.
  • Present relevant clinical information to Medical Directors regarding the member's condition, treatment plan, discharge needs, and potential home or post-acute care requirements.
  • Proactively identify hospitalized members requiring discharge planning support.
  • Collaborate with hospital case managers, physicians, members, and families to facilitate safe and timely transitions to the most appropriate setting.
  • Evaluate potential alternative levels of care and post-acute services when appropriate.
  • Refer members to Case Management and Disease Management programs when additional support is needed.
  • Identify potential quality-of-care concerns, including delays in care, and escalate appropriately.
  • Maintain timely and accurate documentation of utilization review activities and clinical determinations.
  • Ensure utilization decisions comply with applicable state, federal, and accreditation requirements.
  • Develop strong working relationships with providers while delivering a high level of customer service.
  • Identify utilization trends and potential areas for improvement and communicate findings to leadership.
  • Support provider education related to managed care and utilization management processes.
Qualifications
  • Active Pennsylvania Registered Nurse (RN) license required.
  • Minimum of 3 years of acute-care clinical experience in a hospital or healthcare environment.
  • Post-acute care experience required.
  • Previous utilization management, utilization review, concurrent review, case management, and/or discharge planning experience preferred.
  • Strong understanding of medical necessity, level-of-care determination, discharge planning, and transitions of care.
  • Excellent clinical judgment and problem-solving skills.
  • Strong written and verbal communication skills with the ability to effectively collaborate with physicians, providers, and multidisciplinary teams.
  • Highly organized with the ability to manage multiple cases and competing priorities.
  • Strong team-oriented approach and commitment to quality patient care.

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