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Utilization Management Coordinator Rn Jobs (NOW HIRING)

Humana

Utilization Management Registered Nurse

As a Utilization Management Registered Nurse: * You will use clinical nursing skills to interpret ... You will help deliver coordinated care for our members * You will understand department, segment ...

Humana

Utilization Management Registered Nurse

As a Utilization Management Registered Nurse: * You will use clinical nursing skills to interpret ... You will help deliver coordinated care for our members * You will understand department, segment ...

Humana

Utilization Management Registered Nurse

As a Utilization Management Registered Nurse: * You will use clinical nursing skills to interpret ... You will help deliver coordinated care for our members * You will understand department, segment ...

OpTech LLC

RN Utilization Management

Detroit, MI · On-site

Detroit, Michigan Registered Nurse (RN) Contract We are seeing a Michigan RN Utilization Manager ... care coordination, etc. 6. Identify and document quality of care issues; resolve or route to ...

WakeMed Health

Patient Flow Coordinator, RN

Raleigh, NC · On-site

$17 - $22.25/hr

Patient Flow Coordinator, RN The Patient Flow Coordinator, RN assists in facilitating the admission ... utilization management regulatory requirements. The Capacity and Transfer Management Center ...

Blaze Health

Utilization Management RN

Robbinsdale, MN · On-site

About this position The Utilization Management RN, under the supervision of the Utilization ... They provide clinically based information to assist with care coordination and support the delivery ...

OpTech

RN Utilization Management

Detroit, MI · On-site

Detroit, Michigan Registered Nurse (RN) Contract We are seeing a Michigan RN Utilization Manager ... care coordination, etc. 6. Identify and document quality of care issues; resolve or route to ...

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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 11, 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 Registered Nurse

Madera, CA • On-site

Valley Children's Healthcare
Hospitals • 1 - 5K employees
Learn more about Valley Children's Healthcareexternal

$57.29 - $81.72/day

Other

Re-posted 13 days ago

Valley Children's Hospital rating

6.4

Company rating: 6.4 out of 10

Based on 14 frontline employees who took The Breakroom Quiz

Job description

Job Summary:
The Utilization Management Nurse supports the case management department by providing a variety of utilization management functions including but not limited to daily screening of patient admission relative to specified criteria, active involvement in denial management, acting as a resource to staff regarding clinical criteria, communication with payors to address concerns and other duties as assigned. The Utilization Management Nurse will work collaboratively with the Utilization Nurse Program Coordinator to ensure compliance with regulatory, organizational and department requirements. The Utilization Review Nurse will receive direction from the Utilization Review Program Coordinator for daily and long term tasks and projects.
Qualifications:
Education
  • Associates Degree Nursing (required)
  • Bachelors Degree Nursing or related field (preferred)
Licenses and Certifications
  • RN - Registered Nurse License - CA-BRN - California Board of Registered Nursing (required)
Work Experience
  • Minimum three (3) years Full time equivalent RN experience in an acute care hospital. (required)
  • Pediatric experience and experience in Case Management and/or Utilization Review. (preferred)
Skills and Abilities
  • Knowledge of UM regulations.
    Knowledge of private and public payer reimbursement practices and procedures.
    Excellent organizational and communication skills and ability to work with a variety of health care professionals.
    Ability to work independently.
  • Computer Skills Proficiency with word processing, spreadsheets and database software.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Compensation Range:
$57.29 - $81.72
Workshift:
Day (United States of America)
Position Exempt:
No
FTE %:
90
Scheduled Weekly Hours:
36
Daily Hours:
8
Have Questions?
Call Recruitment Services at 559-353-7071 or email us at recruiting@valleychildrens.org
Disclaimer: Final compensation will be dependent upon skills and experience.

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