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Utilization Management Nurse Consultant Jobs (NOW HIRING)

Oak St. Health

Utilization Management Nurse Consultant-1

$26.01 - $74.78/hr

Must have active current and unrestricted RN licensure in state of residence. Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours. This ...

New

Oak St. Health

Utilization Management Nurse Consultant-1

$26.01 - $74.78/hr

Must have active current and unrestricted RN licensure in state of residence. Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours. This ...

New

Oak St. Health

Utilization Management Nurse Consultant-1

$26.01 - $74.78/hr

Must have active current and unrestricted RN licensure in state of residence. Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours. This ...

New

Intus Care

Utilization Management Nurse

$80K - $95K/yr

Utilization Management Nurse IntusCare is the only end-to-end ecosystem built specifically to help Programs of All-Inclusive Care for the Elderly (PACE) programs deliver exceptional care, strengthen ...

New

Intus, Inc

Utilization Management Nurse

$80K - $95K/yr

Role Overview The Utilization Management Nurse plays a critical role in ensuring high-quality, cost-effective, and compliant care for PACE participants supported by IntusCare. This individual ...

HealthONE

Utilization Management Nurse

Dalton, GA · On-site

Job Title Utilization Management Nurse The Utilization Management Nurse performs comprehensive clinical reviews of requested services utilizing clinical criteria, received through various mechanisms.

Intus Care

Contract Utilization Management Nurse

$42/hr

Contract Utilization Management Nurse IntusCare is the only end-to-end ecosystem built specifically to help Programs of All-Inclusive Care for the Elderly (PACE) programs deliver exceptional care ...

Access Dubuque

Utilization Management Nurse

Dubuque, IA · On-site

Utilization Management Nurse Cottingham & Butler/ SISCO 1 Positions ID: 4627707008 Posted On 07/01/2025 Refreshed On 07/15/2026 Job Overview Utilization Management Nurse Location : Onsite in Dubuque ...

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Utilization Management Nurse Consultant information

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$39K

$89.5K

$163K

How much do utilization management nurse consultant jobs pay per year?

As of Aug 15, 2026, the average yearly pay for utilization management nurse consultant 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 nurse consultant?

To thrive as a Utilization Management Nurse Consultant, you need a current RN license, experience in clinical nursing, and a solid understanding of healthcare regulations and medical necessity criteria. Familiarity with utilization review software, electronic health records (EHRs), and guidelines such as InterQual or MCG is typically required. Excellent critical thinking, attention to detail, and effective communication skills help you collaborate with healthcare providers and advocate for appropriate patient care. These skills ensure accurate assessment of medical services, regulatory compliance, and optimal patient outcomes while managing healthcare costs.

What are some common challenges utilization management nurse consultants face when collaborating with healthcare providers and insurance companies?

Utilization Management Nurse Consultants often navigate complex situations where they must balance patient care needs with insurance policies and cost considerations. Challenges can include negotiating medical necessity with physicians, addressing gaps in documentation, and ensuring timely communication between providers and payers. Maintaining a collaborative and diplomatic approach is essential, as the role requires advocating for quality patient outcomes while adhering to regulatory and organizational guidelines. Effective time management and strong communication skills are key to overcoming these challenges and building positive relationships across interdisciplinary teams.

What does a utilization management nurse consultant do?

A Utilization Management Nurse Consultant is a registered nurse who evaluates the medical necessity, appropriateness, and efficiency of healthcare services, procedures, and facilities. They review patient medical records, coordinate with healthcare providers, and help ensure that care provided aligns with insurance guidelines and clinical standards. Their goal is to promote quality care while managing costs and preventing unnecessary treatments. Utilization Management Nurse Consultants often work for insurance companies, hospitals, or third-party review organizations.

What is the difference between Utilization Management Nurse Consultant vs Utilization Review Nurse?

AspectUtilization Management Nurse ConsultantUtilization Review Nurse
CertificationsRN license, possibly certifications in case management or utilization reviewRN license, certifications in case management or utilization review often preferred
Work EnvironmentCollaborates with healthcare providers, insurance companies, and case managers in clinical review settingsPerforms chart reviews and authorizations mainly within insurance or healthcare organizations
Employer & Industry UsageHospitals, insurance companies, healthcare consulting firmsInsurance companies, managed care organizations, healthcare providers

While both roles involve reviewing patient cases to ensure appropriate care, the Utilization Management Nurse Consultant typically provides expert guidance, policy development, and complex case analysis, whereas the Utilization Review Nurse focuses on performing clinical reviews and authorizations within established protocols.

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Utilization Management Nurse Consultant jobs near you
Infographic showing various Utilization Management Nurse Consultant job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 14% Part Time, and 3% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution, with an average salary of $89,483 per year, or $43 per hour.

Utilization Management Nurse

Careers Integrated Resources Inc

Downers Grove, IL • On-site

Other

Posted 5 days ago

Job description

Utilization Management Nurse

Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.

Job Description

Job Title: Utilization Management Nurse Consultant

Duration: 6 months (Possible ext)

Location: Downers Grove, IL

Responsibilities:

· Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities.

· Develops, implements and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work.

· Services and strategies, policies and programs are comprised of network management, clinical coverage, and policies.

· Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Requires an RN (consideration for LCSW) with unrestricted active license.

· Fundamental Components & Physical Requirements include but are not limited to

· (* denotes essential functions)

· Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members

· Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care

· Communicates with providers and other parties to facilitate care/treatment

· Identifies members for referral opportunities to integrate with other products, services and/or programs

· Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization

· Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function

· Background/Experience Desired

· Managed Care experience preferred

· 3-5 years of clinical experience required

· Education and Certification Requirements

· RN consideration for LCSW) with current unrestricted state license required.

· Additional Information (situational competencies, skills, work location requirements, etc.)

· Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding

· Effective communication skills, both verbal and written.

· Ability to multitask, prioritize and effectively adapt to a fast paced changing environment

· Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.

· Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.

· Typical office working environment with productivity and quality expectations

· Additional for Behavioral Health:

· Experience in Behavioral Health required

· Managed Care experience preferred.

· Onsite location will be Downers Grove.

· Work hours from 8:00 am until 5:00 pm with weekend rotation among the team of clinicians (approximated to rotate once every 1 & ½ to 2 months).

· The ability to create and process clinical for Behavioral Health cases on a live phone queue, create and process clinical to of a determination to the provider.

Additional Job Details :

· Required to have computer skills.

· Work with-toggle between up to 5-6 applications/systems at a time.

· Travel Required: No

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