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Utilization Management Nurse Jobs in Tennessee (NOW HIRING)

Covenant Health

RN UTILIZATION MGMT I

Knoxville, TN · On-site

Overview Registered Nurse Utilization Management Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health is the region's top-performing healthcare network with 10 ...

Covenant Health

RN UTILIZATION MGMT I

Knoxville, TN

Registered Nurse Utilization Management Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health is the region's top-performing healthcare network with 10 hospitals ...

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Utilization Management Nurse information

See Tennessee salary details

$35.4K

$81.2K

$147.9K

How much do utilization management nurse jobs pay per year?

As of Aug 30, 2026, the average yearly pay for utilization management nurse in Tennessee is $81,216.00, according to ZipRecruiter salary data. Most workers in this role earn between $58,500.00 and $94,800.00 per year, depending on experience, location, and employer.

What is a utilization management nurse?

A Utilization Management Nurse is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services provided to patients. They review medical records and treatment plans to ensure that care meets established guidelines and is cost-effective. Utilization Management Nurses work with healthcare providers, insurance companies, and patients to coordinate care and prevent unnecessary procedures or hospitalizations. Their goal is to support high-quality patient care while managing healthcare costs.

What does a utilization management nurse do?

A utilization management nurse ensures that healthcare services are administered appropriately. Their job responsibilities include working in a hospital, health practice, or other clinical setting reviewing patient clinical records, drafting clinical appeals, and overseeing staff members. The qualifications for a utilization management nurse include a nursing degree and a registered nursing license. Most people in this job also have career experience in case management and utilization review.

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

To thrive as a Utilization Management Nurse, you need a registered nursing license, strong clinical judgment, and experience in case management or utilization review. Familiarity with medical management software, InterQual or Milliman guidelines, and insurance authorization processes is typically required. Excellent analytical thinking, communication, and negotiation skills help you coordinate with providers and advocate for patients. These competencies ensure appropriate resource use, compliance with regulations, and optimal patient outcomes.

What are some common challenges a utilization management nurse faces when coordinating care between providers and insurance companies?

A Utilization Management Nurse often navigates the challenge of balancing patient advocacy with insurance guidelines, ensuring that care recommendations meet both clinical standards and payer requirements. Communicating complex medical information to both providers and insurance representatives can be demanding, especially when there are disagreements about coverage or medical necessity. Additionally, staying updated on changing policies and maintaining thorough documentation under tight deadlines are frequent aspects of the role. Strong collaboration skills and attention to detail are essential for success in this position.

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

AspectUtilization Management NurseCase Manager
CredentialsRN license, certifications in utilization reviewRN license, case management certification often preferred
Work EnvironmentInsurance companies, healthcare organizations, utilization review departmentsHospitals, community health agencies, insurance companies
Primary FocusReviewing medical necessity and appropriateness of servicesCoordinating patient care and discharge planning

Utilization Management Nurses primarily focus on reviewing medical necessity and approving healthcare services, while Case Managers coordinate patient care and facilitate discharge planning. Both roles require RN licensure and work within healthcare or insurance settings, but their core responsibilities differ in scope and focus.

More about Utilization Management Nurse jobs

What are the most commonly searched types of Utilization Management Nurse jobs in Tennessee?

The most popular types of Utilization Management Nurse jobs in Tennessee are:

What are popular job titles related to Utilization Management Nurse jobs in Tennessee?

For Utilization Management Nurse jobs in Tennessee, the most frequently searched job titles are:

What job categories do people searching Utilization Management Nurse jobs in Tennessee look for?

The top searched job categories for Utilization Management Nurse jobs in Tennessee are:

What cities in Tennessee are hiring for Utilization Management Nurse jobs?

Cities in Tennessee with the most Utilization Management Nurse job openings:

What are popular job titles related to Utilization Management Nurse jobs in TN?

For Utilization Management Nurse jobs in TN, the most frequently searched job titles are:

Utilization Management Nurse jobs near you
Infographic showing various Utilization Management Nurse job openings in Tennessee as of August 2026, with employment types broken down into 67% Full Time, 22% Part Time, and 11% Contract. Highlights an 78% In-person, 11% Hybrid, and 11% Remote job distribution, with an average salary of $81,216 per year, or $39 per hour.

Utilization Management Nurse

ArchWell Health

Nashville, TN • On-site

Other

Re-posted 20 days ago

ArchWell Health rating

8.0

Company rating: 8.0 out of 10

Based on 20 frontline employees who took The Breakroom Quiz

3rd of 245 rated social care providers

Job description

Utilization Management Nurse

Reporting to the Director of Utilization Management, the Utilization Management Nurse is responsible for ensuring that patients receive appropriate, cost-effective care by reviewing and evaluating medical services, treatments, and procedures. This role identifies trends for opportunities to educate and collaborate with healthcare providers, patients, and specialists to optimize resource utilization and improve patient outcomes.

Duties/Responsibilities
  • Conducts prospective, concurrent, and retrospective utilization reviews for medical necessity to ensure treatment and services are appropriate and necessary by reviewing medical records and treatment plans.
  • Works collaboratively with healthcare providers and Medical Directors to provide guidance on approvals or requests for health plan determination reviews as applicable utilizing CMS clinical guidelines and insurance policies.
  • Maintains accurate and detailed records of reviews, interventions, and communications to ensure adherence to health plan requirements and organizational policies.
  • Analyze utilization trends to ensure progress towards organizational goals
  • Educates healthcare providers and patients regarding appropriate levels of care and service criteria and guidelines.
  • Collaborates with Network and specialists to identify opportunities to educate on value-based care, resolve specialty gaps by markets, improve cost-effectiveness and coordination of care to meet patient needs.
Required Skills/Abilities
  • Strong knowledge of utilization management functions in value-based care, including data analysis, claims review, reimbursement practices, and medical records reviews.
  • Thorough, in-depth knowledge of evidence-based practice, legal rules and regulations and best practices in healthcare
  • Ability to effectively leverage business and organizational knowledge within and across functional areas
  • Must possess a high degree of emotional intelligence and integrity, driven and focused work ethic
  • Continuous desire to learn and embrace new methods; ability to adapt and be resilient.
  • Self-starter with the ability to think creatively and work effectively
  • Ability to build a relationship and work effectively with various seniorities and diverse populations.
  • Excellent critical reasoning, decision-making, and problem-solving skills to make informed decisions and ensure effective resource utilization while maintaining quality patient care.
  • Willingness and ability to travel, up to 20%
Education and Experience
  • AA/AS degree in Nursing required; BA/BS degree in Nursing (BSN) or Healthcare Administration preferred
  • A valid, active Registered Nurse (RN) license in state(s) of employment required
  • A minimum of 3 years', current direct utilization management required
  • Work in an acute care facility, community-based clinic, public health department or specialization with the senior population preferred
  • Proficient PC skills
  • Fluency in Spanish or other languages spoken by people in the communities we serve is desirable, but not required

ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.

What ArchWell Health employees say

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Hours and flexibility

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About ArchWell Health

Sourced by ZipRecruiter

At ArchWell Health, we help our members lead healthier lives through superior senior primary care and stronger patient-to-doctor relationships. You’ll find plenty of reasons to love being an ArchWell Health member. You’ll also discover that they add up to something huge—a healthier and happier you.

Industry

Outpatient health care

Company size

11 - 50 Employees

Headquarters location

Nashville, TN, US

Year founded

2020

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