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Utilization Management Nurse Jobs in Utah (NOW HIRING)

Imh

Manager Utilization and Care Management

Murray, UT · On-site +1

$44.99 - $69.44/hr

The Clinical Manager collaborates with nursing leaders, physicians, and other stakeholders to ... Utilization review Experience * Care management Experience * Team Performance management

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Utilization Management Nurse information

See Utah salary details

$35.5K

$81.5K

$148.4K

How much do utilization management nurse jobs pay per year?

As of Aug 25, 2026, the average yearly pay for utilization management nurse in Utah is $81,462.00, according to ZipRecruiter salary data. Most workers in this role earn between $58,700.00 and $95,100.00 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.

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Utilization Management Nurse jobs near you
Infographic showing various Utilization Management Nurse job openings in Utah as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 16% Part Time, and 2% Contract. Highlights an 82% Physical, 3% Hybrid, and 15% Remote job distribution, with an average salary of $81,462 per year, or $39.2 per hour.

Utilization Management Coordinator

Salt Lake City, UT • On-site

University of Utah Health
Colleges, Universities, and Professional Schools • 10K+ employees

7.2

Company rating: 7.2 out of 10

Based on 159 frontline employees who took The Breakroom Quiz

386th of 622 rated colleges and universities

People enjoy working here

Good employer

Recommended by students

Learn more about University of Utah Healthexternal

Other

Re-posted 20 days ago

Job description

Overview
As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission. EO/AA
This position is responsible for assisting with the coordination of utilization review, concurrent review and medical necessity review. Provides customer service and interaction with providers and members. This position is not responsible for providing care to patients.
Corporate Overview: The University of Utah is a Level 1 Trauma Center and is nationally ranked and recognized for our academic research, quality standards and overall patient experience. Our five hospitals and eleven clinics provide excellence in our comprehensive services, medical advancement, and overall patient outcomes.
Responsibilities
Essential Functions
  • Receives requests for prior authorization, concurrent review, post service, or a claim review, and enters the request in the Utilization Management Platform.
  • Checks eligibility, network status, procedure coverage, prior authorization status, and obtains clinical records in order to prepare authorization for RN or MD review.
  • Communicates the authorization determination to the requestor and/or member.
  • Answers and/or responds to calls from operational phone queues.
  • Assists providers and members by confirming benefits, verifying member eligibility, quoting prior authorization status and answering questions about prior authorizations.
  • Ensures timely notification of decisions to members and providers by fax, mail and telephone.
  • Facilitates Utilization Management processes with Medical Review Officers, UM Nurses, hospitals, physicians and other various internal and external customers.
  • Maintain understanding of business rules and regulatory requirements pertaining to UM processes and operations.
  • Other duties as assigned for preservice, concurrent review, post service and claim reviews.
Knowledge / Skills / Abilities
  • Demonstrated potential ability to perform the essential functions as outlined above.
  • Demonstrated human relations and effective communication skills.
  • Demonstrated computer literacy.
  • Ability to handle highly sensitive and confidential issues in a professional manner.
  • Ability to prioritize and organize tasks.

Qualifications
Required
  • Two years of health care experience or education equivalency.
  • Understanding of medical terminology.
  • Previous experience in a utilization review setting.

Qualifications (Preferred)
Preferred
  • Bachelor's degree in a health-related discipline, business, or the equivalency.
  • Coding (CPT, ICD-10, HCPCS and hospital billing codes).
Working Conditions and Physical Demands
Employee must be able to meet the following requirements with or without an accommodation.
  • This is a sedentary position that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.

Physical Requirements
Color Determination, Far Vision, Listening, Manual Dexterity, Near Vision, Sitting, Speaking, Standing
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About University of Utah

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The University of Utah is the state’s flagship institution of higher education, with 18 schools and colleges, more than 100 undergraduate majors and graduate programs, and an enrollment of more than 38,000 students. It is a member of the Association of American Universities—an invitation-only, prestigious group of 71 leading research institutions. The U is advancing a new national model for higher education that delivers societal impact through education, research, health care, and community service, while making social, economic, and cultural contributions that improve lives across Utah and around the world.

Industry

Colleges, universities, and professional schools

Company size

10,000+ Employees

Headquarters location

Salt Lake City, UT, US

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