The Surgical UR RN is expected to serve as a resource for utilization management best practices and support broader utilization review functions as operational needs dictate. Qualifications Required ...
The Surgical UR RN is expected to serve as a resource for utilization management best practices and support broader utilization review functions as operational needs dictate. Qualifications Required ...
The Surgical UR RN is expected to serve as a resource for utilization management best practices and support broader utilization review functions as operational needs dictate. Required Education:
The Surgical UR RN is expected to serve as a resource for utilization management best practices and support broader utilization review functions as operational needs dictate. Required Education:
The Surgical UR RN is expected to serve as a resource for utilization management best practices and support broader utilization review functions as operational needs dictate. Qualifications Required ...
The Surgical UR RN is expected to serve as a resource for utilization management best practices and support broader utilization review functions as operational needs dictate. Qualifications Required ...
The Surgical UR RN is expected to serve as a resource for utilization management best practices and support broader utilization review functions as operational needs dictate. Qualifications Required ...
The Surgical UR RN is expected to serve as a resource for utilization management best practices and support broader utilization review functions as operational needs dictate. Qualifications Required ...
The Surgical UR RN is expected to serve as a resource for utilization management best practices and support broader utilization review functions as operational needs dictate. Qualifications Required ...
The Surgical UR RN is expected to serve as a resource for utilization management best practices and support broader utilization review functions as operational needs dictate. Qualifications Required ...
... utilization managers, medical social workers, and bedside RNs to ensure timely progression of ... patients to appropriate levels of care, • Conduct patient assessments to determine readmission ...
... utilization managers, medical social workers, and bedside RNs to ensure timely progression of ... patients to appropriate levels of care, • Conduct patient assessments to determine readmission ...
Overview The RN Case Manager is to support the physician and interdisciplinary team in facilitating ... This role integrates and coordinates Utilization management, care coordination and discharge ...
Overview The RN Case Manager is to support the physician and interdisciplinary team in facilitating ... This role integrates and coordinates Utilization management, care coordination and discharge ...
Overview The RN Case Manager is to support the physician and interdisciplinary team in facilitating ... This role integrates and coordinates Utilization management, care coordination and discharge ...
Overview The RN Case Manager is to support the physician and interdisciplinary team in facilitating ... This role integrates and coordinates Utilization management, care coordination and discharge ...
Overview The RN Case Manager is to support the physician and interdisciplinary team in facilitating ... This role integrates and coordinates Utilization management, care coordination and discharge ...
Overview The RN Case Manager is to support the physician and interdisciplinary team in facilitating ... This role integrates and coordinates Utilization management, care coordination and discharge ...
Overview The RN Case Manager is to support the physician and interdisciplinary team in facilitating ... This role integrates and coordinates Utilization management, care coordination and discharge ...
Overview The RN Case Manager is to support the physician and interdisciplinary team in facilitating ... This role integrates and coordinates Utilization management, care coordination and discharge ...
Overview The RN Case Manager is to support the physician and interdisciplinary team in facilitating ... This role integrates and coordinates Utilization management, care coordination and discharge ...
Overview The RN Case Manager is to support the physician and interdisciplinary team in facilitating ... This role integrates and coordinates Utilization management, care coordination and discharge ...
Overview The RN Case Manager is to support the physician and interdisciplinary team in facilitating ... This role integrates and coordinates Utilization management, care coordination and discharge ...
Overview The RN Case Manager is to support the physician and interdisciplinary team in facilitating ... This role integrates and coordinates Utilization management, care coordination and discharge ...
Overview The RN Case Manager is to support the physician and interdisciplinary team in facilitating ... This role integrates and coordinates Utilization management, care coordination and discharge ...
Overview The RN Case Manager is to support the physician and interdisciplinary team in facilitating ... This role integrates and coordinates Utilization management, care coordination and discharge ...
RN Case Manager The RN Case Manager is to support the physician and interdisciplinary team in ... This role integrates and coordinates Utilization management, care coordination and discharge ...
RN Case Manager The RN Case Manager is to support the physician and interdisciplinary team in ... This role integrates and coordinates Utilization management, care coordination and discharge ...
RN Case Manager The RN Case Manager is to support the physician and interdisciplinary team in ... This role integrates and coordinates Utilization management, care coordination and discharge ...
RN Case Manager The RN Case Manager is to support the physician and interdisciplinary team in ... This role integrates and coordinates Utilization management, care coordination and discharge ...
RN Case Manager The RN Case Manager is to support the physician and interdisciplinary team in ... This role integrates and coordinates Utilization management, care coordination and discharge ...
RN Case Manager The RN Case Manager is to support the physician and interdisciplinary team in ... This role integrates and coordinates Utilization management, care coordination and discharge ...
Overview The RN Case Manager is to support the physician and interdisciplinary team in facilitating ... This role integrates and coordinates Utilization management, care coordination and discharge ...
Overview The RN Case Manager is to support the physician and interdisciplinary team in facilitating ... This role integrates and coordinates Utilization management, care coordination and discharge ...
The RN Case Manager is to support the physician and interdisciplinary team in facilitating patient ... This role integrates and coordinates Utilization management, care coordination and discharge ...
The RN Case Manager is to support the physician and interdisciplinary team in facilitating patient ... This role integrates and coordinates Utilization management, care coordination and discharge ...
The RN Case Manager is to support the physician and interdisciplinary team in facilitating patient ... This role integrates and coordinates Utilization management, care coordination and discharge ...
The RN Case Manager is to support the physician and interdisciplinary team in facilitating patient ... This role integrates and coordinates Utilization management, care coordination and discharge ...
Overview The RN Case Manager is to support the physician and interdisciplinary team in facilitating ... This role integrates and coordinates Utilization management, care coordination and discharge ...
Overview The RN Case Manager is to support the physician and interdisciplinary team in facilitating ... This role integrates and coordinates Utilization management, care coordination and discharge ...
Utilization Management Nurse information
See Decatur, AL salary details
$36.6K - $47.1K
15% of jobs
$47.1K - $57.7K
8% of jobs
$59.2K is the 25th percentile. Wages below this are outliers.
$57.7K - $68.3K
15% of jobs
The median wage is $74.9K / yr.
$68.3K - $78.8K
20% of jobs
$78.8K - $89.4K
11% of jobs
$94.7K is the 75th percentile. Wages above this are outliers.
$89.4K - $100K
13% of jobs
$100K - $110.5K
5% of jobs
$110.5K - $121.1K
3% of jobs
$121.1K - $131.7K
4% of jobs
$131.7K - $142.2K
3% of jobs
$142.2K - $152.8K
3% of jobs
$36.6K
$83.9K
$152.8K
How much do utilization management nurse jobs pay per year?
As of Aug 6, 2026, the average yearly pay for utilization management nurse in Decatur, AL is $83,886.00, according to ZipRecruiter salary data. Most workers in this role earn between $60,500.00 and $98,000.00 per year, depending on experience, location, and employer.
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 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 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 is the difference between Utilization Management Nurse vs Case Manager?
| Aspect | Utilization Management Nurse | Case Manager |
|---|---|---|
| Credentials | RN license, certifications in utilization review | RN license, case management certification often preferred |
| Work Environment | Insurance companies, healthcare organizations, utilization review departments | Hospitals, community health agencies, insurance companies |
| Primary Focus | Reviewing medical necessity and appropriateness of services | Coordinating 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.
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.
More about Utilization Management Nurse jobs
What are popular job titles related to Utilization Management Nurse jobs in Decatur, AL? For Utilization Management Nurse jobs in Decatur, AL, the most frequently searched job titles are:
What cities near Decatur, AL are hiring for Utilization Management Nurse jobs? Cities near Decatur, AL with the most Utilization Management Nurse job openings:
Other
Re-posted yesterday
Job description
Surgical Utilization Review Registered Nurse
The Surgical Utilization Review Registered Nurse is responsible for conducting concurrent medical necessity reviews to ensure appropriate level-of-care determinations, regulatory compliance, and reimbursement integrity. This position serves as a liaison between physicians, advanced practice providers, nursing, case management, revenue cycle, and payer organizations to facilitate accurate patient status assignment, timely authorization management, and denial prevention. The primary focus of this role is surgical utilization review, including pre-operative, post-operative, and procedural patient populations. Responsibilities include validating compliance with Medicare, commercial payer, and organizational requirements, including Inpatient Only (IPO) procedures, Two-Midnight Rule criteria, observation services, and medical necessity requirements. This role requires strong collaboration with surgeons, physician assistants, nurse practitioners, hospitalists, and clinical staff to obtain clarifying documentation, facilitate timely order placement, and support appropriate status determinations. The Surgical UR RN is expected to serve as a resource for utilization management best practices and support broader utilization review functions as operational needs dictate.
QualificationsRequired Education: Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) or Licensed Registered Nurse
Preferred Education: Bachelors Science Nursing or higher
Required Experience: 2 years previous nursing experience
Preferred Experience: Utilization Review or Case Management experience
Required License/Registration/Certification: Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) or Licensed Registered Nurse
Preferred License/Registration/Certification: ACM or CCM Certification
Computer Skills Required: Data entry skills; Demonstrable skills with Google Docs, Google Sheets, Microsoft Suite and email applications.
About Huntsville Hospital
Sourced by ZipRecruiter
Huntsville Hospital, located in Huntsville, Alabama, USA, operates in the healthcare industry. The organization's official website can be visited at huntsvillehospital.org. The hospital is a community-owned, not-for-profit healthcare system that was first established in 1895. This institution of paramount importance currently offers comprehensive health services dedicated to meeting the diverse needs of its community. The institution provides its services across a broad spectrum; this includes a children's hospital, women and infants’ hospital, a senior-orientated network, surgical services, orthopedic services, and more. Above all, Huntsville Hospital's core values emphasize patient safety, dignity, and care. Their mission is to deliver high-quality care and create a healthier community.
Industry
Hospitals
Company size
10,000+ Employees
Headquarters location
Huntsville, AL, US