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Utilization Management Nurse Jobs in Decatur, AL

Central Business Solutions

Registered Nurse

Harvest, AL · On-site

... Utilization Management or Interdisciplinary Care Management Meeting to facilitate appropriate ... Enhances nursing practice by attending all mandated in-service programs and other GHC and outside ...

divvyDOSE

Registered Nurse- Home Health

Cullman, AL · On-site

$36.98 - $81.63/hr

Registered Nurse In Home Health Explore opportunities with Alabama HomeCare of Cullman a part of ... Adheres to and participates in the agency's utilization management model You'll be rewarded and ...

divvyDOSE

Registered Nurse- Home Health

Cullman, AL

$36.98 - $81.63/hr

Registered Nurse In Home Health Explore opportunities with Alabama HomeCare of Cullman a part of ... Adheres to and participates in the agency's utilization management model You'll be rewarded and ...

IntelyCare

Registered Nurse- Home Health

Cullman, AL

$36.98 - $81.63/hr

Registered Nurse In Home Health Explore opportunities with Alabama HomeCare of Cullman a part of ... Adheres to and participates in the agency's utilization management model You'll be rewarded and ...

UMR

Registered Nurse- Home Health

Cullman, AL

$36.98 - $81.63/hr

Registered Nurse In Home Health Explore opportunities with Alabama HomeCare of Cullman a part of ... Adheres to and participates in the agency's utilization management model You'll be rewarded and ...

UMR

Registered Nurse- Home Health

Cullman, AL

$36.98 - $81.63/hr

Registered Nurse In Home Health Explore opportunities with Alabama HomeCare of Cullman a part of ... Adheres to and participates in the agency's utilization management model You'll be rewarded and ...

Optum

Registered Nurse- Home Health

Cullman, AL · On-site

$36.98 - $81.63/hr

As the Registered Nurse in Home Health you will provide and direct provisions of nursing care to ... Adheres to and participates in the agency's utilization management model You'll be rewarded and ...

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Utilization Management Nurse information

See Decatur, AL salary details

$36.6K

$83.9K

$152.8K

How much do utilization management nurse jobs pay per year?

As of May 29, 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 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, and why are they important?

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 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?

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 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 job categories do people searching Utilization Management Nurse jobs in Decatur, AL look for? The top searched job categories for Utilization Management Nurse jobs in Decatur, AL 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:
Utilization Management Nurse jobs near you
Infographic showing various Utilization Management Nurse job openings in Decatur, AL as of May 2026, with employment types broken down into 2% As Needed, 23% Full Time, 72% Part Time, and 3% Temporary. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $83,886 per year, or $40.3 per hour.

RN Case Manager - Case Manager - FT - 1st Shift

Huntsville Hospital Health System

Huntsville, AL

Other

Medical, Dental, Vision, Life, Retirement

Posted 19 days ago

Huntsville Hospital Health System rating

6.1

Company rating: 6.1 out of 10

Based on 201 frontline employees who took The Breakroom Quiz

707th of 864 rated healthcare providers

Job description

Overview
The RN Case Manager is to support the physician and interdisciplinary team in facilitating patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payers. This role integrates and coordinates Utilization management, care coordination and discharge planning functions. The Case Manager is accountable for a designated patient caseload and plans effectively in order to meet patient needs, manage the length of stay, and promote efficient use of resources.
Qualifications
Education:
Minimum of A.S.N. from an accredited college or university (BSN Preferred) and current Alabama licensure.
Experience:
Three years acute care experience required.
Additional Skills/Abilities:
Excellent interpersonal communication and negotiation skills; strong organizational and time management skills as evidenced by capacity to prioritize multiple tasks and role components; ability to work independently and exercise sound judgment in interactions with physicians, patients and their families, and payers.
About Us
Highlights of our hospitals
Huntsville Hospital was recently named Best Regional Hospital and #2 in Alabama by U.S. News & World Report. With 971 beds, a specialized Orthopedic & Spine Tower, a Level III Regional Neonatal ICU, and the largest Emergency Department and Level 1 Trauma Center in the state with our own specialized Red Shirt Trauma Program, there are many opportunities to apply your knowledge and skills. We are a certified Primary Stroke Center and named "One of the Top 100 Hospitals in the Nation with Great Heart Programs." From six cath labs and four EP labs to multiple medical and step-down units, you can continually grow your skillset! We offer a training center on campus for continuing education, Shared Governance Program, Clinical Ladder for professional development, The Daisy Award, and if you are a new grad, a Nurse Residency Program to help you transition from student to professional nurse. We care about you and your well-being by offering an excellent benefits package, childcare, health and wellness programs, an onsite employee pharmacy, a free health clinic, tuition assistance, and much more. We are committed to creating a diverse environment and proud to be an equal opportunity employer. We are a partner to the U.S. Army's Partnership for Your Success (PaYS) program.
Ask us about incentives and additional opportunities.
Huntsville Hospital Benefits:
We are committed to providing competitive benefits. Our benefits package for eligible employees includes medical, dental, vision, life insurance, flexible spending; short term and long term disability; several retirement account options with 401K organization match; nurse residency program; tuition assistance; student loan reimbursement; On-site training and education opportunities; Employee Discounts to phone providers, local restaurants, tickets to shows, apartment application and much more!
Learn more about Huntsville Hospital Health System:
  • Careers: https://careers.hhsys.org/careers-home
  • Benefits: https://careers.hhsys.org/us/en/benefits
  • Education & Professional Development: https://www.huntsvillehospital.org/education
  • Life In Huntsville: https://www.huntsvillehospital.org/about-huntsville-al

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