ZipRecruiter

Log In

1

Utilization Management Nurse Jobs in Decatur, GA

Elevance Health

Med Mgmt Nurse (contract)

Decatur, GA · Hybrid

The nurse should be familiar with utilization management and case review. Excellent computer skills. * Should be familiar with MCG or InterQual Job Type: Contract Opportunity Additional Details:

Kaiser Permanente

Lead RN Utilization Management

Clarkston, GA · On-site

$33.50 - $45.50/hr

Acts independently to manage multiple scheduling tasks and assignments. * Evaluates emergency situations and leads the nursing response to clinical emergencies. * Phishes the schedule daily (2-3 days ...

Kaiser Permanente

Lead RN Utilization Management

Brookhaven, GA · On-site

$33.50 - $45.25/hr

Acts independently to manage multiple scheduling tasks and assignments. * Evaluates emergency situations and leads the nursing response to clinical emergencies. * Phishes the schedule daily (2-3 days ...

Elevance Health

Med Mgmt Nurse (contract)

Decatur, GA · Hybrid

The nurse should be familiar with utilization management and case review. Excellent computer skills. * Should be familiar with MCG or InterQual Job Type: Contract Opportunity Additional Details:

Kaiser Permanente

Lead RN Utilization Management

Mableton, GA · On-site

$31 - $41.75/hr

Acts independently to manage multiple scheduling tasks and assignments. * Evaluates emergency situations and leads the nursing response to clinical emergencies. * Phishes the schedule daily (2-3 days ...

Kaiser Permanente

Lead RN Utilization Management

Dunwoody, GA · On-site

$33.75 - $45.50/hr

Acts independently to manage multiple scheduling tasks and assignments. * Evaluates emergency situations and leads the nursing response to clinical emergencies. * Phishes the schedule daily (2-3 days ...

Kaiser Permanente

Lead RN Utilization Management

Riverdale, GA · On-site

$30.75 - $41.50/hr

Acts independently to manage multiple scheduling tasks and assignments. * Evaluates emergency situations and leads the nursing response to clinical emergencies. * Phishes the schedule daily (2-3 days ...

Kaiser Permanente

Lead RN Utilization Management

East Point, GA · On-site

$32.75 - $44.25/hr

Acts independently to manage multiple scheduling tasks and assignments. * Evaluates emergency situations and leads the nursing response to clinical emergencies. * Phishes the schedule daily (2-3 days ...

Kaiser Permanente

Lead RN Utilization Management

Atlanta, GA

$32.75 - $44.25/hr

Acts independently to manage multiple scheduling tasks and assignments. * Evaluates emergency situations and leads the nursing response to clinical emergencies. * Phishes the schedule daily (2-3 days ...

Kaiser Permanente

Lead RN Utilization Management

Atlanta, GA · On-site

$32.75 - $44.25/hr

Acts independently to manage multiple scheduling tasks and assignments. * Evaluates emergency situations and leads the nursing response to clinical emergencies. * Phishes the schedule daily (2-3 days ...

Kaiser Permanente

Lead RN Utilization Management

Chamblee, GA · On-site

$33.25 - $45.25/hr

Acts independently to manage multiple scheduling tasks and assignments. * Evaluates emergency situations and leads the nursing response to clinical emergencies. * Phishes the schedule daily (2-3 days ...

Kaiser Permanente

Lead RN Utilization Management

Marietta, GA · On-site

$30.75 - $41.75/hr

Acts independently to manage multiple scheduling tasks and assignments. * Evaluates emergency situations and leads the nursing response to clinical emergencies. * Phishes the schedule daily (2-3 days ...

Kaiser Permanente

Lead RN Utilization Management

Norcross, GA · On-site

$32.25 - $43.50/hr

Acts independently to manage multiple scheduling tasks and assignments. * Evaluates emergency situations and leads the nursing response to clinical emergencies. * Phishes the schedule daily (2-3 days ...

Kaiser Permanente

Lead RN Utilization Management

Kennesaw, GA · On-site

$31.50 - $42.50/hr

Acts independently to manage multiple scheduling tasks and assignments. * Evaluates emergency situations and leads the nursing response to clinical emergencies. * Phishes the schedule daily (2-3 days ...

Kaiser Permanente

Lead RN Utilization Management

Tucker, GA · On-site

$32 - $43.25/hr

Acts independently to manage multiple scheduling tasks and assignments. * Evaluates emergency situations and leads the nursing response to clinical emergencies. * Phishes the schedule daily (2-3 days ...

Kaiser Permanente

Lead RN Utilization Management

Atlanta, GA · On-site

$32.75 - $44.25/hr

Acts independently to manage multiple scheduling tasks and assignments. * Evaluates emergency situations and leads the nursing response to clinical emergencies. * Phishes the schedule daily (2-3 days ...

previous pagenext page

Showing results 21-40

All JobsUtilization Management Nurse JobsUtilization Management Nurse Jobs in Decatur, GA

Utilization Management Nurse information

See Decatur, GA salary details

$38.1K

$87.4K

$159.1K

How much do utilization management nurse jobs pay per year?

As of Aug 18, 2026, the average yearly pay for utilization management nurse in Decatur, GA is $87,365.00, according to ZipRecruiter salary data. Most workers in this role earn between $63,000.00 and $102,000.00 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 Decatur, GA?

The most popular types of Utilization Management Nurse jobs in Decatur, GA are:

What are popular job titles related to Utilization Management Nurse jobs in Decatur, GA?

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

What job categories do people searching Utilization Management Nurse jobs in Decatur, GA look for?

The top searched job categories for Utilization Management Nurse jobs in Decatur, GA are:

What cities near Decatur, GA are hiring for Utilization Management Nurse jobs?

Cities near Decatur, GA with the most Utilization Management Nurse job openings:

Utilization Management Nurse jobs near you
Infographic showing various Utilization Management Nurse job openings in Decatur, GA as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 16% Part Time, and 2% Contract. Highlights an 84% Physical, 3% Hybrid, and 13% Remote job distribution, with an average salary of $87,365 per year, or $42 per hour.

Utilization Specialist

RiverWoods Behavioral Health

Riverdale, GA

Part-time

Re-posted yesterday

Job description

Overview

PURPOSE STATEMENT: 

Proactively monitor utilization of services for patients to optimize reimbursement for the facility.  

Responsibilities

ESSENTIAL FUNCTIONS: 

  • Act as liaison between managed care organizations and the facility professional clinical staff. 
  • Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements. 
  • Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.  
  • Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office. 
  • Conduct quality reviews for medical necessity and services provided.   
  • Facilitate peer review calls between facility and external organizations.  
  • Initiate and complete the formal appeal process for denied admissions or continued stay.  
  • Assist the admissions department with pre-certifications of care.  
  • Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates. 

OTHER FUNCTIONS:  

  • Perform other functions and tasks as assigned. 
Qualifications

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS: 

  • Required Education: High school diploma or equivalent. 
  • Preferred Education: Associate's, Bachelor's, or Master's degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field. 
  • Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred 

LICENSES/DESIGNATIONS/CERTIFICATIONS:  

  • Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services. 
  • CPR and de-escalation and restraint certification required (training available upon hire and offered by facility.   
  • First aid may be required based on state or facility requirements. 

 

ADDITIONAL REGULATORY REQUIREMENTS: 

While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances  (e.g. emergencies, changes in workload, rush jobs or technological developments) dictate. 

We are committed to providing equal  employment opportunities to all applicants for employment regardless of an individual's characteristics protected by applicable state, federal and local laws.

Employment Type: PART_TIME

Apply