Supports and facilitates the design, development and implementation of Utilization Management data ... Case Management: 1. Graduate of an accredited school of nursing, with strong clinical case ...
Supports and facilitates the design, development and implementation of Utilization Management data ... Case Management: 1. Graduate of an accredited school of nursing, with strong clinical case ...
Supports and facilitates the design, development and implementation of Utilization Management data ... Case Management: 1. Graduate of an accredited school of nursing, with strong clinical case ...
Supports and facilitates the design, development and implementation of Utilization Management data ... Case Management: 1. Graduate of an accredited school of nursing, with strong clinical case ...
Supports and facilitates the design, development and implementation of Utilization Management data ... Case Management: 1. Graduate of an accredited school of nursing, with strong clinical case ...
Supports and facilitates the design, development and implementation of Utilization Management data ... Case Management: 1. Graduate of an accredited school of nursing, with strong clinical case ...
Supports and facilitates the design, development and implementation of Utilization Management data ... Case Management: 1. Graduate of an accredited school of nursing, with strong clinical case ...
Supports and facilitates the design, development and implementation of Utilization Management data ... Case Management: 1. Graduate of an accredited school of nursing, with strong clinical case ...
Supports and facilitates the design, development and implementation of Utilization Management data ... Case Management: 1. Graduate of an accredited school of nursing, with strong clinical case ...
Supports and facilitates the design, development and implementation of Utilization Management data ... Case Management: 1. Graduate of an accredited school of nursing, with strong clinical case ...
Lead risk mitigation efforts related to care management and utilization management, including ... Preferred Qualifications * MBA * Relevant professional credentials (CPA, CIA, CISSP, JD, SOA, RN, ...
Lead risk mitigation efforts related to care management and utilization management, including ... Preferred Qualifications * MBA * Relevant professional credentials (CPA, CIA, CISSP, JD, SOA, RN, ...
Lead risk mitigation efforts related to care management and utilization management, including ... Preferred Qualifications * MBA * Relevant professional credentials (CPA, CIA, CISSP, JD, SOA, RN, ...
Lead risk mitigation efforts related to care management and utilization management, including ... Preferred Qualifications * MBA * Relevant professional credentials (CPA, CIA, CISSP, JD, SOA, RN, ...
Lead risk mitigation efforts related to care management and utilization management, including ... Preferred Qualifications * MBA * Relevant professional credentials (CPA, CIA, CISSP, JD, SOA, RN, ...
Lead risk mitigation efforts related to care management and utilization management, including ... Preferred Qualifications * MBA * Relevant professional credentials (CPA, CIA, CISSP, JD, SOA, RN, ...
Care Manager - RN
Sandy Springs, GA · On-site
The RN Care Manager's primary responsibilities are to oversee care management and coordination of ... One (1) year of care / case / utilization management experience (provider and/or managed care ...
Care Manager - RN
Sandy Springs, GA · On-site
The RN Care Manager's primary responsibilities are to oversee care management and coordination of ... One (1) year of care / case / utilization management experience (provider and/or managed care ...
The RN Care Manager's primary responsibilities are to oversee care management and coordination of ... One (1) year of care / case / utilization management experience (provider and/or managed care ...
The RN Care Manager's primary responsibilities are to oversee care management and coordination of ... One (1) year of care / case / utilization management experience (provider and/or managed care ...
Care Manager - RN
Sandy Springs, GA · On-site
Responsibilities The RN Care Manager's primary responsibilities are to oversee care management and ... One (1) year of care / case / utilization management experience (provider and/or managed care ...
Care Manager - RN
Sandy Springs, GA · On-site
Responsibilities The RN Care Manager's primary responsibilities are to oversee care management and ... One (1) year of care / case / utilization management experience (provider and/or managed care ...
Responsibilities The RN Care Manager's primary responsibilities are to oversee care management and ... One (1) year of care / case / utilization management experience (provider and/or managed care ...
Responsibilities The RN Care Manager's primary responsibilities are to oversee care management and ... One (1) year of care / case / utilization management experience (provider and/or managed care ...
Care Manager - RN
Sandy Springs, GA · On-site
Responsibilities The RN Care Manager's primary responsibilities are to oversee care management and ... One (1) year of care / case / utilization management experience (provider and/or managed care ...
Care Manager - RN
Sandy Springs, GA · On-site
Responsibilities The RN Care Manager's primary responsibilities are to oversee care management and ... One (1) year of care / case / utilization management experience (provider and/or managed care ...
Care Manager - RN
Sandy Springs, GA · On-site
Responsibilities The RN Care Manager's primary responsibilities are to oversee care management and ... One (1) year of care / case / utilization management experience (provider and/or managed care ...
Care Manager - RN
Sandy Springs, GA · On-site
Responsibilities The RN Care Manager's primary responsibilities are to oversee care management and ... One (1) year of care / case / utilization management experience (provider and/or managed care ...
Nurse Practitioner
$105K - $125K/yr
Collaborate with interdisciplinary teams for utilization management. * Work with individuals with ... Board Certified NP * We would prefer a minimum of 1year internal medicine and cardiology experience.
Quick apply
Nurse Practitioner
$105K - $125K/yr
Collaborate with interdisciplinary teams for utilization management. * Work with individuals with ... Board Certified NP * We would prefer a minimum of 1year internal medicine and cardiology experience.
Nurse Practitioner
$105K - $125K/yr
We are seeking a dedicated Nurse Practitioner to join our healthcare team. The ideal candidate will ... Collaborate with interdisciplinary teams for utilization management. Work with individuals with ...
Nurse Practitioner
$105K - $125K/yr
We are seeking a dedicated Nurse Practitioner to join our healthcare team. The ideal candidate will ... Collaborate with interdisciplinary teams for utilization management. Work with individuals with ...
Case Manager
Alpharetta, GA · Remote
$19.50 - $25.25/hr
Master's This is a TEMP- TO-PERM Care Manager RN position. The position is created to meet and ... Candidates need 2-3 years of Behavioral Health Experience, and 3-5 years of Utilization Management ...
Case Manager
Alpharetta, GA · Remote
$19.50 - $25.25/hr
Master's This is a TEMP- TO-PERM Care Manager RN position. The position is created to meet and ... Candidates need 2-3 years of Behavioral Health Experience, and 3-5 years of Utilization Management ...
(Hybrid Georgia) Supervisor, Care Management
Atlanta, GA · Hybrid
$140.40K/yr
Perform case reviews of RN CM peers evaluating policy/protocol adherence, interdisciplinary team ... Represent CMs on established case review meetings for utilization management * Host team meetings ...
(Hybrid Georgia) Supervisor, Care Management
Atlanta, GA · Hybrid
$140.40K/yr
Perform case reviews of RN CM peers evaluating policy/protocol adherence, interdisciplinary team ... Represent CMs on established case review meetings for utilization management * Host team meetings ...
(Hybrid Georgia) Supervisor, Care Management
Atlanta, GA · On-site
$140.40K/yr
Perform case reviews of RN CM peers evaluating policy/protocol adherence, interdisciplinary team ... Represent CMs on established case review meetings for utilization management * Host team meetings ...
(Hybrid Georgia) Supervisor, Care Management
Atlanta, GA · On-site
$140.40K/yr
Perform case reviews of RN CM peers evaluating policy/protocol adherence, interdisciplinary team ... Represent CMs on established case review meetings for utilization management * Host team meetings ...
(Hybrid Georgia) Supervisor, Care Management
Atlanta, GA · Hybrid
$140.40K/yr
Perform case reviews of RN CM peers evaluating policy/protocol adherence, interdisciplinary team ... Represent CMs on established case review meetings for utilization management * Host team meetings ...
(Hybrid Georgia) Supervisor, Care Management
Atlanta, GA · Hybrid
$140.40K/yr
Perform case reviews of RN CM peers evaluating policy/protocol adherence, interdisciplinary team ... Represent CMs on established case review meetings for utilization management * Host team meetings ...
Utilization Management Nurse information
See Decatur, GA salary details
$38.1K - $49.1K
15% of jobs
$49.1K - $60.1K
8% of jobs
$61.7K is the 25th percentile. Wages below this are outliers.
$60.1K - $71.1K
15% of jobs
The median wage is $78K / yr.
$71.1K - $82.1K
20% of jobs
$82.1K - $93.1K
11% of jobs
$98.6K is the 75th percentile. Wages above this are outliers.
$93.1K - $104.1K
13% of jobs
$104.1K - $115.1K
5% of jobs
$115.1K - $126.1K
3% of jobs
$126.1K - $137.1K
4% of jobs
$137.1K - $148.1K
3% of jobs
$148.1K - $159.1K
3% of jobs
$38.1K
$87.4K
$159.1K
How much do utilization management nurse jobs pay per year?
As of Jun 1, 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 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?
| 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.
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:
- Remote Occupational Therapy Utilization Review
- Nurse 1099 Remote
- Remote Bcba Utilization Review
- Overnight Mercy Health Rn
- Registered Nurse Resume Sample
- Remote Registered Nurse Visa Sponsorship
- Remote Utilization Review Nurse Practitioner
- Remote Anthem Utilization Review Nurse
- Contractual Encompass Health Rn
- Live In Cigna Utilization Review Nurse
What cities near Decatur, GA are hiring for Utilization Management Nurse jobs? Cities near Decatur, GA with the most Utilization Management Nurse job openings:
Full-time
Posted 8 days ago
Northside Hospital rating
7.3
Based on 425 frontline employees who took The Breakroom Quiz
289th of 864 rated healthcare providers
Job description
Overview
Northside Hospital is award-winning, state-of-the-art, and continually growing. Constantly expanding the quality and reach of our care to our patients and communities creates even more opportunity for the best healthcare professionals in Atlanta and beyond. Discover all the possibilities of a career at Northside today.
ResponsibilitiesProcesses, tracks and appeals clinical denials. Supports and facilitates the design, development and implementation of Utilization Management data collection methodologies and studies in the respective functional areas. Displays and analyzes data to identify trends. Works collaboratively to develop plan of action.
QualificationsREQUIRED:
Case Management:
1. Graduate of an accredited school of nursing, with strong clinical case management experience
2. Three (3) years experience in Utilization Management/Case Management or related field,
with specific experience in the following areas: the application of industry prevalent guideline criteria; knowledge of coding, billing, audit and reimbursement payer methodologies and guidelines. Experience in the collection, interpretation, and presentation of data to medical staff members; and, interaction with managed care companies, including appealing denials.
Work Hours:8am- 4:30pm Weekend Requirements:NoOn-Call Requirements:NoEmployment Type: FULL_TIMEWhat Northside Hospital employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About Northside Hospital
Sourced by ZipRecruiter
* 288-bed hospital, offering a full range of services including comprehensive and interventional stroke care, preventative and corrective cardiac care, full-service orthopedic and spine treatment, an ER 24/7®, and general surgery * As one of the first hospitals in the area to achieve Atrial Fibrillation Certification (SCPC), our technologically advanced hospital allows our highly skilled physicians, nursing and caregivers to serve our growing community * Northside Hospital was the first nationally recognized Comprehensive Stroke Center in Pinellas County and nationally recognized for quality and safety by earning an 'A' rating from the Leapfrog Group
Industry
Hospitals
Company size
10,000+ Employees
Headquarters location
Atlanta, GA, US
Year founded
1970