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Utilization Management Nurse Jobs in Decatur, GA

Integrated Resources INC

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 ...

genex

Telephonic Nurse Case Manager

Atlanta, GA

Provision of comprehensive Utilization Management, incorporating the strategies of cost containment ... Uses clinical/nursing skills to determine whether all aspects of a patient's care, at every level ...

genex

Telephonic Nurse Case Manager

Atlanta, GA

Provision of comprehensive Utilization Management, incorporating the strategies of cost containment ... Uses clinical/nursing skills to determine whether all aspects of a patient's care, at every level ...

Genex

Telephonic Nurse Case Manager

Atlanta, GA · On-site

Provision of comprehensive Utilization Management, incorporating the strategies of cost containment ... Main responsibilities include but are not limited to: • Uses clinical/nursing skills to determine ...

KARNA LLC

Medical Claims Review Nurse

Atlanta, GA · On-site

The nurse will be responsible for reviewing claims that pend to Medical Review to ensure all ... Utilization Management (UM), and/or Case Management * Experience with claims review in the acute ...

Pharmacy Careers

Appeals Pharmacist (Remote)

Lawrenceville, GA · On-site +1

$49.50 - $60.25/hr

Collaborate with physicians, nurses, and medical directors during case reviews. * Track, document ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

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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 Jun 28, 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 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, 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.

How to make $100,000 as an RN?

To earn $100,000 as a Utilization Management Nurse, gaining experience in case review, obtaining certifications like CCM or ANCC, and working in high-paying settings such as insurance companies or managed care organizations can help increase earning potential. Advanced roles or leadership positions may also offer higher salaries for experienced nurses in this field.

What does a utilization management nurse do?

A utilization management nurse reviews medical records and treatment plans to determine the necessity, appropriateness, and efficiency of healthcare services. They collaborate with healthcare providers and insurance companies to approve or deny coverage based on established guidelines, often using electronic health records and clinical criteria. This role requires strong clinical knowledge, attention to detail, and familiarity with healthcare policies and documentation standards.

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.

How to make an extra 2000 a month as a nurse?

Utilization Management Nurses can increase their income by taking on additional shifts, working overtime, or pursuing certifications that qualify them for higher-paying roles. They can also consider part-time consulting, telehealth opportunities, or specialized training in areas like case management to boost earning potential.

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.

How to make $150,000 as a nurse?

Utilization Management Nurses can earn $150,000 by gaining extensive experience, obtaining certifications such as Certified Case Manager (CCM), and working in high-paying settings like insurance companies or specialty healthcare organizations. Advancing to senior or managerial roles and developing strong clinical and administrative skills can also increase earning potential.

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 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 June 2026, with employment types broken down into 2% Internship, 4% As Needed, 52% Full Time, 22% Part Time, 18% Contract, and 2% Nights. Highlights an 97% Physical, 1% Hybrid, and 2% Remote job distribution, with an average salary of $87,365 per year, or $42 per hour.
Clinical Audit/Denials Specialist, RN

Clinical Audit/Denials Specialist, RN

Northside Hospital Inc.

Atlanta, GA • On-site, Remote

Full-time

Posted 3 days ago

Northside Hospital rating

7.3

Company rating: 7.3 out of 10

Based on 435 frontline employees who took The Breakroom Quiz

295th of 877 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.
Responsibilities
Processes, 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.
Qualifications
REQUIRED
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.

General:
  1. Excellent written and verbal communication skills.
  2. Ability to communicate effectively with business office, physicians, clinical care team and case management team.
  1. Ability to type accurately at an approximate rate of 30 words per minute.

Work Hours:
8am - 4:30pm
Weekend Requirements:
No
On-Call Requirements:
No

What Northside Hospital employees say

Pay

Benefits

Hours and flexibility

Workplace

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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

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