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Utilization Management Nurse Jobs in Rochester, MN

Lead daily therapy department operations, including staffing, scheduling, and utilization ... Ability to manage staffing, scheduling, and operational performance * Experience in skilled nursing ...

Rehab Director

Spring Valley, MN · On-site

$29 - $56/hr

Lead daily therapy department operations, including staffing, scheduling, and utilization ... Ability to manage staffing, scheduling, and operational performance * Experience in skilled nursing ...

Rehab Director

Spring Valley, MN · On-site

$29 - $56/hr

Lead daily therapy department operations, including staffing, scheduling, and utilization ... Ability to manage staffing, scheduling, and operational performance * Experience in skilled nursing ...

As an RN Case Manager, you will play a critical role in making our patients' final days, weeks, and months as comfortable as possible. Enjoy the opportunity to work closely with the company's owners ...

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Utilization Management Nurse information

See Rochester, MN salary details

$39.6K

$91K

$165.7K

How much do utilization management nurse jobs pay per year?

As of Jul 23, 2026, the average yearly pay for utilization management nurse in Rochester, MN is $90,959.00, according to ZipRecruiter salary data. Most workers in this role earn between $65,600.00 and $106,200.00 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.

What does a utilization management nurse do?

A utilization management nurse reviews medical records and treatment plans to determine if healthcare services meet insurance or clinical guidelines for necessity and appropriateness. They collaborate with healthcare providers and insurance companies to approve, modify, or deny coverage, often using electronic health records and adhering to regulatory standards. Certification in case management or utilization review is common in this role.

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 part-time or per diem shifts, especially in high-demand settings. Developing specialized skills or certifications, such as case management or health informatics, can also qualify them for higher-paying roles or consulting opportunities outside regular hours.

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?

A Utilization Management Nurse can earn $150,000 by gaining extensive experience, obtaining advanced certifications such as CCM or ANCC, and working in high-paying settings like insurance companies or specialty healthcare organizations. Developing strong analytical skills and understanding healthcare policies can also enhance earning potential, often requiring a master's degree or specialized training. Salary varies based on location, employer, and level of expertise.

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.

How to get into utilization management as a nurse?

To become a utilization management nurse, candidates typically need a registered nurse (RN) license and experience in clinical settings. Additional certifications such as Certified Professional in Healthcare Quality (CPHQ) or case management credentials can improve job prospects, and strong knowledge of healthcare policies and documentation is essential.
What are popular job titles related to Utilization Management Nurse jobs in Rochester, MN? For Utilization Management Nurse jobs in Rochester, MN, the most frequently searched job titles are:
What cities near Rochester, MN are hiring for Utilization Management Nurse jobs? Cities near Rochester, MN with the most Utilization Management Nurse job openings:
Infographic showing various Utilization Management Nurse job openings in Rochester, MN as of July 2026, with employment types broken down into 50% Full Time, and 50% Contract. Highlights an 50% In-person, and 50% Remote job distribution, with an average salary of $90,959 per year, or $43.7 per hour.
Registered Nurse - Case Manager Transitional Planning - RN

Registered Nurse - Case Manager Transitional Planning - RN

Mayo Clinic

Rochester, MN • On-site

Full-time

Medical, Dental, Vision, Retirement

Posted 29 days ago


Mayo Clinic rating

7.9

Company rating: 7.9 out of 10

Based on 690 frontline employees who took The Breakroom Quiz

105th of 889 rated healthcare providers


Job description


The Registered Nurse (RN) Case Manager works within an interdisciplinary team to facilitate the patient plan of care throughout the continuum of care by ensuring appropriate utilization management, care coordination, resource utilization, and clinical documentation. The RN Case Manager will function within the Mayo Clinical Nursing Professional Practice Model, which includes accountability for assessing, planning, implementing, evaluating, and communicating the patient care plan progression. The RN Case Manager utilizes the principles of mutual respect, patient/family advocacy and provides leadership within the team of internal partners and outside agencies to facilitate best practices that achieve quality clinical, financial, and patient satisfaction outcomes. The RN Case Manager provides leadership through education on case management/utilization management concepts, committee work, research, and community involvement. The RN Case Manager bridges communication between providers, patients and families, members of the interdisciplinary team, and outside agencies to assure high-quality care that meets the patient's needs and is delivered in a cost-effective and timely manner. The ANA Nursing: Scope and Standards of Practice and Code of Ethics provide a basis for the practice of the RN. The American Case Manager Association Standards of Practice and Scope of Services for Health Care Delivery System Case Management and Transitions of Care Professionals (2013) are reflected.
For New Graduate Nurses: Please apply through the Nurse Residency Program posting, which is specifically designed to support New Graduate RNs. Visit the Nurse Residency webpage for program details including current and upcoming application windows. Within the Nurse Residency application process, you may indicate work units and specialties of interest. If selected to move forward, you will meet with a Nursing Placement Coordinator who will help you explore Mayo Clinic opportunities that are best aligned with your current and future professional goals. Together, we'll identify a work area that provides an excellent foundation for your nursing career.
This role is eligible for TN sponsorship. Successful sponsorship will require state licensure and completion of the VisaScreen or equivalent certification.
Qualifications
Graduate of an accredited, or those in the candidacy process, baccalaureate nursing program, as recognized by the Accreditation Commission for Education in Nursing (ACEN), Commission on Collegiate Nursing Education (CCNE), National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA). One year of RN experience is required. If graduated from a nursing program that was not accredited by ACEN,CCNE, and NLN CNEA, at least one year of RN experience in an applicable care setting is required. If graduation did not occur within the last two years, one year of RN experience in an applicable care setting is required or, effective October 1st, 2017 one year of current LPN experience at Mayo Clinic is required.
Additional Qualifications:
3 years of recent acute medical/surgical hospital nursing preferred. 1 year of Case Management experience preferred. Certification (CCM or ACM-RN) preferred.
Internal applicants are required to attach their three most recent performance appraisals.
License or Certification:
Current RN license by applicable state requirements.
Basic Cardiac Life Support for healthcare providers- BCLS - certificate of course completion required and must not expire within 3 months after start date. A scanned copy of the certificate of completion or transcripts, including your full name, must be attached to your profile to be considered.
We will only accept certificates of course completion from the following providers:
• American Heart Association (Title: BLS for Healthcare Providers or BLS Provider)
• Red Cross (Title: CPR/AED for Professional Rescuers and Health Care Providers or BLS for Healthcare Providers)
Additional specialty certification/training as required by the work area.
About Us
Why Mayo Clinic
Mayo Clinic is top-ranked in more specialties than any other care provider according to U.S. News & World Report. As we work together to put the needs of the patient first, we are also dedicated to our employees, investing in competitive compensation and comprehensive benefit plans - to take care of you and your family, now and in the future. And with continuing education and advancement opportunities at every turn, you can build a long, successful career with Mayo Clinic.
Benefits Highlights
  • Medical: Multiple plan options.
  • Dental: Delta Dental or reimbursement account for flexible coverage.
  • Vision: Affordable plan with national network.
  • Pre-Tax Savings: HSA and FSAs for eligible expenses.
  • Retirement: Competitive retirement package to secure your future.

About the Team
Just as our reputation has spread beyond our Minnesota roots, so have our locations. Today, our employees are located at our three major campuses in Phoenix/Scottsdale, Arizona, Jacksonville, Florida, Rochester, Minnesota, and at Mayo Clinic Health System campuses throughout Midwestern communities, and at our international locations. Each Mayo Clinic location is a special place where our employees thrive in both their work and personal lives. Learn more about what each unique Mayo Clinic campus has to offer, and where your best fit is.
Equal Opportunity
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, protected veteran status or disability status. Learn more about the "EOE is the Law". Mayo Clinic participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization.

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About Mayo Clinic

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Mayo Clinic is the largest integrated, not-for-profit medical group practice in the world. We're building the future, one where the best possible care is available to everyone — and more people can heal at home. Our relentless research turns into earlier diagnoses and new cures. That's how we inspire hope in those who need it most. At Mayo Clinic, experts work together to solve the most challenging unmet needs of patients. Our history of innovation dates back almost 150 years, when brothers Will and Charlie Mayo pioneered an integrated, team-based approach to medicine. Today, that trailblazing spirit drives innovations like Mayo Clinic Platform — which powers new technologies to change how care is delivered to all.

Industry

Hospitals

Company size

10,000+ Employees

Headquarters location

Rochester, MN, US

Year founded

1919