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Utilization Management Nurse Jobs in Springfield, MO

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Utilization Management Nurse information

See Springfield, MO salary details

$35.5K

$81.4K

$148.3K

How much do utilization management nurse jobs pay per year?

As of Aug 17, 2026, the average yearly pay for utilization management nurse in Springfield, MO is $81,387.00, according to ZipRecruiter salary data. Most workers in this role earn between $58,700.00 and $95,000.00 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?

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 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.

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 popular job titles related to Utilization Management Nurse jobs in Springfield, MO?

For Utilization Management Nurse jobs in Springfield, MO, the most frequently searched job titles are:

What job categories do people searching Utilization Management Nurse jobs in Springfield, MO look for?

The top searched job categories for Utilization Management Nurse jobs in Springfield, MO are:

What cities near Springfield, MO are hiring for Utilization Management Nurse jobs?

Cities near Springfield, MO with the most Utilization Management Nurse job openings:

Utilization Management Nurse jobs near you
Infographic showing various Utilization Management Nurse job openings in Springfield, MO as of August 2026, with employment types broken down into 60% Full Time, 20% Part Time, and 20% Contract. Highlights an 100% In-person job distribution, with an average salary of $81,387 per year, or $39.1 per hour.

Assessment and Referral Manager

Perimeter Healthcare

Springfield, MO • On-site

Full-time

Posted 25 days ago

Job description

Assessment & Referral Manager - Behavioral Health Hospital
📍Perimeter Behavioral Hospital of Springfield | Springfield, MO
Perimeter Behavioral Hospital of Springfield is seeking an experienced and compassionate Manager of Admissions to lead our Assessment and Referral Department. This is a high-impact leadership role for a behavioral health professional who is skilled in crisis assessment, team supervision, clinical coordination, and building strong referral relationships. The Manager of Admissions plays a key role in helping patients and families access the right level of care at the right time.
🤝Why Join Perimeter?
At Perimeter Healthcare, we are committed to delivering hope through compassionate, comprehensive behavioral health treatment. Our teams serve patients across inpatient hospitals, residential treatment centers, and outpatient settings, with a shared focus on service excellence, patient safety, and meaningful recovery. As Manager of Admissions, you will help shape the first point of care for patients, families, referral sources, and community partners.
• Lead the daily operations of the Assessment and Referral Department.
🌱 Supervise, train, and support admissions team members to ensure timely, accurate, and clinically appropriate assessments.
📝Conduct and oversee intake assessments for individuals with behavioral, emotional, and mental health needs.
🔄Coordinate admissions decisions and referrals in collaboration with psychiatry,
nursing, therapy, utilization management, business office, and marketing teams.
💬Serve as a professional liaison for patients, families, referral sources,
community partners, and internal departments.
⏱Ensure inquiries, walk-ins, faxes, and referral calls are handled with
professionalism, urgency, and compassion.
🛡Support insurance verification, initial authorizations, and appropriate
communication with utilization management and financial counseling.
📊Monitor referral trends, maintain accurate data, and use inquiry information to support referral development and process improvement.
⚖Promote compliance with patient safety standards, EMTALA requirements, legal and ethical guidelines, and facility policies.
🏥Participate as a member of the Senior Leadership Team and serve in the Administrator- on-Call rotation as required.
🌟What You'll Bring
  • Strong knowledge of behavioral health assessment, crisis intervention, and appropriate levels of care.
  • Experience working in an inpatient behavioral health setting, preferably with children and adolescents.
  • Demonstrated leadership ability, including staff supervision, coaching, competency oversight, and scheduling support.
  • Professional communication skills with patients, families, physicians, referral sources, and interdisciplinary team members.
  • Ability to remain calm, organized, and solution-focused in high-pressure or crisis situations.
  • Knowledge of community and regional mental health resources.
  • Understanding of insurance verification, managed care, and authorization processes preferred.
  • Computer proficiency, including experience working in a Windows-based environment.
  • Commitment to patient safety, service excellence, confidentiality, and ethical clinical practice.
🎓Qualifications
Required:
  • Must be at least 21 years of age.
  • Master's degree in counseling, social work, or a related helping profession.
  • Current licensure or active pursuit of licensure in counseling, social work, or a related clinical field.
  • Experience in behavioral health assessment and/or treatment.
  • At least one year of supervisory experience.
  • Knowledge of patient rights, legal and ethical standards, EMTALA, and crisis intervention practices.
Preferred:
  • Two or more years of experience on an inpatient behavioral health unit.
  • RN licensure.
  • Experience with admissions, intake, utilization management, managed care, or referral development.
  • Knowledge of behavioral health treatment for children, adolescents, adults, and geriatric populations.

🏢Work Environment and Physical Requirements
This position is based in an inpatient behavioral health hospital setting. The role requires professional interaction with patients who may be experiencing crisis, emotional distress, or behavioral challenges. The employee may be required to stand, walk, sit, reach, bend, kneel, climb, talk, hear, and occasionally lift or move up to 50 pounds. The position may require participation in approved safety interventions, local travel, flexibility with scheduling, and after-hours Administrator-on-Call responsibilities as needed.
💙Make an Impact
If you are a licensed or license-eligible behavioral health professional with strong leadership skills and a passion for helping patients access quality care, we invite you to apply. Join a team that values clinical excellence, collaboration, accountability, and compassionate service.
Equal Employment Opportunity
Perimeter Behavioral Health is committed to providing an environment of diversity and inclusion where equal employment opportunities are available to all applicants and employees. We are an equal opportunity employer and make employment decisions without regard to race, color, religion, age, sex, sexual orientation, pregnancy, gender identity, genetic information, national origin, disability status, protected veteran status, or any other characteristic protected by federal, state, or local laws.
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