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Utilization Management Nurse Jobs in Springfield, MO

Citizens Memorial

MDS RN-FND PHF Nurs LTC

Bolivar, MO · On-site

The skilled nursing facility is a 78-bed facility located in Bolivar, MO that includes a memory care unit for individuals with Alzheimer's disease and dementia. The primary purpose is to work closely ...

Citizens Memorial

MDS RN-FND PHF Nurs LTC

Bolivar, MO · On-site

The skilled nursing facility is a 78-bed facility located in Bolivar, MO that includes a memory care unit for individuals with Alzheimer's disease and dementia. The primary purpose is to work closely ...

New

GoHealth Urgent Care

APP Manager

Springfield, MO · On-site

$101K - $138K/yr

Advanced Practice Provider (APP) Manager Physician Assistant (PA) / Nurse Practitioner (NP) ... Partner with Medical Directors and site leaders on staffing, workflows, and provider utilization

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All JobsUtilization Management Nurse JobsUtilization Management Nurse Jobs in Springfield, MO

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 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 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.

Clinical Supervisor RN 4A Full Time Nights

Mercy

Springfield, MO • On-site

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 25 days ago

Mercy rating

6.5

Company rating: 6.5 out of 10

Based on 209 frontline employees who took The Breakroom Quiz

605th of 887 rated healthcare providers

Job description

Find your calling at Mercy! The Clinical Supervisor assures delivery of safe, high quality and cost effective care provided by competent co-workers. They ensure efficient utilization of available resources to meet
productivity and financial goals. Clinical Supervisor works collaboratively and effectively with
other administrative personnel, physicians and co-workers to communicate and improve
processes across the continuum. Clinical Supervisor ensures units are appropriately staffed to
provide patient care. Clinical Supervisor is proactively involved in patient flow and bed
management issues in collaboration with the Staffing Office. They are leaders who inspire a shared vision, demonstrating the value of change and presenting it to co-workers with enthusiasm. Clinical Supervisor models the way by displaying professional standards, a positive attitude, and engaging co-workers to become leaders of change. They challenge current process and enable others to promote change by providing support, mentorship, and guidance to those who provide direct patient care. Clinical Supervisor encourages the heart of co-workers by providing both public and private recognition and connecting on a personal level with those they serve through servant leadership. Clinical Supervisor holds direct and indirect care providers accountable for their professional responsibilities and adherence to policy and regulatory guidelines. Clinical Supervisor performs duties and responsibilities in a manner consistent with the Mission, Values and Mercy Service Standards. Clinical Supervisor is involved in the evaluation process in collaboration with the CLinical Manager as directed. Performs duties and responsibilities in a manner consistent with our mission, values, and Mercy Service Standards. Position Details:

Education: Graduate from an accredited Nursing program.
Licensure: Current RN license with the State Board of Nursing.
Experience: 3-5 years of hospital nursing experience.
Certification/Registration: Must have American Heart Association Healthcare Provider card or complete a course within probation period. TNCC , ACLS and ENPC or PALS.
Skills, knowledge and abilities: Demonstrates skills in human relations and communication, written verbal, and electronic. Demonstrates clinical competence in patient care delivery. Possesses the ability to assess data and assist personnel in providing appropriate level of care. Performs responsibilities while fulfilling the Philosophy of skills, knowledge and abilities.

Preferred Education: Bachelor's degree in Nursing.

Why Mercy?

From day one, Mercy offers outstanding benefits - including medical, dental, and vision coverage, paid time off, tuition support, and matched retirement plans for team members working 32+ hours per pay period.

Join a caring, collaborative team where your voice matters. At Mercy, you'll help shape the future of healthcare through innovation, technology, and compassion. As we grow, you'll grow with us.


keyword(s): RN

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About Mercy

Sourced by ZipRecruiter

Our mission is clear. We bring to life a healing ministry through our compassionate care and exceptional service. At Mercy, we believe in careers that match the unique gifts of unique individuals - careers that not only make the most of your skills and talents, but also your heart.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Chesterfield, MO, US

Year founded

1827

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