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Utilization Management Nurse Jobs (NOW HIRING)

Oak St. Health

Utilization Management Nurse Consultant

$29.10 - $62.32/hr

Utilization Management Nurse Consultant We're building a world of health around every individual -- shaping a more connected, convenient and compassionate health experience. At CVS Health ® , you'll ...

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CVS Health

Utilization Management Nurse Consultant

$29.10 - $62.32/hr

Utilization Management Nurse Consultant Clinical Precertification RN (Medicare) We're building a world of health around every individual -- shaping a more connected, convenient and compassionate ...

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Utilization Management Nurse information

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$39K

$89.5K

$163K

How much do utilization management nurse jobs pay per year?

As of Jun 29, 2026, the average yearly pay for utilization management nurse in the United States is $89,483.00, according to ZipRecruiter salary data. Most workers in this role earn between $64,500.00 and $104,500.00 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.

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Utilization Management Nurse jobs near you
Infographic showing various Utilization Management Nurse job openings in the United States as of June 2026, with employment types broken down into 2% Internship, 7% As Needed, 55% Full Time, 7% Part Time, 27% Contract, and 2% Nights. Highlights an 99% Physical, and 1% Remote job distribution, with an average salary of $89,483 per year, or $43 per hour.
Utilization Management Nurse

Utilization Management Nurse

Integrated Resources INC

Downers Grove, IL

Contractor

Posted 23 days ago

Job description

Company Description

Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.

Job Description

Job Title: Utilization Management Nurse Consultant

Duration: 6 months (Possible ext)

Location: Downers Grove, IL

Responsibilities:

Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities.

Develops, implements and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work.

Services and strategies, policies and programs are comprised of network management, clinical coverage, and policies.

Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Requires an RN (consideration for LCSW) with unrestricted active license.

Fundamental Components & Physical Requirements include but are not limited to

(* denotes essential functions)

Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members

Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care

Communicates with providers and other parties to facilitate care/treatment

Identifies members for referral opportunities to integrate with other products, services and/or programs

Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization

Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function

Background/Experience Desired

Managed Care experience preferred

3-5 years of clinical experience required

Education and Certification Requirements

RN consideration for LCSW) with current unrestricted state license required.

Additional Information (situational competencies, skills, work location requirements, etc.)

Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding

Effective communication skills, both verbal and written.

Ability to multitask, prioritize and effectively adapt to a fast paced changing environment

Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.

Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.

Typical office working environment with productivity and quality expectations

Additional for Behavioral Health:

Experience in Behavioral Health required

Managed Care experience preferred.

Onsite location will be Downers Grove.

Work hours from 8:00 am until 5:00 pm with weekend rotation among the team of clinicians (approximated to rotate once every 1 & to 2 months).

The ability to create and process clinical for Behavioral Health cases on a live phone queue, create and process clinical to of a determination to the provider.

Additional Job Details:

Required to have computer skills.

Work with-toggle between up to 5-6 applications/systems at a time.

Travel Required: No

Qualifications

n/a

Additional Information

Kind Regards

Sumit Agarwal

732-902-2125

Integrated Resources logo

About Integrated Resources

Sourced by ZipRecruiter

Integrated Resources Inc (IRI), based in Edison, NJ, US, is an esteemed player in the staffing solutions industry with a credible presence on their official website irionline.com. Notably, IRI provides a range of professional staffing services including contract, contract-to-hire, and direct hire solutions to a wide spectrum of industries such as healthcare, life sciences, manufacturing, financial, insurance, and others. Since its inception, IRI has been committed to delivering top-talent and optimum solutions to meet its clients' diverse needs.

Industry

Recruiting and staffing services

Company size

51 - 200 Employees

Headquarters location

Edison, NJ, US

Year founded

1996

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