POSITION SUMMARY The RN Utilization Management is responsible for the overall Utilization Management process for assigned patient population. This includes reviewing clinical information to determine ...
POSITION SUMMARY The RN Utilization Management is responsible for the overall Utilization Management process for assigned patient population. This includes reviewing clinical information to determine ...
POSITION SUMMARY The RN Utilization Management is responsible for the overall Utilization Management process for assigned patient population. This includes reviewing clinical information to determine ...
POSITION SUMMARY The RN Utilization Management is responsible for the overall Utilization Management process for assigned patient population. This includes reviewing clinical information to determine ...
Utilization Review RN - Per Diem* *IMPORTANT NOTE: In lieu of benefits due to "per diem" status, 15 ... CCM (certification in case management) is preferred. License Required * Must be licensed as a ...
Quick apply
Utilization Review RN - Per Diem* *IMPORTANT NOTE: In lieu of benefits due to "per diem" status, 15 ... CCM (certification in case management) is preferred. License Required * Must be licensed as a ...
Utilization Review RN - Per Diem* *IMPORTANT NOTE: In lieu of benefits due to "per diem" status, 15 ... CCM (certification in case management) is preferred. License Required * Must be licensed as a ...
Quick apply
Utilization Review RN - Per Diem* *IMPORTANT NOTE: In lieu of benefits due to "per diem" status, 15 ... CCM (certification in case management) is preferred. License Required * Must be licensed as a ...
Utilization Management Registered Nurse The Utilization Management Registered Nurse (UM RN) is ... Available for Per Diem Employees and Part-time Employees working under 20 hours per week. ** 403b ...
Utilization Management Registered Nurse The Utilization Management Registered Nurse (UM RN) is ... Available for Per Diem Employees and Part-time Employees working under 20 hours per week. ** 403b ...
Utilization Management Registered Nurse The Utilization Management Registered Nurse (UM RN) is ... Available for Per Diem Employees and Part-time Employees working under 20 hours per week. ** 403b ...
Utilization Management Registered Nurse The Utilization Management Registered Nurse (UM RN) is ... Available for Per Diem Employees and Part-time Employees working under 20 hours per week. ** 403b ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... Available for Per Diem Employees and Part-time Employees working under 20 hours per week. ** 403b ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... Available for Per Diem Employees and Part-time Employees working under 20 hours per week. ** 403b ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... Available for Per Diem Employees and Part-time Employees working under 20 hours per week. ** 403b ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... Available for Per Diem Employees and Part-time Employees working under 20 hours per week. ** 403b ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... Available for Per Diem Employees and Part-time Employees working under 20 hours per week. ** 403b ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... Available for Per Diem Employees and Part-time Employees working under 20 hours per week. ** 403b ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... Available for Per Diem Employees and Part-time Employees working under 20 hours per week. ** 403b ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... Available for Per Diem Employees and Part-time Employees working under 20 hours per week. ** 403b ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... Available for Per Diem Employees and Part-time Employees working under 20 hours per week. ** 403b ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... Available for Per Diem Employees and Part-time Employees working under 20 hours per week. ** 403b ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... Available for Per Diem Employees and Part-time Employees working under 20 hours per week. ** 403b ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... Available for Per Diem Employees and Part-time Employees working under 20 hours per week. ** 403b ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... Available for Per Diem Employees and Part-time Employees working under 20 hours per week. ** 403b ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... Available for Per Diem Employees and Part-time Employees working under 20 hours per week. ** 403b ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... Available for Per Diem Employees and Part-time Employees working under 20 hours per week. ** 403b ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... Available for Per Diem Employees and Part-time Employees working under 20 hours per week. ** 403b ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... Available for Per Diem Employees and Part-time Employees working under 20 hours per week. ** 403b ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... Available for Per Diem Employees and Part-time Employees working under 20 hours per week. ** 403b ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... Available for Per Diem Employees and Part-time Employees working under 20 hours per week. ** 403b ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... Available for Per Diem Employees and Part-time Employees working under 20 hours per week. ** 403b ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... Available for Per Diem Employees and Part-time Employees working under 20 hours per week. ** 403b ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... Available for Per Diem Employees and Part-time Employees working under 20 hours per week. ** 403b ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... Available for Per Diem Employees and Part-time Employees working under 20 hours per week. ** 403b ...
The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical ... Available for Per Diem Employees and Part-time Employees working under 20 hours per week. ** 403b ...
RN - ProMedica Provider Services - Utilization Management
$32.25 - $47/hr
Utilization Management Weekly Hours: 0 Status ... Per Diem Shift: Days (United States of America) Pay Grade: $32.25 - $47.00 This is a remote ...
RN - ProMedica Provider Services - Utilization Management
$32.25 - $47/hr
Utilization Management Weekly Hours: 0 Status ... Per Diem Shift: Days (United States of America) Pay Grade: $32.25 - $47.00 This is a remote ...
Per Diem Opening(s)*** THIS POSITION MAY CLOSE WITHOUT NOTICE ONCE A SUFFICIENT NUMBER OF QUALIFIED ... Additional Position Requirements Minimum three (3) years of Utilization Management experience.
Per Diem Opening(s)*** THIS POSITION MAY CLOSE WITHOUT NOTICE ONCE A SUFFICIENT NUMBER OF QUALIFIED ... Additional Position Requirements Minimum three (3) years of Utilization Management experience.
Utilization Management Per Diem information
See salary details
$39K - $50.3K
15% of jobs
$50.3K - $61.5K
8% of jobs
$63.2K is the 25th percentile. Wages below this are outliers.
$61.5K - $72.8K
15% of jobs
The median wage is $79.9K / yr.
$72.8K - $84.1K
20% of jobs
$84.1K - $95.4K
11% of jobs
$101K is the 75th percentile. Wages above this are outliers.
$95.4K - $106.6K
13% of jobs
$106.6K - $117.9K
5% of jobs
$117.9K - $129.2K
3% of jobs
$129.2K - $140.5K
4% of jobs
$140.5K - $151.7K
3% of jobs
$151.7K - $163K
3% of jobs
$39K
$89.5K
$163K
How much do utilization management per diem jobs pay per year?
As of Jun 8, 2026, the average yearly pay for utilization management per diem 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 is a Utilization Management Per Diem position?
A Utilization Management Per Diem position involves reviewing and evaluating medical services to ensure they are necessary and provided efficiently, typically in a healthcare or insurance setting. 'Per diem' means the employee works on an as-needed or flexible basis rather than a set schedule, providing coverage during busy periods or when regular staff are unavailable. These roles are commonly filled by nurses or healthcare professionals who assess patient care for appropriateness and compliance with policies. Utilization management helps control costs while ensuring patients receive appropriate care.
What is the difference between Utilization Management Per Diem vs Utilization Review Nurse?
| Aspect | Utilization Management Per Diem | Utilization Review Nurse |
|---|---|---|
| Credentials | RN license, certification in case management or utilization review | RN license, certification in case management or utilization review |
| Work Environment | Per diem, hospital or insurance settings, flexible shifts | Full-time or part-time, hospital, insurance, or healthcare facilities |
| Employer Usage | Used for short-term staffing, on-call basis | Regular review and approval of patient care, ongoing case management |
Utilization Management Per Diem professionals typically work on a flexible, short-term basis, focusing on specific cases or shifts. In contrast, Utilization Review Nurses often hold ongoing roles, managing patient care reviews regularly. Both roles require similar credentials but differ mainly in work setting and employment structure.
How does a Utilization Management Per Diem professional typically interact with other healthcare team members during the review process?
Utilization Management Per Diem professionals work closely with physicians, nurses, social workers, and insurance representatives to ensure that patients receive appropriate care while efficiently utilizing healthcare resources. Communication is often conducted through electronic health records, case review meetings, and phone consultations. Collaboration is key, as you may need to gather additional clinical information or clarify care plans to support authorization and coverage decisions. Being proactive and diplomatic in these interactions helps facilitate smoother care transitions and positive patient outcomes.
What qualifications do you need to be a utilization review nurse?
To be a utilization review nurse, candidates typically need a registered nurse (RN) license, which requires completing an accredited nursing program and passing the NCLEX-RN exam. Relevant experience in case management, insurance, or clinical settings, along with knowledge of healthcare regulations and utilization review processes, is also important. Certifications such as the Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ) can enhance qualifications.
What are the key skills and qualifications needed to thrive as a Utilization Management Per Diem nurse, and why are they important?
To thrive as a Utilization Management Per Diem nurse, you need a current RN license, strong clinical assessment skills, and a solid understanding of medical necessity criteria and healthcare regulations. Familiarity with utilization review software, electronic health records (EHRs), and case management systems is commonly required. Excellent analytical thinking, communication, and time-management abilities help you collaborate effectively and make sound, timely decisions. These skills ensure accurate care reviews, regulatory compliance, and efficient patient care coordination in a flexible, part-time work environment.
More about Utilization Management Per Diem jobs
What cities are hiring for Utilization Management Per Diem jobs? Cities with the most Utilization Management Per Diem job openings:
What are the most commonly searched types of Utilization Management jobs? The most popular types of Utilization Management jobs are:
What states have the most Utilization Management Per Diem jobs? States with the most job openings for Utilization Management Per Diem jobs include:
What job categories do people searching Utilization Management Per Diem jobs look for? The top searched job categories for Utilization Management Per Diem jobs are:
Per diem
Medical, Dental, Vision, Life, Retirement, PTO
Posted 19 days ago
AtlantiCare rating
7.5
Based on 105 frontline employees who took The Breakroom Quiz
221st of 869 rated healthcare providers
Job description
POSITION SUMMARY
The RN Utilization Management is responsible for the overall Utilization Management process for assigned patient population. This includes reviewing clinical information to determine the appropriate level of care assignment, along with the completion and submission of reviews to insurance payers with appropriate follow-up. The RN utilizes Evidenced Based "MCG" criteria/guidelines and other approved Atlanticare applications to assess and document the medical necessity and appropriate patient status/level of care determination. This position analyzes clinical information received to facilitate authorization from insurance providers, maximize reimbursement by preventing denials, and ensures clinical data is sufficient to obtain an authorization. The RN works closely with Physician Advisors (PAs) to confirm that status and level-of-care mismatches, along with provider documentation concerns, are thoroughly reviewed and addressed, including follow-up on final decisions and peer-to-peer discussion outcomes as required. This position ensures that the obligation for clinical review is met according to the payer contracts and validates the accuracy of insurance information in the system. The RN is knowledgeable of the payer contracting arrangements, admission notification and clinical review requirements, as well as the regulatory and compliance requirements for government payers regarding clinical reviews and medical necessity. This role ensures that appropriate and accurate information is placed into the patient accounting system to result in clean, compliant, and timely claim processing. This role also provides notification of denial issues and potential avoidance of a denial, along with changes in insurance information to all appropriate areas (e.g. clinical team, Patient Accounting). The RN supports system-wide improvement initiatives within the hospitals and the medical staff structure to ensure effective and timely performance improvement. This role Participates in UR Committee work as requested.
QUALIFICATIONS
EDUCATION: Graduate of an accredited school of nursing required. Bachelor's in nursing Required. Utilization/Coding certification preferred or in process.
LICENSE/CERTIFICATION:
Current licensure as a Registered Nurse in the State of New Jersey or current multi state license required.
Effective Jan 2026: Current MCG (Milliman Clinical Guideline) certification required within 2 years of hire or transfer. Current incumbents must obtain MCG by 1/1/2027.
American Heart Association BLS certification required within 6 months of hire or transfer. Current incumbents must obtain BLS by 6/30/2026.
EXPERIENCE: Prior Utilization/insurance case management experience Preferred. Experience on MCG/InterQual, HEDIS, CDI or Quality review preferred. Recent acute care Medical-Surgical nursing experience preferred. Proficient in using common computer software applications preferred (Word, Excel formatting). Proficiency in Clinical Applications preferred at time of hire; incumbents within position will be trained appropriately and then skill will be required for this position within 30-60 days from date of hire.
PERFORMANCE EXPECTATIONS
Demonstrates the technical competencies as established on the Assessment and Evaluation Tool.
WORK ENVIRONMENT
This position requires desk/computer work a majority of the time. There is some standing, walking and occasional lifting up to 20 pounds. The essential functions for this position are listed on the Assessment and Evaluation Tool.
REPORTING RELATIONSHIP
This position reports to department leadership.
The above statement reflect the general details considered necessary to describe the principle functions of the job as identified and shall not be considered as a detailed description of all work requirements that may be inherent in the position.
Total Rewards at AtlantiCare
At AtlantiCare, we believe in supporting the whole person. Our market-competitive Total Rewards package is designed to promote the physical, emotional, social, and financial well-being of our team members. We offer a comprehensive suite of benefits and resources, including:
Generous Paid Time Off (PTO)
Medical, Prescription Drug, Dental & Vision Insurance
Retirement Plans with employer contributions
Short-Term & Long-Term Disability Coverage
Life & Accidental Death & Dismemberment Insurance
Tuition Reimbursement to support your educational goals
Flexible Spending Accounts (FSAs) for healthcare and dependent care
Wellness Programs to help you thrive
Voluntary Benefits, including Pet Insurance and more
Benefits offerings may vary based on position and are subject to eligibility requirements.
Join a team that values your well-being and invests in your future.
The RN Utilization Management is responsible for the overall Utilization Management process for assigned patient population. This includes reviewing clinical information to determine the appropriate level of care assignment, along with the completion and submission of reviews to insurance payers with appropriate follow-up. The RN utilizes Evidenced Based "MCG" criteria/guidelines and other approved Atlanticare applications to assess and document the medical necessity and appropriate patient status/level of care determination. This position analyzes clinical information received to facilitate authorization from insurance providers, maximize reimbursement by preventing denials, and ensures clinical data is sufficient to obtain an authorization. The RN works closely with Physician Advisors (PAs) to confirm that status and level-of-care mismatches, along with provider documentation concerns, are thoroughly reviewed and addressed, including follow-up on final decisions and peer-to-peer discussion outcomes as required. This position ensures that the obligation for clinical review is met according to the payer contracts and validates the accuracy of insurance information in the system. The RN is knowledgeable of the payer contracting arrangements, admission notification and clinical review requirements, as well as the regulatory and compliance requirements for government payers regarding clinical reviews and medical necessity. This role ensures that appropriate and accurate information is placed into the patient accounting system to result in clean, compliant, and timely claim processing. This role also provides notification of denial issues and potential avoidance of a denial, along with changes in insurance information to all appropriate areas (e.g. clinical team, Patient Accounting). The RN supports system-wide improvement initiatives within the hospitals and the medical staff structure to ensure effective and timely performance improvement. This role Participates in UR Committee work as requested.
QUALIFICATIONS
EDUCATION: Graduate of an accredited school of nursing required. Bachelor's in nursing Required. Utilization/Coding certification preferred or in process.
LICENSE/CERTIFICATION:
Current licensure as a Registered Nurse in the State of New Jersey or current multi state license required.
Effective Jan 2026: Current MCG (Milliman Clinical Guideline) certification required within 2 years of hire or transfer. Current incumbents must obtain MCG by 1/1/2027.
American Heart Association BLS certification required within 6 months of hire or transfer. Current incumbents must obtain BLS by 6/30/2026.
EXPERIENCE: Prior Utilization/insurance case management experience Preferred. Experience on MCG/InterQual, HEDIS, CDI or Quality review preferred. Recent acute care Medical-Surgical nursing experience preferred. Proficient in using common computer software applications preferred (Word, Excel formatting). Proficiency in Clinical Applications preferred at time of hire; incumbents within position will be trained appropriately and then skill will be required for this position within 30-60 days from date of hire.
PERFORMANCE EXPECTATIONS
Demonstrates the technical competencies as established on the Assessment and Evaluation Tool.
WORK ENVIRONMENT
This position requires desk/computer work a majority of the time. There is some standing, walking and occasional lifting up to 20 pounds. The essential functions for this position are listed on the Assessment and Evaluation Tool.
REPORTING RELATIONSHIP
This position reports to department leadership.
The above statement reflect the general details considered necessary to describe the principle functions of the job as identified and shall not be considered as a detailed description of all work requirements that may be inherent in the position.
Total Rewards at AtlantiCare
At AtlantiCare, we believe in supporting the whole person. Our market-competitive Total Rewards package is designed to promote the physical, emotional, social, and financial well-being of our team members. We offer a comprehensive suite of benefits and resources, including:
Generous Paid Time Off (PTO)
Medical, Prescription Drug, Dental & Vision Insurance
Retirement Plans with employer contributions
Short-Term & Long-Term Disability Coverage
Life & Accidental Death & Dismemberment Insurance
Tuition Reimbursement to support your educational goals
Flexible Spending Accounts (FSAs) for healthcare and dependent care
Wellness Programs to help you thrive
Voluntary Benefits, including Pet Insurance and more
Benefits offerings may vary based on position and are subject to eligibility requirements.
Join a team that values your well-being and invests in your future.
What AtlantiCare employees say
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About AtlantiCare
Sourced by ZipRecruiter
AtlantiCare aims to deliver the highest quality of care combined with the best experience for our patients and their families. We believe you'll find that our culture of collaboration and care exemplifies the value we place on our patients, their families and our team members.
Industry
Hospitals
Company size
5,001 - 10,000 Employees
Headquarters location
Egg Harbor Township, NJ, US
Year founded
1993