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Utilization Review Nurse Jobs in Decatur, GA (NOW HIRING)

Olaro

Travel Utilization Review Nurse

Atlanta, GA

Utilization Review * Discipline: RN * Start Date: ASAP * Duration: 13 weeks * 40 hours per week * Shift: 8 hours, days * Employment Type: Travel PHP Job ID #488537. Pay package is based on 8 hour ...

Emory Healthcare

Utilization Review Specialist

Atlanta, GA · Remote

$47.40 - $54.95/hr

The Utilization Review (UR) Specialist is a Registered Nurse responsible for conducting thorough medical necessity reviews to assist with determining appropriate patient class designation. The UR ...

KARNA LLC

Medical Claims Review Nurse

Atlanta, GA · On-site

The nurse will be responsible for reviewing claims that pend to Medical Review to ensure all ... Ability to identify areas to improve cost, quality, and utilization of care within a population

Acadia Healthcare

Utilization Specialist

Riverdale, GA

Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...

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Acadia Healthcare

Utilization Specialist

Riverdale, GA · On-site

Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...

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All JobsUtilization Review Nurse JobsUtilization Review Nurse Jobs in Decatur, GA

Utilization Review Nurse information

See Decatur, GA salary details

$20

$41

$67

How much do utilization review nurse jobs pay per hour?

As of Jun 21, 2026, the average hourly pay for utilization review nurse in Decatur, GA is $41.28, according to ZipRecruiter salary data. Most workers in this role earn between $32.64 and $47.40 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Utilization Review Nurse, and why are they important?

To thrive as a Utilization Review Nurse, you need a strong background in clinical nursing, critical thinking, and knowledge of healthcare regulations, usually supported by an RN license and nursing degree. Familiarity with utilization management software, medical coding systems (like ICD-10 and CPT), and case management certifications (such as CCM or URAC) is typically required. Excellent communication, negotiation, and organizational skills help you collaborate with providers and advocate for patient care while managing complex cases. These skills ensure appropriate resource use, regulatory compliance, and high-quality patient outcomes in healthcare settings.

What does a Utilization Review Nurse do?

A Utilization Review Nurse is responsible for evaluating the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, coordinate with healthcare providers, and ensure that care meets established guidelines and insurance requirements. Their primary goal is to ensure patients receive appropriate care while helping to manage healthcare costs and prevent unnecessary procedures.

What are some typical challenges Utilization Review Nurses face when communicating with healthcare providers and insurance companies?

Utilization Review Nurses often need to balance clinical judgment with insurance guidelines, which can lead to challenging conversations with providers who may disagree with coverage decisions. They must clearly explain the rationale behind approvals or denials and ensure all documentation is thorough and compliant. Navigating differing priorities while maintaining positive, professional relationships is key, and strong communication skills help facilitate collaboration and resolve conflicts efficiently.

What Does a Utilization Review Nurse Do?

A utilization review nurse determines the best course of treatment for a patient using preapproved policy criteria. Utilization review nurses collect and review patient records, clinical documentation, and billing information to recommend the best use of patient care resources. Their assessments help determine the length of hospital stays, the effectiveness of the care plan, and the necessity of the services administered. Utilization review nurses inform and educate patients about their options based on their insurance benefits and limitations. Utilization review nurses also assess patient care services in clinical appeals for approval or denial.

How to make $150,000 as a nurse?

To earn $150,000 as a Utilization Review Nurse, gaining extensive experience, obtaining certifications such as the Certified Professional Utilization Review (CPUR), and working in high-demand settings like insurance companies or managed care organizations can help increase earning potential. Advanced skills in medical record review, strong knowledge of healthcare policies, and sometimes working overtime or in leadership roles contribute to higher salaries.

What does a nurse do in a utilization review?

A utilization review nurse evaluates medical records and treatment plans to determine the necessity, appropriateness, and efficiency of healthcare services. They ensure that patient care aligns with insurance policies and clinical guidelines, often working with healthcare providers and insurance companies to approve or deny services. This role requires strong clinical knowledge, attention to detail, and familiarity with healthcare regulations and documentation tools.

How to get into utilization review as a nurse?

To become a utilization review nurse, you typically need to be a registered nurse with clinical experience and obtain knowledge of insurance policies and healthcare regulations. Many employers prefer candidates with certifications such as the Certified Professional in Healthcare Quality (CPHQ) or related credentials. Gaining experience in case management or clinical review can improve your chances of entering the field.

What is the difference between Utilization Review Nurse vs Case Manager?

AspectUtilization Review NurseCase Manager
CredentialsRN license, certification in utilization review (e.g., URAC)RN license, case management certification (e.g., CCM)
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, insurance companies, community health settings
Employer & Industry UsagePrimarily in insurance and healthcare organizations for reviewing medical necessityIn healthcare and insurance for coordinating patient care and discharge planning

Utilization Review Nurses focus on evaluating the necessity and appropriateness of medical services, often working in insurance or healthcare settings. Case Managers coordinate patient care, discharge planning, and resource management. While both roles require RN licensure and related certifications, their primary responsibilities differ: UR Nurses review medical necessity, whereas Case Managers facilitate patient care and services.

Is it hard to be a utilization review nurse?

Being a utilization review nurse can be challenging due to the need for strong clinical knowledge, attention to detail, and the ability to make quick, accurate decisions based on medical records and guidelines. The job often involves working with insurance policies, documentation, and sometimes tight deadlines, but it also offers a structured environment and opportunities for certification and professional development.
More about Utilization Review Nurse jobs
What are the most commonly searched types of Utilization Review Nurse jobs in Decatur, GA? The most popular types of Utilization Review Nurse jobs in Decatur, GA are:
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What cities near Decatur, GA are hiring for Utilization Review Nurse jobs? Cities near Decatur, GA with the most Utilization Review Nurse job openings:
Utilization Review Nurse jobs near you
Infographic showing various Utilization Review Nurse job openings in Decatur, GA as of June 2026, with employment types broken down into 100% Full Time. Highlights an 60% In-person, and 40% Remote job distribution, with an average salary of $85,865 per year, or $41.3 per hour.

Travel Utilization Review Nurse

Olaro

Atlanta, GA

Contractor

Posted 14 days ago

Job description

Olaro is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Atlanta, Georgia.

Job Description & Requirements
  • Specialty: Utilization Review
  • Discipline: RN
  • Start Date: ASAP
  • Duration: 13 weeks
  • 40 hours per week
  • Shift: 8 hours, days
  • Employment Type: Travel

PHP Job ID #488537. Pay package is based on 8 hour shifts and 40 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: Utilization Review (UR) - Critical Need

About Olaro

Olaro Company Description


Olaro is a trusted partner in healthcare staffing, connecting nurses and allied health

professionals with opportunities nationwide. For over 35 years, we’ve helped clinicians

expand their horizons by matching them with assignments that fit their lifestyle, career

goals, and personal ambitions.


At Olaro, we value your expertise and support your growth at every step. We offer

competitive pay, comprehensive benefits, and access to diverse clinical experiences

that build your skills and open doors to new possibilities. With 24/7 support, streamlined

onboarding, and a team committed to your success, you’ll always have a proven guide

by your side.


Whether you want to explore new locations, broaden your clinical experience, or

achieve better work–life balance, Olaro provides the flexibility and support to help you

thrive. Join us, and let’s shape the future of healthcare together.

Apply