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

Oscar Health

Sr. Quality of Care Review Nurse

Atlanta, GA · Remote

$83K - $109K/yr

We're hiring a Sr. Quality of Care Review Nurse to join our Quality team. Oscar is the first health ... Health plan utilization management experience or case management experience. * Experience in health ...

Pharmacy Careers

Remote Clinical Review Pharmacist

Atlanta, GA · On-site

$114K - $136K/yr

Remote Clinical Review Pharmacist - Work From Home | Evidence-Based Decisions | Flexible Schedule ... Collaborate with physicians, nurses, and utilization-management teams on complex cases. * Document ...

New

Bestica Healthcare

RN Case Manager

Atlanta, GA · On-site

Acute Hospital * Long Term Acute Care/Rehab/Skilled Nursing Case Management/Utilization Review: * Admission Criteria * Care coordination * Discharge Planning * Utilize InterQual Criteria * Utilize ...

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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 Aug 10, 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 much do utilization review nurses make?

Utilization review nurses in Texas typically earn an average annual salary of around $70,000 to $85,000, depending on experience, certifications, and employer. Salaries can vary based on healthcare setting, location, and workload, with some experienced nurses earning higher wages or additional benefits.

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.

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:
What are popular job titles related to Utilization Review Nurse jobs in Decatur, GA? For Utilization Review Nurse jobs in Decatur, GA, the most frequently searched job titles are:
What job categories do people searching Utilization Review Nurse jobs in Decatur, GA look for? The top searched job categories for Utilization Review Nurse jobs in Decatur, GA are:
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 August 2026, with employment types broken down into 3% As Needed, 65% Full Time, 27% Part Time, and 5% Contract. Highlights an 94% In-person, and 6% Remote job distribution, with an average salary of $85,865 per year, or $41.3 per hour.

Travel Nurse RN - Case Manager, Utilization Review

AMN Healthcare Revenue Cycle

Atlanta, GA • On-site

$1.8K - $2.7K/wk

Contractor

Medical, Dental, Vision, Life, Retirement

This job post has expired today. Applications are no longer accepted.

Job description

AMN Healthcare Revenue Cycle 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
  • 36 hours per week
  • Shift: 12 hours
  • Employment Type: Travel

Job Description & Requirements
RN Case Manager
StartDate: 8/10/2026 Pay Rate: $1800.00 - $2700.00
POSITION SUMMARY RN Case Manager Unit: Population Management -Diabetes
POSITION DUTIES 

    • Responsibilities include, but are not limited to, comprehensive patient assessment, symptom management, data analysis, care planning, case management, implementation of interventions, and evaluation of outcomes for patients with past, current, or suspected chronic diagnoses.
    • Chronic Conditions management, focused on outreach and management of the disease state (renal, respiratory as example), disease management specifically in diabetes, respiratory, or renal care.
    • Develop and facilitate individualized plans of care in collaboration with treating physicians, patients, their support networks, and family members. Coordinate and modify plans of care as needed to ensure seamless, patient-centered care across inpatient, outpatient, home, and other supportive care settings.
    • Perform clinical assessments and triage of new and established patients (including patients enrolled in clinical research studies) by telephone, in clinic, or in collaboration with the interdisciplinary healthcare team. Coordinate appointments for specialty consults, procedures, diagnostic testing, and support services within established service lines.
    • Deliver ongoing patient and caregiver education related to diagnoses, treatment plans, medications, symptom management, self-injection techniques, specialty-specific devices, and disease self-management. Monitor treatment response, identify side effects or dose-limiting toxicities, communicate findings to treating providers, and implement timely interventions.
    • Maintain collaborative relationships with physicians, primary care providers, specialty services, diagnostics, laboratory, radiology, inpatient teams, and other key stakeholders to ensure coordinated care, continuity of services, and optimal patient outcomes.
    • Support clinical quality and professional practice by identifying quality indicators, conducting systematic reviews, maintaining specialty-specific databases, reviewing policies, implementing evidence-based practice improvements, and ensuring compliance with clinical standards, protocols, and quality requirements. 
  • Float department (if needed): Supporting different specialties- renal, respiratory, and diabetes—all in the same location

MINIMUM REQUIRED QUALIFICATIONS GA or Compact RN License in hand
PREFERRED QUALIFICATIONS Kaiser Exp (not req)
LENGTH OF ASSIGNMENT 13 weeks 
SHIFT / HOURS PER WEEK 8:00am - 5:00pm (NO WEEKENDS)
SYSTEMS EPIC
START DATE 08/10/26
Facility Location
With its alluring charm and energetic buzz, Atlanta beckons newcomers from near and far. Part Southern belle, part economic powerhouse, the capital of Georgia is a favorite destination for travel nurses in search of career-boosting assignments, while the city’s numerous entertainment options and warm Southern hospitality make it a great place to call home.
Job Benefits
Becoming an AMN Healthcare professional gives you the incredible opportunity to gain critical career experience, work with new people, and earn a highly competitive salary—but the perks don't stop there. There are many additional benefits to enjoy, including:
  • Medical, dental and vision benefits
  • Earned time off and paid holidays
  • Paid continuing education time
  • 401(K) retirement planning
  • Short-term disability, life insurance, paid jury duty
  • Access to the largest network of facilities and providers in the country
  • Industry experienced workforce management team
  • Licensure and certification reimbursement

About the Company
At AMN Healthcare, we strive to be recognized as the most trusted, innovative, and influential force in helping healthcare organizations provide quality patient care that continually evolves to make healthcare more human, more effective, and more achievable.

AMN Healthcare Revenue Cycle Job ID #3546849. Pay package is based on 12 hour shifts and 36 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: RN Case Manager

About AMN Healthcare Revenue Cycle

AMN Healthcare is a leading force in the healthcare industry, committed to being the most trusted, innovative, and influential partner for healthcare organizations. With a focus on providing quality patient care, AMN Healthcare offers holistic solutions that reduce costs, streamline processes, and improve efficiencies. The company boasts over 30 years of experience and takes pride in staffing leading healthcare facilities with the nation's best travelers. As an industry leader, AMN Healthcare offers a diverse team dedicated to supporting healthcare workers and facilities, ensuring a personalized and supportive experience for both clients and candidates.

Benefits
  • Medical benefits
  • Dental benefits
  • Company provided housing options
  • Continuing Education

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