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

Memorial Health

RN - New Graduate

Lincoln, IL · On-site

$30.23 - $48.37/hr

... through utilization of the nursing process. They will provide age-appropriate care and will ... To review Memorial's Benefits click here: Benefits - Memorial HR Qualifications Licensure ...

Memorial Health

RN - New Graduate

Lincoln, IL

$30.23 - $48.37/hr

... through utilization of the nursing process. They will provide age-appropriate care and will ... To review Memorial's Benefits click here: Benefits - Memorial HR Licensure/Certification/Registry:

Memorial Health

RN - New Graduate

Lincoln, IL · On-site

$30.23 - $48.37/hr

... through utilization of the nursing process. They will provide age-appropriate care and will ... To review Memorial's Benefits click here: Benefits - Memorial HR Qualifications Licensure ...

Memorial Health

Patient Care Facilitator

Decatur, IL

$39.15 - $62.64/hr

Current RN licensure in the State of Illinois and CPR certification Experience: Minimum of 2 years ... Routinely reviews the plan of care with the patient and family to assist them in understanding ...

Memorial Health

Patient Care Facilitator

Decatur, IL · On-site

$39.15 - $62.64/hr

Current RN licensure in the State of Illinois and CPR certification Experience: Minimum of 2 years ... Routinely reviews the plan of care with the patient and family to assist them in understanding ...

Memorial Health

Patient Care Facilitator

Decatur, IL · On-site

$39.15 - $62.64/hr

Current RN licensure in the State of Illinois and CPR certification Experience: Minimum of 2 years ... Routinely reviews the plan of care with the patient and family to assist them in understanding ...

Goldwater Care Clinton

MDS Coordinator

Clinton, IL

$85K - $90K/yr

... reviews to assure achievement of optimal allowable Resource Utilization Group (RUG) category ... Nurse or Licensed Practical Nurse with current unencumbered state licensure · Long Term Care ...

Goldwater Care Clinton

MDS Coordinator

Clinton, IL · On-site

$85K - $90K/yr

... reviews to assure achievement of optimal allowable Resource Utilization Group (RUG) category ... Nurse or Licensed Practical Nurse with current unencumbered state licensure · Long Term Care ...

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

Utilization Review Nurse information

See Decatur, IL salary details

$20

$41

$66

How much do utilization review nurse jobs pay per hour?

As of Jul 16, 2026, the average hourly pay for utilization review nurse in Decatur, IL is $41.01, according to ZipRecruiter salary data. Most workers in this role earn between $32.40 and $47.12 per hour, depending on experience, location, and employer.

How to make $300,000 as a nurse?

To earn $300,000 as a Utilization Review Nurse, professionals typically need extensive experience, advanced certifications such as CCM or ANCC, and may work in high-paying healthcare settings or take on additional responsibilities like case management or leadership roles. Working overtime, specializing in complex cases, or pursuing advanced degrees can also increase earning potential.

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.

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, candidates typically need a registered nurse (RN) license and experience in clinical settings. Additional certifications such as Certified Professional in Healthcare Quality (CPHQ) or case management credentials can improve job prospects, and familiarity with medical records, insurance policies, and utilization review software is often required.

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 involves reviewing medical records and determining appropriate care levels, which requires strong clinical knowledge, attention to detail, and good communication skills. The job can be demanding due to tight deadlines, the need for accuracy, and the responsibility of making critical decisions that impact patient care and insurance processes.
More about Utilization Review Nurse jobs
What are the most commonly searched types of Utilization Review Nurse jobs in Decatur, IL? The most popular types of Utilization Review Nurse jobs in Decatur, IL are:
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What cities near Decatur, IL are hiring for Utilization Review Nurse jobs? Cities near Decatur, IL with the most Utilization Review Nurse job openings:
Utilization Review Nurse jobs near you
Infographic showing various Utilization Review Nurse job openings in Decatur, IL as of July 2026, with employment types broken down into 2% As Needed, 63% Full Time, 19% Part Time, and 16% Contract. Highlights an 99% Physical, and 1% Remote job distribution, with an average salary of $85,305 per year, or $41 per hour.
RN - New Graduate

RN - New Graduate

Memorial Health

Lincoln, IL • On-site

$30.23 - $48.37/hr

Full-time

Re-posted 7 days ago

Memorial Health rating

6.9

Company rating: 6.9 out of 10

Based on 174 frontline employees who took The Breakroom Quiz

449th of 886 rated healthcare providers

Job description

Min
USD $30.23/Hr.
Max
USD $48.37/Hr.
Overview
****Sign-on Bonuses up to $15,000.00****
The New Graduate Registered Nurse is a full-time registered nurse position with a one-year nationally recognized Nurse Residency Program that assists you in transitioning from a new graduate to a professional nurse. As a New Graduate Registered Nurse, you will receive a carefully planned combination of on-the-job and classroom education.
This program allows you to build relationships with other new RNs and to work collaboratively on a project that is important to advancing the care of our patients. The New Graduate Registered Nurse will receive support from their Nurse Manager, Preceptor, Mentor, other unit staff as well as a Nursing Outcome Improvement Facilitator.
Our curriculum focuses on 3 core components; Clinical Leadership, Patient Safety and Outcomes and the Professional Role as a Registered Nurse. There are monthly residency sessions that will provide you with a strong foundation for the lifelong learning ahead. The last six months of the program is committed to an evidence based practice project. As a group you will work with your unit and unit manager on a clinical issue that you see as problematic or an area of improvement.
In addition to the residency, the New Graduate Registered Nurse will be responsible for delegation, supervision, and provision of nursing care for a designated group of patients through utilization of the nursing process. They will provide age-appropriate care and will participate in research when appropriate and incorporate research findings into evidence-based clinical practice.
To review Memorial's Benefits click here: Benefits - Memorial HR
Qualifications
Licensure/Certification/Registry:
  • Licensed as RN in State of Illinois.
  • Current BLS/CPR certification per policy.

Other Knowledge/Skills/Abilities:
  • Must be able to position and/or transfer an average adult patient and possess gross coordination sufficient to perform other patient care duties as required. Must be able to withstand prolonged periods of standing. Must be able to perform difficult manipulative skills such as IV insertion and IM injections.
  • Environmental working conditions include exposure to blood, bodily fluids and tissue, contagious diseases and/or radioactive or other potentially hazardous materials.

I can be reached at Cox.Justin@mhsil.com

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