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

Registered Nurse (Navy Nurse Corps) Category / Component: Officer • Both Overview Navy Nurse ... will be reviewed with you by a recruiter. Additional qualifications for this job may include:

Registered Nurse (Navy Nurse Corps) Category / Component: Officer • Both Overview Navy Nurse ... will be reviewed with you by a recruiter. Additional qualifications for this job may include:

RN - Acute Care

Lincoln, IL · On-site

$30.23 - $48.37/hr

... review Memorial's Benefits click here: Benefits - Memorial HR Qualifications Who We're Looking For: A compassionate nurse who thrives in a fast-paced environment, values teamwork and is committed to ...

RN - Acute Care

Lincoln, IL

$30.23 - $48.37/hr

... review Memorial's Benefits click here: Benefits - Memorial HR Who We're Looking For: A compassionate nurse who thrives in a fast-paced environment, values teamwork and is committed to delivering ...

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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.
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:
What are popular job titles related to Utilization Review Nurse jobs in Decatur, IL? For Utilization Review Nurse jobs in Decatur, IL, the most frequently searched job titles are:
What job categories do people searching Utilization Review Nurse jobs in Decatur, IL look for? The top searched job categories for Utilization Review Nurse jobs in Decatur, IL are:
What cities near Decatur, IL are hiring for Utilization Review Nurse jobs? Cities near Decatur, IL with the most Utilization Review Nurse job openings:
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.
Registered Nurse

Full-time

Medical, Dental, Vision, Retirement

Re-posted 2 days ago


United States Navy rating

6.3

Company rating: 6.3 out of 10

Based on 378 frontline employees who took The Breakroom Quiz

38th of 46 rated military and defense


Job description

Job Title: Registered Nurse (Navy Nurse Corps)
Category / Component: Officer • Both

Overview
Navy Nurse Corps officers deliver professional nursing care to service members, families, and global communities in leading edge military medical centers, hospital ships, and operational units, while advancing their education and clinical practice through generous scholarships and specialty training.

Key Responsibilities
Provide direct patient care in medical surgical, critical care, perioperative, mental health, primary care, and other nursing specialties; assess, plan, implement, and evaluate nursing care for individuals and families; function as a nurse practitioner, nurse anesthetist, or other advanced practice nurse when appropriately trained; lead and supervise nursing teams, manage patient flow and unit operations, and contribute to quality improvement and clinical education initiatives.

What to Expect
Shift based work in inpatient and outpatient settings with possible on call duties; opportunities for deployment, humanitarian missions, and shipboard assignments; rapid growth in leadership responsibility as you manage teams, coordinate complex care, and take on administrative roles; strong emphasis on continuing education, specialty certifications, and professional development.

Work Environment
Assignments at Navy and joint medical centers such as Bethesda, Portsmouth, and San Diego; billets aboard hospital ships such as USNS Comfort and USNS Mercy; potential positions on surface ships, with aviation units, and within Fleet Marine Force medical organizations; daily collaboration with physicians, other nurses, Hospital Corpsmen, and allied health professionals.

Pathways, Training & Advancement
Officer Development School followed by orientation and clinical integration at a Navy medical facility; specialty training and clinical rotations based on billet requirements and experience; career progression opportunities into advanced practice roles, nursing administration, education, research, and staff positions; access to leadership courses and Navy funded graduate education for qualified officers.
Entry through programs such as NROTC Nurse Option scholarships, the Nurse Candidate Program for nursing students, direct accession for licensed registered nurses, and Reserve accession for practicing nurses in needed specialties; specific accession paths and incentives vary based on current Navy requirements.

Qualifications
All Navy jobs require meeting general enlistment or commissioning standards, which typically include:

  • Eligibility to serve in the United States Navy, which may involve United States citizenship or other legal residency and work status, depending on the program and current law and policy
  • A high school diploma or equivalent for enlisted positions, and a bachelor’s or qualifying professional degree for officer positions
  • Meeting age limits that vary by program and are set in law and Navy policy. Some communities have more restrictive age ranges
  • Meeting medical, vision, and dental standards, including body composition and physical fitness requirements, with some jobs requiring more demanding standards
  • Meeting character and conduct standards, including background screening
  • Achieving required test scores for your program, such as the Armed Services Vocational Aptitude Battery for enlisted roles or officer qualification tests for officer programs
  • Eligibility for a security clearance when required for your rating or designator
  • Additional qualifications can include specific skills, education, licensure, or experience that are unique to a job or community and will be reviewed with you by a recruiter.

Additional qualifications for this job may include:
Bachelor of Science in Nursing from a CCNE or other nationally accredited program or enrollment in such a program for student pipelines; current and unrestricted registered nurse license or the ability to obtain one within established timelines for new graduates; United States citizenship and ability to meet age, medical, fitness, and security clearance standards for commissioning as a Navy officer.

Education
Education benefits are available through standard Navy programs such as Tuition Assistance, the Post-9/11 GI Bill, ACE-recommended college credit for Navy training, Navy COOL-funded certifications, USMAP apprenticeships, and other Navy College Program opportunities. Specific options depend on the Sailor’s status, training, and current Navy policy.

Pay, Benefits & Service
Pay, benefits, and service commitments follow standard Navy Active and/or Reserve policies for this type of role, including basic pay, allowances when eligible, health coverage, and retirement options. Exact entitlements, special pays, and service obligations depend on program, component, years of service, and current law and Navy guidance.

Incentives
Incentives such as bonuses, special pays, and loan repayment may be available at times for specific ratings or communities, but they change frequently and cannot be guaranteed. Applicants must confirm current incentives and eligibility with an official Navy recruiter or authoritative Navy source.

Notes and Disclaimers
This description is a general overview of typical duties, training, and opportunities in this community. It does not replace official Navy instructions, policies, or contracts and does not guarantee specific assignments, training, incentives, or outcomes. Actual opportunities depend on Navy needs, individual performance, screening results, and current law and policy.


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Industry

National security, national security and international affairs, public safety statistics centers and offices, guided missile and space vehicle manufacturing and public administration

Company size

10,000+ Employees

Headquarters location

Washington, DC, US

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