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Utilization Review Nurse Jobs in Springfield, MO

Citizens Memorial

MDS RN-FND PHF Nurs LTC

Bolivar, MO · On-site

The skilled nursing facility is a 78-bed facility located in Bolivar, MO that includes a memory care unit for individuals with Alzheimer's disease and dementia. The primary purpose is to work closely ...

Citizens Memorial

MDS RN-FND PHF Nurs LTC

Bolivar, MO · On-site

The skilled nursing facility is a 78-bed facility located in Bolivar, MO that includes a memory care unit for individuals with Alzheimer's disease and dementia. The primary purpose is to work closely ...

Citizens Memorial

MDS RN-FND PHF Nurs LTC

Bolivar, MO · On-site

The skilled nursing facility is a 78-bed facility located in Bolivar, MO that includes a memory care unit for individuals with Alzheimer's disease and dementia. The primary purpose is to work closely ...

Citizens Memorial

Registered Nurse

Bolivar, MO · On-site

... utilization of motivational interviewing to help initiate healthful behavior change, and ... Completion of an accredited program (Registered Nurse) * Experience: At least one year of related ...

Citizens Memorial

Registered Nurse

Bolivar, MO · On-site

... utilization of motivational interviewing to help initiate healthful behavior change, and ... Completion of an accredited program (Registered Nurse) * Experience: At least one year of related ...

Citizens Memorial

Registered Nurse

Bolivar, MO

Placement in Nurse Residency program for newly graduated nurses [if applicable-only RN hospital positions] What Your Day Looks Like: Medical Home strives to improve patient outcomes by facilitating ...

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All JobsUtilization Review Nurse JobsUtilization Review Nurse Jobs in Springfield, MO

Utilization Review Nurse information

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$19

$38

$62

How much do utilization review nurse jobs pay per hour?

As of Aug 28, 2026, the average hourly pay for utilization review nurse in Springfield, MO is $38.46, according to ZipRecruiter salary data. Most workers in this role earn between $30.38 and $44.18 per hour, depending on experience, location, and employer.

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 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 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 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 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.

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The most popular types of Utilization Review Nurse jobs in Springfield, MO are:

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For Utilization Review Nurse jobs in Springfield, MO, the most frequently searched job titles are:

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Utilization Review Nurse jobs near you
Infographic showing various Utilization Review Nurse job openings in Springfield, MO as of August 2026, with employment types broken down into 1% As Needed, 76% Full Time, 18% Part Time, 1% Temporary, 3% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $79,999 per year, or $38.5 per hour.

MDS RN-FND PHF Nurs LTC

Citizens Memorial

Bolivar, MO

Full-time

Medical, Retirement, PTO

Posted 15 days ago

Citizens Memorial Hospital rating

6.4

Company rating: 6.4 out of 10

Based on 56 frontline employees who took The Breakroom Quiz

751st of 1,064 rated hospitals

Job description

Citizens Memorial Hospital Foundation (CMH) is recruiting a Registered Nurse (RN) or Licensed Practical Nurse to be our MDS coordinator and care for our residents in Parkview Healthcare Facility.

The skilled nursing facility is a 78-bed facility located in Bolivar, MO that includes a memory care unit for individuals with Alzheimer's disease and dementia.

The primary purpose is to work closely with facility Director of Nursing to assure staff or residents needs are met.  Is responsible to plan, organize, implement, evaluate and coordinate the development, education, orientation and scheduling of the nursing staff in accordance to Foundation policies, Federal / State regulations and quality care needs; behaves in a manner consistent with mission and objectives of CMH and performs other duties as requested.

The position is full-time, days.

Benefits include:

  • Competitive Wages
  • Annual merit increases 
  • No cost health insurance option for employee
  • Full suite of insurance benefits available for employee and family
  • Early access to pay with on-demand PayActiv Program
  • Employee assistance program
  • Paid time off
  • Increased company matched Retirement Plan
  • Company paid long term disability plan
  • Employee discounts

Please call Cynthia McDaniel at 417-328-6793 or email at cynthia.mcdaniel@citizensmemorial.com

Keywords:  MDS, RN, LVN, LPN, LTC

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