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Utilization Review Rn Jobs in Chattanooga, TN (NOW HIRING)

HealthONE

Utilization Management Nurse

Dalton, GA · On-site

Job Title Utilization Management Nurse The Utilization Management Nurse performs comprehensive ... medical review criteria * Current, active Compact State license in Nursing (RN) Physical ...

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Utilization Review Rn information

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How much do utilization review rn jobs pay per hour?

As of Aug 20, 2026, the average hourly pay for utilization review rn in Chattanooga, TN is $38.50, according to ZipRecruiter salary data. Most workers in this role earn between $30.43 and $44.23 per hour, depending on experience, location, and employer.

What is a utilization review RN?

A Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, collaborate with healthcare teams, and ensure that patient care meets established guidelines and payer requirements. Their role helps control costs, optimize care, and support compliance with healthcare regulations. Utilization Review RNs often work in hospitals, insurance companies, or managed care organizations.

How does a utilization review RN collaborate with physicians and other healthcare professionals during the patient care review process?

A Utilization Review RN works closely with physicians, case managers, and other healthcare team members to ensure that patients receive appropriate care while adhering to regulatory and insurance guidelines. This collaboration often involves discussing clinical findings, clarifying documentation, and negotiating care plans to meet both patient needs and payer requirements. Effective communication and teamwork are essential, as Utilization Review RNs frequently serve as liaisons between clinical staff and insurance representatives to facilitate timely authorizations and prevent unnecessary delays in patient care.

What are the key skills and qualifications needed to thrive as a utilization review RN, and why are they important?

To thrive as a Utilization Review RN, you need a current RN license, strong clinical assessment skills, and knowledge of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or ACM is often required. Excellent critical thinking, communication, and negotiation skills help you advocate for appropriate patient care while collaborating with providers and payers. These skills ensure cost-effective, quality care and compliance with regulatory standards in healthcare delivery.

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

AspectUtilization Review RnCase Manager
CredentialsRN license, certifications in utilization reviewRN license, certifications in case management
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community agencies, insurance companies
Primary FocusReviewing medical necessity and appropriateness of careCoordinating patient care and discharge planning

Utilization Review Rns primarily focus on evaluating the necessity of medical treatments, while Case Managers coordinate patient care and discharge planning. Both roles require RN licensure and certifications, but their daily responsibilities and work environments differ slightly, with Utilization Review Rns concentrating on review processes and Case Managers on patient advocacy and care coordination.

How to get into utilization review as a registered nurse?

To become a utilization review RN, you typically need a valid registered nurse license and experience in clinical settings. Additional certifications such as the Certified Professional in Healthcare Quality (CPHQ) or case management certification can enhance job prospects, and familiarity with electronic health records (EHR) systems is often required.

What are the most commonly searched types of Utilization Review Rn jobs in Chattanooga, TN?

The most popular types of Utilization Review Rn jobs in Chattanooga, TN are:

What are popular job titles related to Utilization Review Rn jobs in Chattanooga, TN?

For Utilization Review Rn jobs in Chattanooga, TN, the most frequently searched job titles are:

What job categories do people searching Utilization Review Rn jobs in Chattanooga, TN look for?

The top searched job categories for Utilization Review Rn jobs in Chattanooga, TN are:

What cities near Chattanooga, TN are hiring for Utilization Review Rn jobs?

Cities near Chattanooga, TN with the most Utilization Review Rn job openings:

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Chattanooga, TN as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 3% Contract, and 1% Nights. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $80,078 per year, or $38.5 per hour.

Utilization Management Nurse

HealthONE

Dalton, GA • On-site

Other

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 29 days ago

Job description

Job Title

Utilization Management Nurse

Job Description

The Utilization Management Nurse performs comprehensive clinical reviews of requested services utilizing clinical criteria, received through various mechanisms.

Essential Job Duties
  • Initiate referrals to ensure appropriate coordination of care.
  • Seek the advice of the Medical Director when appropriate, according to policy.
  • Assists non-clinical staff in performance of administrative reviews.
  • Performing comprehensive provider and member appeals, denial interpretation for letters, retrospective claim review, special review requests, and UM pre-certifications and appeals, utilizing medical appropriateness criteria, clinical judgement, and contractual eligibility.
  • Regular and predictable attendance.
  • Consistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practice.
  • Works to encourage and promote Company culture throughout the organization.
  • Other duties as may be assigned
Qualifications
  • 3 years Clinical experience preferred
  • 1-2 years of Utilization Review preferred
  • Proficient in Microsoft Office (Outlook, Word, Excel)
  • Working knowledge of NCQA preferred
  • Must be able to work in an independent and creative manner.
  • Ability to manage multiple projects and priorities
  • Adaptive to high pace and changing environment
  • Customer service oriented
  • Proficient in interpreting benefits, contract language and medical policy/medical review criteria
  • Current, active Compact State license in Nursing (RN)
Physical Requirements

Prolonged periods of sitting at a desk and working on a computer. Moderate to significant amount of stress in meeting deadlines and dealing with day-to-day responsibilities. Must be able to drive a vehicle and daytime/overnight travel as required.

Benefits
  • 401K (4% Match, Immediate Vesting)
  • Accident insurance
  • Competitive salary
  • Critical Illness Insurance
  • Dental Insurance
  • Employee Assistance Program
  • Flexible Spending Account
  • Health & Wellness Program
  • Health Savings Account
  • Life & AD&D Insurance
  • Long Term Disability
  • Medical Insurance
  • Paid Time Off
  • Pet Insurance
  • Short Term Disability
  • Vision Insurance
Pre-Employment Screening

Drug Screen and Background Check Required

Company Statement

HealthOne is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, disability, sex, age, ethnic or national origin, marital status, sexual orientation, gender identity or presentation, pregnancy, genetics, veteran status, or any other status protected by state or federal law.

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