Utilization Management Nurse Consultant Jobs
Utilization management nurse consultant jobs are open across health insurance, managed care, and hospital systems, from staff-level to senior and lead roles, with specializations in prior authorization, case review, and clinical appeals. Scan the live roles below and apply to whichever ones fit.
Find JobsOverview
Showing 5 of 171+ Utilization Management Nurse Consultant jobs
50 West Town Street
Columbus, Ohio, 43215
United States
Investing in opportunities for Ohioans that work for every person and every family in every corner of our state is at the hallmark of Governor DeWine’s agenda for Ohio’s future. To ensure Ohio is “the best place to live, work, raise and family and start a business,” we must have strong schools, a great quality of life, and compassion for those who need our help.
Ohio Department of Medicaid plays a unique and necessary role in supporting the governor’s vision. As the single state Medicaid agency responsible for administering high-quality, person-centric healthcare, the department is committed to supporting the health and wellbeing of nearly one in every four Ohioans served. We do so by:
- Delivering a personalized care experience to more than three million people served.
- Improving care for children and adults with complex behavioral health needs.
- Working collectively with our partners and providers to measurably strengthen wellness and health outcomes.
- Streamlining administrative burdens so doctors and healthcare providers have more time for patient care.
- Ensuring financial transparency and operational accountability across all Medicaid programs and services.
Office: Health Innovation &Quality
Bureau: Clinical Operations
Classification: Medicaid Health Systems Specialist RN (PN: 20102136)
Job Overview:
As the Utilization Management (UM) Nurse in the Bureau of Clinical Operations, Ohio Department of Medicaid (ODM), your responsibilities will include:
- Reviews Clinical Coverage Policies (CCPs) of the managed care plans to ensure managed care coverage meets medical necessity, benefit coverage rules, and applicable Ohio Administrative Code standards.
- Conducts validation of pre and post services across all service categories Durable Medical Equipment (DME), inpatient/outpatient to meet required clinical criteria and documentation thresholds
- Assists with rules language by interpreting Fee for Service (FFS) rules against managed care impact and CCP requirements
- Verifies completeness, prior authorization and other submissions in alignment with UM policy requirements.
- Participates in cross-team collaboration with medical directors, reviewers, policy teams, and managed care leads to ensure UM consistency and alignment with statewide managed care requirements.
Compensation is as listed on the posting unless required by legislation or union contract.
Travel required, as needed. Must provide own transportation. Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence.
At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees*. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes:
- Medical Coverage
- Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period
- Paid time off, including vacation, personal, sick leave and 11 paid holidays per year
- Childbirth, Adoption, and Foster Care leave
- Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more)
- Public Retirement Systems (such as OPERS, STRS, SERS, and HPRS) & Optional Deferred Compensation (Ohio Deferred Compensation)
- Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.
- Or for positions other than those requiring valid license as registered nurse, completion of undergraduate core program in business administration, social or behavioral science, health or statistics additional 24 mos. exp. specific to subject area of which 12 mos. exp. in use of spreadsheet and database software. Note: education & experience to be commensurate with approved position description on file.
- Or for positions other than those requiring valid license as registered nurse, 24 months experience as Medicaid Health Systems Analyst, (65291) may be substituted for the experience required, but not for the mandated licensure.
- Or equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required, but not for the mandated licensure.
Job Skills: Nursing, Health Administration
Ohio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.
50 West Town Street
Columbus, Ohio, 43215
United States
Investing in opportunities for Ohioans that work for every person and every family in every corner of our state is at the hallmark of Governor DeWine’s agenda for Ohio’s future. To ensure Ohio is “the best place to live, work, raise and family and start a business,” we must have strong schools, a great quality of life, and compassion for those who need our help.
Ohio Department of Medicaid plays a unique and necessary role in supporting the governor’s vision. As the single state Medicaid agency responsible for administering high-quality, person-centric healthcare, the department is committed to supporting the health and wellbeing of nearly one in every four Ohioans served. We do so by:
- Delivering a personalized care experience to more than three million people served.
- Improving care for children and adults with complex behavioral health needs.
- Working collectively with our partners and providers to measurably strengthen wellness and health outcomes.
- Streamlining administrative burdens so doctors and healthcare providers have more time for patient care.
- Ensuring financial transparency and operational accountability across all Medicaid programs and services.
Office: Health Innovation &Quality
Bureau: Clinical Operations
Classification: Medicaid Health Systems Specialist RN (PN: 20102136)
Job Overview:
As the Utilization Management (UM) Nurse in the Bureau of Clinical Operations, Ohio Department of Medicaid (ODM), your responsibilities will include:
- Reviews Clinical Coverage Policies (CCPs) of the managed care plans to ensure managed care coverage meets medical necessity, benefit coverage rules, and applicable Ohio Administrative Code standards.
- Conducts validation of pre and post services across all service categories Durable Medical Equipment (DME), inpatient/outpatient to meet required clinical criteria and documentation thresholds
- Assists with rules language by interpreting Fee for Service (FFS) rules against managed care impact and CCP requirements
- Verifies completeness, prior authorization and other submissions in alignment with UM policy requirements.
- Participates in cross-team collaboration with medical directors, reviewers, policy teams, and managed care leads to ensure UM consistency and alignment with statewide managed care requirements.
Compensation is as listed on the posting unless required by legislation or union contract.
Travel required, as needed. Must provide own transportation. Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence.
At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees*. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes:
- Medical Coverage
- Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period
- Paid time off, including vacation, personal, sick leave and 11 paid holidays per year
- Childbirth, Adoption, and Foster Care leave
- Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more)
- Public Retirement Systems (such as OPERS, STRS, SERS, and HPRS) & Optional Deferred Compensation (Ohio Deferred Compensation)
- Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.
- Or for positions other than those requiring valid license as registered nurse, completion of undergraduate core program in business administration, social or behavioral science, health or statistics additional 24 mos. exp. specific to subject area of which 12 mos. exp. in use of spreadsheet and database software. Note: education & experience to be commensurate with approved position description on file.
- Or for positions other than those requiring valid license as registered nurse, 24 months experience as Medicaid Health Systems Analyst, (65291) may be substituted for the experience required, but not for the mandated licensure.
- Or equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required, but not for the mandated licensure.
Job Skills: Nursing, Health Administration
Ohio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.
Utilization Management Nurse Consultant Jobs by Experience Level
See All 171+ Utilization Management Nurse Consultant Jobs
Find roles that match your experience and apply in just a few clicks.
Find JobsUtilization Management Nurse Consultant Job Market
Who's Hiring
Top Industries Hiring
- Insurance
- Healthcare & Medical Services
- Education
- Manufacturing
- Technology & Software
What Employers Look For
The qualifications that appear most often in utilization management nurse consultant jobs.
- Active registered nurse license, with compact multistate licensure often preferred
- Minimum two to three years of acute care or clinical nursing experience
- Working knowledge of InterQual or MCG clinical criteria for authorization decisions
- Experience with prior authorization, concurrent review, or retrospective clinical review
- Familiarity with ICD-10 coding, CPT codes, and medical necessity documentation standards
- Strong written communication skills for denial letters, appeal responses, and case documentation
Tips for Your Utilization Management Nurse Consultant Job Search
Tailor your resume for UM language
Hiring managers scan for terms like prior authorization, InterQual, MCG criteria, and denial management. If your clinical background includes these but under different job titles, translate that experience explicitly so your resume clears the initial screening.
Highlight your clinical licensure upfront
Most utilization management nurse consultant postings require an active RN license, and some specify multistate compact licensure. List your license number, state, and expiration date near the top of your resume so reviewers don't have to search for it.
Target postings by payer versus provider side
Payer-side roles at insurance carriers focus on claim review and denial ratios, while provider-side roles at hospitals center on length-of-stay and discharge planning. Decide which environment fits your background before applying, then adjust your cover letter accordingly.
Apply early to roles that fit
Migrate Mate lists utilization management nurse consultant openings from across the United States in one place, so you can find roles that match and apply directly to each listing.
Prepare for criteria-based case scenarios
Interviewers frequently present a clinical vignette and ask you to walk through an authorization decision using InterQual or MCG guidelines. Practice narrating your clinical reasoning out loud, referencing the relevant criteria level and what additional documentation you would request.
Negotiate remote arrangements before accepting
Many utilization management nurse consultant positions are fully remote, but some require periodic on-site audits or staff meetings. Confirm the exact remote policy, any equipment stipulations, and whether the role is restricted to specific states before you sign an offer.
Utilization Management Nurse Consultant Jobs: Frequently Asked Questions
Which companies are hiring the most utilization management nurse consultants?
The companies hiring the most utilization management nurse consultants right now include CommunityCare, Optum, and UF Health, with the largest share of openings in California, New York, and Florida, based on current listings on Migrate Mate as of November 2026. Health insurance carriers and large managed care organizations consistently account for the greatest volume of postings.
How many utilization management nurse consultant jobs are remote?
About 78% of utilization management nurse consultant openings are fully remote or hybrid as of November 2026, making it one of the more remote-friendly nursing roles available. Prior authorization review and telephonic case management functions tend to be the most consistently remote, while on-site audits and discharge planning coordination are more likely to require a physical presence.
How do you become a utilization management nurse consultant?
Start by earning your RN license and gaining several years of acute care or specialty clinical experience, since employers expect you to apply real patient-care judgment to authorization decisions. From there, familiarize yourself with InterQual or MCG criteria, ICD-10 and CPT coding basics, and payer coverage policies. Earning a certification such as the Certified Case Manager credential strengthens your application and signals formal UM competency to hiring teams.
Can I get a utilization management nurse consultant job with limited experience?
Most employers expect at least two years of direct clinical nursing experience before moving into a utilization management nurse consultant role, because the work requires applying bedside judgment to authorization criteria without direct patient contact. If you're close to that threshold, seek out hybrid positions that blend case management with utilization review, or look for payer-side training programs that onboard nurses with strong clinical backgrounds and provide structured UM mentorship.
What does the utilization management nurse consultant interview process look like?
The process typically begins with a phone screen from a recruiter or nurse manager focused on your clinical background and familiarity with authorization criteria. A second round usually involves a panel interview with UM leadership and may include a written or verbal case scenario where you walk through a prior authorization decision. Some employers add a brief skills assessment covering medical necessity language, denial rationale, or payer policy interpretation before extending an offer.
Where can I find and apply to utilization management nurse consultant jobs?
You can find and apply to utilization management nurse consultant jobs on Migrate Mate, which lists current openings from across the United States. Search for roles that match your clinical background, licensure, and preferred work setting, then apply directly to each listing that fits.
See All 171+ Utilization Management Nurse Consultant Jobs
Find roles that match your experience and apply in just a few clicks.
Find Jobs