Utilization Management Nurse Jobs
Utilization Management Nurse jobs are open across health insurance payers, hospital systems, managed care organizations, and third-party administrators, at every level from staff nurse to senior and lead, with specializations in prior authorization, concurrent review, and case management. Find a role that fits from the openings below and apply directly.
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Showing 5 of 180+ Utilization Management Nurse jobs
Description
Care Manager RN - REMOTE position. This position is Per Diem and will work 8- hour, Day shifts.
The Care Management Recovery Advocate (CMRA) is responsible for providing overall management and communication of clinically-based appeals between Providence Health and Services, California Region (PH&S) outside payers. Activities will be patient-focused, uniform, compliant, and support steadfast advocacy for reimbursement of services provided to patients served within the PH&S ministries.
Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence California Regional Services and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.
Required Qualifications:
Associate's Degree in Nursing.
Upon hire: California Registered Nurse License
4 years Direct patient care experience in an acute hospital setting.
4 years Experience as a case manager in an acute hospital setting.
Preferred Qualifications:
Bachelor’s Degree in Nursing or,
Master's Degree in Nursing.
Upon hire: Case management certification
Experience working with denials and appeals in/for an acute care setting.
Experience in a multi-hospital and/or integrated healthcare system.
Familiarity with Revenue Cycle processes.
Working knowledge of regulations and provider contracts governing coverage of inpatient services (e.g., Medicare, Medi-Cal, Commercial Payers).
Why Join Providence?
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.
About Providence
At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.
Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.
Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
Requsition ID: 457421
Company: Providence Jobs
Job Category: Care Management
Job Function: Clinical Care
Job Schedule: Per-Diem
Job Shift: Day
Career Track: Nursing
Department: 7000 UTILIZATION MGMT CA SOCAL
Address: CA Torrance 21311 Madrona Ave
Work Location: PMI Madrona-Torrance
Workplace Type: Remote
Pay Range: $57.28 - $88.92
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Description
Care Manager RN - REMOTE position. This position is Per Diem and will work 8- hour, Day shifts.
The Care Management Recovery Advocate (CMRA) is responsible for providing overall management and communication of clinically-based appeals between Providence Health and Services, California Region (PH&S) outside payers. Activities will be patient-focused, uniform, compliant, and support steadfast advocacy for reimbursement of services provided to patients served within the PH&S ministries.
Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence California Regional Services and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.
Required Qualifications:
Associate's Degree in Nursing.
Upon hire: California Registered Nurse License
4 years Direct patient care experience in an acute hospital setting.
4 years Experience as a case manager in an acute hospital setting.
Preferred Qualifications:
Bachelor’s Degree in Nursing or,
Master's Degree in Nursing.
Upon hire: Case management certification
Experience working with denials and appeals in/for an acute care setting.
Experience in a multi-hospital and/or integrated healthcare system.
Familiarity with Revenue Cycle processes.
Working knowledge of regulations and provider contracts governing coverage of inpatient services (e.g., Medicare, Medi-Cal, Commercial Payers).
Why Join Providence?
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.
About Providence
At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.
Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.
Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
Requsition ID: 457421
Company: Providence Jobs
Job Category: Care Management
Job Function: Clinical Care
Job Schedule: Per-Diem
Job Shift: Day
Career Track: Nursing
Department: 7000 UTILIZATION MGMT CA SOCAL
Address: CA Torrance 21311 Madrona Ave
Work Location: PMI Madrona-Torrance
Workplace Type: Remote
Pay Range: $57.28 - $88.92
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Utilization Management Nurse Jobs by Experience Level
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Find JobsUtilization Management Nurse Job Market
Who's Hiring
Top Industries Hiring
- Healthcare & Medical Services15
- Insurance5
- Technology & Software4
- Manufacturing1
What Employers Look For
The qualifications that appear most often in utilization management nurse jobs.
- Active registered nurse license in the state of hire or compact licensure
- Minimum two to three years of acute care or direct clinical nursing experience
- Working knowledge of InterQual or Milliman Care Guidelines criteria
- Experience with prior authorization, concurrent review, or discharge planning
- Familiarity with ICD-10 coding and medical necessity documentation standards
- Proficiency with electronic health records and utilization management software platforms
Tips for Your Utilization Management Nurse Job Search
Tailor your resume for UM terminology
Recruiters and applicant tracking systems scan for specific terms like prior authorization, InterQual, MCG criteria, and level-of-care determination. Audit every bullet on your resume and replace vague clinical language with the utilization management vocabulary that appears in the postings you're targeting.
Highlight your criteria knowledge upfront
Many UM nurse postings screen for hands-on experience with InterQual or Milliman Care Guidelines before they read anything else. Put the criteria sets you've worked with, and the volume of cases you've reviewed, near the top of your resume so hiring managers see it immediately.
Filter openings by payer versus provider setting
Health insurance companies, hospital utilization review departments, and independent review organizations each operate differently. Decide which setting fits your background before you apply, because your interview answers will need to reflect that environment's workflows, turnaround time expectations, and regulatory requirements.
Apply early to roles that fit
Migrate Mate lists utilization management nurse openings from across the United States in one place, so you can find roles that match and apply directly to each listing.
Prepare for case scenario interview questions
UM nurse interviews almost always include scenario questions where you walk through a denial decision or an appeal. Practice articulating how you apply clinical criteria, document your rationale, and communicate findings to physicians, because interviewers are evaluating your judgment, not just your clinical background.
Negotiate remote status before you accept
Many UM nurse roles are posted as remote-eligible but shift to hybrid after onboarding. Ask directly during the offer stage which days require on-site presence, whether that can change, and what equipment the employer provides, so the arrangement is confirmed in writing before you give notice.
Utilization Management Nurse Jobs: Frequently Asked Questions
Which companies are hiring the most utilization management nurses?
The companies hiring the most utilization management nurses right now include CVS Health, CommunityCare, and CHRISTUS Health, with the largest share of openings in California, Florida, and Pennsylvania, based on current listings on Migrate Mate as of September 2026. Payer-side organizations and large hospital systems tend to post the highest volume of openings on an ongoing basis.
How many utilization management nurse jobs are remote?
About 74% of utilization management nurse openings are fully remote or hybrid as of September 2026, making it one of the more remote-accessible nursing specialties. Prior authorization review and telephonic case management roles are the most likely to be fully remote, while concurrent review and discharge planning positions more often require on-site or hybrid presence.
How do you become a utilization management nurse?
Start by earning your registered nurse license and building at least two years of acute care clinical experience in a setting like med-surg, ICU, or emergency. From there, seek out roles in hospital utilization review or case management to gain exposure to criteria-based review. Learning InterQual or Milliman criteria independently accelerates the transition, and earning a certification such as the Certified Case Manager credential strengthens your candidacy for payer-side roles.
Can you get a utilization management nurse job with limited UM experience?
Yes, many employers will consider candidates with strong clinical backgrounds but no formal UM experience, particularly for hospital-based utilization review roles. Emphasize any experience you have with discharge planning, care coordination, or insurance communication. Completing a UM-focused continuing education course, familiarizing yourself with InterQual criteria, and obtaining a case management certification can compensate for a shorter direct UM history.
What does the utilization management nurse interview process look like?
Most UM nurse interviews include an initial phone screen with a recruiter, followed by one or two video or in-person interviews with a nurse manager or clinical operations director. Expect scenario-based questions where you walk through how you would apply clinical criteria to approve or deny a request, handle a physician peer-to-peer, or document a concurrent review decision. Some employers also ask situational questions about turnaround time management and regulatory compliance.
Where can I find and apply to utilization management nurse jobs?
You can find and apply to utilization management nurse jobs on Migrate Mate, which lists current openings from employers across the United States. Search the listings to find roles that match your experience, credentials, and preferred setting, then apply directly to each opening that fits.
See All 180+ Utilization Management Nurse Jobs
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