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 59+ Utilization Management Nurse jobs
Job Summary: Provides administrative and clinical support to the hospital and treatment teams throughout the review of patients including, but not limited to their placement in various levels of care and receipt of necessary services. The Utilization Management (UM) Registered Nurse will communicate with providers the details of reimbursement issues and participate in treatment teams, Patient Care Committee, and the Utilization Review Staff Committee by providing data and contributing to the improvement of internal processes.
Minimum Education: Has completed the basic professional curricula of a school of nursing as approved and verified by a state board of nursing, and holds or is entitled to hold a diploma or degree therefrom or Master's degree in Nursing.
Licensure, Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License.
Work Experience: Minimum 2 years of related experience in an acute care setting.
Knowledge, Skills and Abilities:
- Ability to organize and prioritize work in an effective and efficient manner.
- Effective interpersonal, written, and oral communication skills.
- Demonstrated ability to integrate the analysis of data to discover facts or develop knowledge, concepts, or interpretations.
- Ability to be detail oriented as required in the examination of numerical data.
- Ability to synthesize clinical case data into concise summaries.
- Working knowledge of Microsoft Word, Excel and Access in the preparation of correspondence and reports.
Essential Functions and Responsibilities:
- Gathers, prepares and supplies required clinical/treatment information needed to obtain authorization within the review interval(s) time requirements.
- Participates in treatment team and/or Patient Care Committee by providing information about eligibility, benefits, and criteria for the selected level of care.
- Assists in discharge planning, as needed.
- Identifies QI Triggers for individual patient situations, reporting them promptly to the UM Manager, appropriate clinicians and Process Improvement/Quality Director.
- Reviews eligibility and benefits of patients to validate accurate level of care utilization.
- Investigates and prepares appeals for insurance companies when denial of reimbursement is related to medical necessity or to other treatment issues.
- Participates in quality-of-care and UM process improvement on an ongoing basis and assists with development of the UR Staff Committee's process improvement goals.
- Provides staff education to further the goals of UR.
Decision Making: The carrying out of non-routine procedures under constantly changing conditions, in conformance with general instructions from supervisor.
Working Relationship: Works directly with patients and/or customers. Works with internal customers via telephone or face to face interaction. Works with other healthcare professionals and staff. Works frequently with individuals at Director level or above.
Special Job Dimensions: None.
Supplemental Information: This document generally describes the essential functions of the job and the physical demands required to perform the job. This compilation of essential functions and physical demands is not all inclusive nor does it prohibit the assignment of additional duties.
Location: Virtual Office, Oklahoma 73105
Must be available to work 3pm-11pm and 11pm-7am.
EOE Protected Veterans/Disability
Job Summary: Provides administrative and clinical support to the hospital and treatment teams throughout the review of patients including, but not limited to their placement in various levels of care and receipt of necessary services. The Utilization Management (UM) Registered Nurse will communicate with providers the details of reimbursement issues and participate in treatment teams, Patient Care Committee, and the Utilization Review Staff Committee by providing data and contributing to the improvement of internal processes.
Minimum Education: Has completed the basic professional curricula of a school of nursing as approved and verified by a state board of nursing, and holds or is entitled to hold a diploma or degree therefrom or Master's degree in Nursing.
Licensure, Registration and/or Certification: Valid multi-state or State of Oklahoma Registered Nurse License.
Work Experience: Minimum 2 years of related experience in an acute care setting.
Knowledge, Skills and Abilities:
- Ability to organize and prioritize work in an effective and efficient manner.
- Effective interpersonal, written, and oral communication skills.
- Demonstrated ability to integrate the analysis of data to discover facts or develop knowledge, concepts, or interpretations.
- Ability to be detail oriented as required in the examination of numerical data.
- Ability to synthesize clinical case data into concise summaries.
- Working knowledge of Microsoft Word, Excel and Access in the preparation of correspondence and reports.
Essential Functions and Responsibilities:
- Gathers, prepares and supplies required clinical/treatment information needed to obtain authorization within the review interval(s) time requirements.
- Participates in treatment team and/or Patient Care Committee by providing information about eligibility, benefits, and criteria for the selected level of care.
- Assists in discharge planning, as needed.
- Identifies QI Triggers for individual patient situations, reporting them promptly to the UM Manager, appropriate clinicians and Process Improvement/Quality Director.
- Reviews eligibility and benefits of patients to validate accurate level of care utilization.
- Investigates and prepares appeals for insurance companies when denial of reimbursement is related to medical necessity or to other treatment issues.
- Participates in quality-of-care and UM process improvement on an ongoing basis and assists with development of the UR Staff Committee's process improvement goals.
- Provides staff education to further the goals of UR.
Decision Making: The carrying out of non-routine procedures under constantly changing conditions, in conformance with general instructions from supervisor.
Working Relationship: Works directly with patients and/or customers. Works with internal customers via telephone or face to face interaction. Works with other healthcare professionals and staff. Works frequently with individuals at Director level or above.
Special Job Dimensions: None.
Supplemental Information: This document generally describes the essential functions of the job and the physical demands required to perform the job. This compilation of essential functions and physical demands is not all inclusive nor does it prohibit the assignment of additional duties.
Location: Virtual Office, Oklahoma 73105
Must be available to work 3pm-11pm and 11pm-7am.
EOE Protected Veterans/Disability
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Find JobsUtilization Management Nurse Job Market
A snapshot from current openings nationwide, updated as new roles post.
Who's Hiring
- Alameda Health System3
- Alignment Healthcare3
- CVS Health3
- Cambia Health Solutions3
- Bright Health Management2
Top Industries Hiring
- Healthcare & Medical Services32
- Insurance18
- Education4
- Consulting & Professional Services2
- Non-Profit & Social Services1
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 Alameda Health System, Alignment Healthcare, and CVS Health, with the largest share of openings in California, New York, and Pennsylvania, based on current listings on Migrate Mate as of June 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 46% of utilization management nurse openings are fully remote or hybrid as of June 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 59+ Utilization Management Nurse Jobs
Jump back to the full list of openings and apply to any utilization management nurse role that fits.
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