Medical Management - Utilization Management RN 145-2016
CommunityCare · United States · US
Utilization Review
Remote
physician
Nurse
Demand80
Career growth68
Healthcare fit84
Remote potential55
5-year outlook
Stable payer-side utilization management demand is likely to continue, with pay typically tracking experienced RN case-management and utilization-review roles. Compensation should improve with managed-care, Medicare Advantage, and population-health experience, though exact salary depends on location, employer, and remote/hybrid status.
Clinical license
Required
Applicant reach
moderate
Seniority
mid
Employment type
full-time
Date found
2026-10-20
Intelligence details
Flexible work details
- Engagement type
- Permanent
- Hours
- Full-time
- Eligible countries
- United States
- License jurisdiction
- US
- Profession fit
- physician, Nurse
- Rate period
- Annual
Listing via Himalayas.
Eligibility, licensing, and location restrictions can change. Always confirm details on the source posting before applying.
Why this is worth applying to
Worth considering for RNs who want a payer-side, non-bedside role using clinical judgment without direct patient care. The main gate is an active Oklahoma RN license and preference for acute care, case management, or managed-care experience.
Who should apply
RNs with acute care experience, discharge planning or case management backgrounds, or population-health/managed-care exposure who want utilization review and care coordination work.
CV angle
Frame acute-care RN experience around applying clinical criteria, medical necessity review, timely documentation, provider communication, high-risk population coordination, and quality escalation. Emphasize any discharge planning, case management, managed care, data entry, and Microsoft application experience without overstating non-clinical titles.
Skills to highlight
- Utilization review
- Medical necessity determination
- Clinical criteria application
- Managed care
- Care coordination
- Discharge planning/case management
- Documentation and time management
- Provider communication
Role summary
An RN utilization management role reviewing outpatient, ancillary, inpatient, and post-acute service requests for medical necessity and appropriateness. The nurse documents determinations, communicates with providers and members, refers cases to the Medical Director when criteria are not met, and identifies care management or quality issues.
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