Nurse case manager vs utilization review nurse

The differences between nurse case managers and utilization review nurses can be seen in a few details. Each job has different responsibilities and duties. It typically takes 1-2 years to become both a nurse case manager and a utilization review nurse. Additionally, a nurse case manager has an average salary of $68,461, which is higher than the $65,425 average annual salary of a utilization review nurse.

The top three skills for a nurse case manager include care management, discharge planning and patients. The most important skills for a utilization review nurse are medical necessity, patients, and acute care.

Nurse case manager vs utilization review nurse overview

	Nurse Case Manager	Utilization Review Nurse
Yearly salary	$68,461	$65,425
Hourly rate	$32.91	$31.45
Growth rate	6%	6%
Number of jobs	83,480	29,776
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 46%	Bachelor's Degree, 43%
Average age	44	44
Years of experience	2	2

What does a nurse case manager do?

A nurse case manager's role focuses on providing advice and medication to patients in an outpatient clinic or hospital. Typically, their responsibilities revolve around conducting extensive assessments, discussing essential matters to patients and families, devising efficient health care plans, coordinating with health care experts to share patients' progress, determining the needed care, and performing follow-up services. There are also instances when a nurse case manager must adjust medication or treatment as needed, refer patients to programs that will support them on their financial and other needs, and implement policies and regulations.

What does a utilization review nurse do?

The primary role of an Utilization Review Nurse is to analyze the condition of each patient carefully and decide if the patient still needs to stay in the hospital or be sent home. They deal with patients' relatives, doctors, and people from insurance companies.

Nurse case manager vs utilization review nurse salary

Nurse case managers and utilization review nurses have different pay scales, as shown below.

	Nurse Case Manager	Utilization Review Nurse
Average salary	$68,461	$65,425
Salary range	Between $48,000 And $97,000	Between $47,000 And $89,000
Highest paying City	San Mateo, CA	Alameda, CA
Highest paying state	Hawaii	Rhode Island
Best paying company	CNA Insurance	Molina Healthcare
Best paying industry	Government	Health Care

Differences between nurse case manager and utilization review nurse education

There are a few differences between a nurse case manager and a utilization review nurse in terms of educational background:

	Nurse Case Manager	Utilization Review Nurse
Most common degree	Bachelor's Degree, 46%	Bachelor's Degree, 43%
Most common major	Nursing	Nursing
Most common college	Duke University	Duke University

Nurse case manager vs utilization review nurse demographics

Here are the differences between nurse case managers' and utilization review nurses' demographics:

	Nurse Case Manager	Utilization Review Nurse
Average age	44	44
Gender ratio	Male, 9.6% Female, 90.4%	Male, 8.5% Female, 91.5%
Race ratio	Black or African American, 11.7% Unknown, 4.3% Hispanic or Latino, 9.1% Asian, 8.9% White, 65.6% American Indian and Alaska Native, 0.4%	Black or African American, 12.0% Unknown, 4.3% Hispanic or Latino, 9.1% Asian, 8.9% White, 65.3% American Indian and Alaska Native, 0.4%
LGBT Percentage	9%	9%

Differences between nurse case manager and utilization review nurse duties and responsibilities

Nurse case manager example responsibilities.

Develop and manage plan of care for symptom management for patients/families in home, ALF, and SNF arena.
Maintain communication with commercial insurance payers, manage Medicare and Medicaid sources and conduct daily clinical updates to insurance companies.
Coordinate surgery schedules with doctor, hospital, medical equipment representative and patients.
General assessment and care/case management of Medicare patients including wind care, diabetes, cardiac complications, respiratory treatments.
Deliver independent private duty nursing to pediatric patients in need of holistic care, including oxygen-dependent, ventilator-dependent, tracheostomy patients.
Interview and assess patients, documenting findings and input into EMR system.

Utilization review nurse example responsibilities.

Monitor patients' status during surgery (circulate in operating room) and manage patients in PACU.
Case management for acute patients refer to LTC
Advise insurance carriers on recommend reimbursement for charges following automate bill audit utilizing ICD-9 and CPT codes.
Provide caregiver oversight relate to care, medication administration and emergency situations.
Identify inappropriate utilization of services/settings through the application of establish clinical criteria using InterQual and CMS guidelines for medical necessity.
Direct contact with IPA providers.

Nurse case manager vs utilization review nurse skills

Common nurse case manager skills

Care Management, 25%
Discharge Planning, 17%
Patients, 11%
Home Health, 8%
Rehabilitation, 3%
Medical Care, 3%

Common utilization review nurse skills

Medical Necessity, 9%
Patients, 7%
Acute Care, 7%
Discharge Planning, 7%
Utilization Management, 6%
Utilization Review, 6%

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Nurse Case Manager
Nurse Case Manager vs Utilization Review Nurse

Updated January 8, 2025

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