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Anthem Utilization Review Nurse Jobs (NOW HIRING)

Fusion HCR

Utilization Review Nurse

Las Vegas, NV · On-site

Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in Acute Care. Overview Seeking an experienced Utilization Review Nurse (RN) to review patient admissions ...

Oscar Health

Utilization Review Nurse

Atlanta, GA · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You will perform frequent case reviews, check medical records and speak with care providers regarding ...

Global Force

Utilization Review Nurse

Las Vegas, NV · On-site

About the job Utilization Review Nurse Sign on bonus may apply up to $15,000 Position Summary: Reviews patient admissions for appropriateness, efficiency of resource utilization and compliance with ...

Oscar Health

Utilization Review Nurse

Miami, FL · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You will perform frequent case reviews, check medical records and speak with care providers regarding ...

Oscar Health

Utilization Review Nurse

Dallas, TX · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You will perform frequent case reviews, check medical records and speak with care providers regarding ...

AbsoluteCARE

Utilization Review Nurse

New Orleans, LA · On-site

The Utilization Review Nurse ensures appropriate utilization of health services by performing initial, concurrent and retrospective clinical case reviews. This role collaborates and communicates with ...

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You will perform frequent case reviews, check medical records and speak with care providers regarding ...

AbsoluteCare

Utilization Review Nurse

New Orleans, LA · On-site

The Utilization Review Nurse ensures appropriate utilization of health services by performing initial, concurrent and retrospective clinical case reviews. This role collaborates and communicates with ...

US Tech Solutions

Utilization Review Nurse

Canton, MA · On-site

$55 - $60/hr

... Nurse to support outpatient utilization review and prior authorization activities for a leading healthcare organization. The ideal candidate will have a strong background in managed care, utilization ...

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Anthem Utilization Review Nurse information

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How much do anthem utilization review nurse jobs pay per hour?

As of Aug 9, 2026, the average hourly pay for anthem utilization review nurse in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as an Anthem Utilization Review nurse?

To thrive as an Anthem Utilization Review Nurse, you need an active RN license, clinical care experience, and strong knowledge of medical necessity criteria and healthcare regulations. Familiarity with utilization management software, InterQual or Milliman guidelines, and proficiency in electronic medical records are commonly required. Attention to detail, critical thinking, and excellent written and verbal communication distinguish top performers in this position. These skills ensure thorough and accurate case reviews, support compliance with policy, and facilitate effective communication between healthcare providers, insurers, and patients.

What does an Anthem Utilization Review nurse do?

A typical day for an Anthem Utilization Review Nurse involves reviewing patient medical records to determine the medical necessity of services, coordinating with healthcare providers via phone or email, and documenting determinations in electronic systems. Nurses in this role often attend team meetings, consult with physicians, and may help educate providers on clinical guidelines and coverage policies. The work is mostly desk-based and may be remote or office-based, depending on Anthem's structure. This position requires balancing productivity targets with careful case analysis, and it offers a predictable schedule with limited direct patient interaction, making it ideal for nurses seeking to apply their expertise in a non-clinical setting.

What is an Anthem Utilization Review nurse?

An Anthem Utilization Review Nurse evaluates medical services and treatments to ensure they meet established guidelines for medical necessity, cost-effectiveness, and quality care. They review patient records, collaborate with healthcare providers, and determine appropriate levels of care based on insurance policies. This role helps manage healthcare costs while ensuring patients receive necessary treatments. Utilization review nurses typically work remotely or in clinical settings and must have a nursing background with expertise in case management and insurance regulations.

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Anthem Utilization Review Nurse jobs near you
Infographic showing various Anthem Utilization Review Nurse job openings in the United States as of August 2026, with employment types broken down into 100% Full Time. Highlights an 50% In-person, and 50% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Nurse

Fusion HCR

Las Vegas, NV • On-site

Other

Re-posted 2 days ago

Job description

Fusion HCR is hiring!Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in Acute Care.
Overview
Seeking an experienced Utilization Review Nurse (RN) to review patient admissions for medical necessity, appropriate level of care, and compliance with payer guidelines. This role works closely with clinical teams to ensure efficient resource utilization and quality patient outcomes.
Responsibilities
  • Review admissions using InterQual and/or Milliman criteria
  • Evaluate medical necessity, level of care, and documentation accuracy
  • Ensure compliance with Medicare, Medicaid, and regulatory guidelines
  • Collaborate with physicians, case management, and care teams
  • Support discharge planning and care coordination
  • Document findings and communicate recommendations

Requirements
  • Active RN license (Nevada)
  • 5+ years acute care nursing experience
  • 3+ years Utilization Review experience
  • 3+ years discharge planning experience (acute care)
  • Experience with InterQual (must be able to pass exam)
  • Experience with Milliman guidelines

Preferred
  • Background in Case Management or CDI
  • Strong knowledge of Joint Commission and CMS guidelines

Why Apply
  • Competitive pay
  • Stable, high-demand role
  • Collaborative healthcare environment

Apply Now
If you have strong Utilization Review, InterQual, and acute care experience, we want to hear from you!

Apply