ZipRecruiter

Log In

1

Anthem Utilization Review Nurse Jobs (NOW HIRING)

Sentara Health Plans

$65 - $85/hr

The Utilization Review Nurse is responsible for utilization management services within the scope of licensure. Conducts primary functions of prior authorization, retrospective review, medical ...

Acrisure

Utilization Review Nurse

Bradenton, FL · On-site

Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure injured workers receive appropriate, timely care in accordance with applicable clinical guidelines ...

Acrisure, LLC

Utilization Review Nurse

Bradenton, FL · On-site

$55 - $90/hr

Utilization Review Nurse, LPN** to evaluate treatment requests and help ensure injured workers receive appropriate, timely care in accordance with applicable clinical guidelines and regulatory ...

Acrisure, LLC

$55 - $90/hr

Utilization Review Nurse, LPN** to evaluate treatment requests and help ensure injured workers receive appropriate, timely care in accordance with applicable clinical guidelines and regulatory ...

Acrisure

Utilization Review Nurse

Bradenton, FL

Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure injured workers receive appropriate, timely care in accordance with applicable clinical guidelines ...

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 ...

Merrimack Health

Utilization Review Nurse

Lawrence, MA · On-site

... they relate to utilization review and discharge planning and payer regulations. MINIMUM EDUCATION AND EXPERIENCE: Required: * Graduate of an accredited professional nursing school * Current ...

next page

Showing results 1-20

All JobsHealthcare JobsNursing JobsNurse Case Manager JobsAnthem Utilization Review Nurse Jobs

Anthem Utilization Review Nurse information

See salary details

$21

$42

$68

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

As of Sep 6, 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 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.

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 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.

How to get into utilization review as an Anthem Utilization Review Nurse?

To become an Anthem Utilization Review Nurse, candidates typically need a registered nurse (RN) license, relevant clinical experience, and knowledge of insurance and healthcare policies. Certification in case management or utilization review, such as the Certified Case Manager (CCM), can enhance prospects. Applying through Anthem's career portal and demonstrating strong assessment and communication skills are essential steps.
More about Anthem Utilization Review Nurse jobs

What cities are hiring for Anthem Utilization Review Nurse jobs?

Cities with the most Anthem Utilization Review Nurse job openings:

What are the most commonly searched types of Anthem Utilization Review Nurse jobs?

The most popular types of Anthem Utilization Review Nurse jobs are:

What states have the most Anthem Utilization Review Nurse jobs?

States with the most job openings for Anthem Utilization Review Nurse jobs include:

What job categories do people searching Anthem Utilization Review Nurse jobs look for?

The top searched job categories for Anthem Utilization Review Nurse jobs are:

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 1% As Needed, 81% Full Time, 14% Part Time, 1% Temporary, and 3% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Nurse

Health Business Solutions LLC

Cooper City, FL • On-site

Full-time

Re-posted 29 days ago

Job description

Job Summary: We are seeking a highly motivated and experienced Utilization Review Nurse to join our team. The Utilization Review Nurse will play a crucial role in supporting our clients in the healthcare industry by providing expert clinical guidance, facilitating effective utilization management, and ensuring revenue cycle efficiency. This position offers a unique opportunity to combine clinical expertise with revenue cycle management knowledge.

Key Responsibilities:

·       Clinical Assessment: Conduct comprehensive clinical assessments of medical records to ensure patients are receiving appropriate care at the correct level of service.

  • Care Coordination: Collaborate with interdisciplinary healthcare teams to coordinate patient care and treatment plans, ensuring the most cost-effective and clinically appropriate care is provided.
  • Revenue Cycle Management: Utilize clinical expertise to support revenue cycle processes, including accurate coding, documentation improvement, and compliance with healthcare regulations.
  • Utilization Review:

a) Apply medical necessity screening criteria and clinical knowledge to ensure appropriateness of admissions and length of stays

b) Conduct initial admission, continuing stay, and 23-hour observations reviews for all patients

c) Support Utilization Review Coordinator team members on cases escalated for level of care determinations

d) Screen cases for Physician Advisor review

e) Collaborate with insurance companies on concurrently denied and high risk for denial cases

  •  Documentation Improvement: Identify opportunities for improving clinical documentation to support accurate coding and billing processes, ultimately improving reimbursement.


  • Data Analysis: Analyze clinical and financial data to identify trends, opportunities for improvement, and areas of potential cost savings for clients.


  • Compliance: Stay up-to-date with healthcare regulations, guidelines, and policies to ensure all patient care and revenue cycle processes are in compliance with industry standards and regulatory requirements to ensure appropriate reimbursement.

Qualifications:

·       Registered Nurse (RN) licensure required; must hold a USRN multi-state/compact nursing license.

·       Bachelor of Science in Nursing (BSN) preferred.

·       Case Management Certification (e.g., CCM) is a plus.

·       Minimum of 3 years of clinical nursing experience, preferably in a hospital or acute care setting.

·       Minimum 2 years of work experience in Utilization Review

·       Strong understanding of revenue cycle management and healthcare reimbursement.

·       Proficiency in medical coding and clinical documentation improvement.

·       Excellent communication, interpersonal, and teamwork skills.

·       Ability to work independently and make sound clinical and financial decisions.

·       Strong analytical and problem-solving skills.

·       Proficient in using healthcare information systems and technology.

·       Commitment to maintaining patient confidentiality and ethical standards.