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Case Manager 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 ... Collaborate with physicians, case management, and care teams * Support discharge planning and care ...

Cibola General Hospital

Case Manager

Grants, NM · On-site

$18.50 - $23.75/hr

Job Type Full-time Description The Case Manager / Utilization Review Nurse (RN) is responsible for coordinating patient care progression, discharge planning, and utilization review activities. This ...

CIBOLA GENERAL HOSPITAL CORPORATION

Case Manager

Grants, NM · On-site

$18.50 - $23.75/hr

Description The Case Manager / Utilization Review Nurse (RN) is responsible for coordinating patient care progression, discharge planning, and utilization review activities. This integrated role ...

Cibola General Hospital

Case Manager

Grants, NM · On-site

$18.50 - $23.75/hr

The Case Manager / Utilization Review Nurse (RN) is responsible for coordinating patient care progression, discharge planning, and utilization review activities. This integrated role ensures ...

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Case Manager Utilization Review Nurse information

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How much do case manager utilization review nurse jobs pay per hour?

As of Jul 15, 2026, the average hourly pay for case manager utilization review nurse in the United States is $47.53, according to ZipRecruiter salary data. Most workers in this role earn between $35.34 and $57.45 per hour, depending on experience, location, and employer.

What is the difference between Case Manager Utilization Review Nurse vs Case Manager?

AspectCase Manager Utilization Review NurseCase Manager
CredentialsRN license, certification in utilization review (e.g., URAC)RN license, case management certification (e.g., CCM)
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community health, insurance providers
Primary FocusReviewing medical necessity and appropriateness of careCoordinating patient care and discharge planning

While both roles involve patient care coordination, the Case Manager Utilization Review Nurse primarily focuses on reviewing medical necessity and insurance approvals, whereas the Case Manager handles broader patient care coordination and discharge planning. Both roles require nursing credentials and are vital in healthcare settings, but their specific responsibilities differ.

How do Case Manager Utilization Review Nurses typically collaborate with physicians and other healthcare providers?

Case Manager Utilization Review Nurses regularly work with physicians, social workers, and other healthcare professionals to ensure patients receive appropriate care while managing resource utilization. They often participate in interdisciplinary team meetings to discuss care plans, review patient progress, and address any barriers to discharge. Building strong communication channels and maintaining up-to-date clinical knowledge are essential, as nurses must advocate for patients while also supporting evidence-based practices and regulatory compliance. This collaborative environment helps streamline patient care and optimize outcomes.

What is a Case Manager Utilization Review Nurse?

A Case Manager Utilization Review Nurse is a registered nurse who evaluates the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, coordinate with healthcare providers, and ensure that treatments meet established guidelines and insurance requirements. Their goal is to optimize patient outcomes while controlling healthcare costs and ensuring compliance with regulations. These nurses also help facilitate communication between patients, providers, and payers to support effective care management.

What are the key skills and qualifications needed to thrive as a Case Manager Utilization Review Nurse, and why are they important?

To excel as a Case Manager Utilization Review Nurse, you need a solid background in nursing, strong clinical assessment skills, and a valid RN license, often with case management certification. Familiarity with utilization review software, electronic health record (EHR) systems, and knowledge of insurance and regulatory guidelines is essential. Exceptional communication, critical thinking, and negotiation abilities set top performers apart in this role. These qualifications ensure effective patient advocacy, cost-effective care, and compliance with healthcare standards.
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Case Manager Utilization Review Nurse jobs near you

Case Manager / Utilization Review Nurse

Conway Regional

Conway, AR • On-site

Full-time

Posted 13 days ago

Job description

Overview

Provides discharge planning and utilization review services in compliance with patient’s discharge planning needs and the hospital’s utilization review program. 

SAFETY SENSITIVE POSITION:

 

This position is a designated as “Safety Sensitive Position” under Act 593 of the State of Arkansas. An employee who is under the influence of Marijuana constitutes a threat to patients/customers which Conway Regional is responsible for in providing and supporting the delivery health care related services.

 


Responsibilities
  • Apply clinical knowledge to determine appropriate acuity levels and utilization through chart review.
  • Effectively organizes workflow to consistently complete assignments in a timely manner.
  • Demonstrates ability to access and effectively utilize primary sources of data.
  • Obtains and maintains medical records in conformance with Medical Information policies.
  • Communicates with co-workers in a manner that is conducive to positive and effective working relationships. Demonstrates respect, honesty and integrity when working with other service providers.
  • Demonstrates compliance with all relevant hospital, state and federal requirements related to maintenance of confidentiality of persons, data and information systems.
  • Takes advantage of opportunities made available through CRHS and other professional organizations for continued professional growth and development.
  • Responsible for analysis of patient information for determination of necessity of admission or continuation of stay.
  • Review for medical necessity of admission on the first working day after admission using approved review criteria.
  • Reviews inpatient procedures to determine appropriate utilization and acuity level. Reviews potential for outpatient setting or swing bed utilization.
  • Reviews all patients for medical necessity of continued stay, or before the next review date, using approved review criteria.
  • Performs retroactive reviews, as necessary, and responds to the appropriate review agency or third party payor.
  • Researches denials issued by review agencies and third party payors and responds within the specified time frames for appeal.
  • Works with others on healthcare team to coordinate for patients discharge needs.
  • Establishes an effective utilization review process and maintains an active, effective utilization review file system. Recommends, develops and revises policies related to the utilization review process.
  • Works collaboratively with physicians, Case Management, the discharge planning process, Admissions, Central Scheduling and other CRHS associates.
  • Educates staff, physicians and other personnel regarding medical necessity requirements as defined by approved review criteria.
  • Assists with other department functions as assigned.

Qualifications
    • Registered Nurse or Licensed Practical Nurse with current, active license to practice in Arkansas, required
    • Proof of the highest level of nursing education achieved, required
    • At least one-year experience in the area of case management/utilization review, preferred
Qualifications:
    • Registered Nurse or Licensed Practical Nurse with current, active license to practice in Arkansas, required
    • Proof of the highest level of nursing education achieved, required
    • At least one-year experience in the area of case management/utilization review, preferred
Education:UNAVAILABLEEmployment Type: FULL_TIME

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