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Case Manager Utilization Review Nurse Jobs (NOW HIRING)

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 ... Utilization Management, Case Management, or Clinical Documentation Improvement. Licensing ...

HOPCo

RN Case Manager - Utilization Review

Phoenix, AZ · On-site

A Case Manager/Utilization Review Nurse, in collaboration with patients/families, physicians and the interdisciplinary team, provides leadership and advocacy in the coordination of patient-centered ...

GQR Healthcare

Travel Utilization Review RN

Tuba City, AZ · On-site

$2.2K - $2.3K/wk

GQR Healthcare is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Tuba City, Arizona. & Requirements * Specialty: Utilization Review * Discipline: RN * Start ...

ICONMA

Clinical Utilization Review Nurse II

Clinical Utilization Review Nurse II Our client, a Healthcare company, is looking for a Clinical ... Comprehensive knowledge of utilization review, case management, performance improvement, and ...

Detroit Medical Center

RN - Case Management

Detroit, MI · On-site

$2.1K/wk

... Manager - Utilization Review Nurse Schedule: Shift: 08:00 - 16:30 Assignment Details: - Contract Length: 12 weeks - Guaranteed Hours: 40 hours per week Requirements: - Active nursing license ...

MTK HealthCare

RN-Case Manager

Portales, NM · On-site

$59 - $62/hr

MTK Healthcare Inc. is Hiring RN Case Manager - Utilization Review & Swing Bed | Portales, NM | Monday-Friday (8:00 AM-4:30 PM), Day Shift Position Details * Position: RN Case Manager - Utilization ...

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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 Aug 8, 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 does a case manager utilization review nurse 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.

What does a case manager utilization review nurse do?

A case manager utilization review nurse evaluates medical cases to determine the necessity, appropriateness, and efficiency of healthcare services. They review patient records, collaborate with healthcare providers, and ensure treatment plans comply with insurance and regulatory guidelines, often using electronic health record systems. This role requires clinical nursing experience and knowledge of healthcare policies.
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Case Manager Utilization Review Nurse jobs near you
Infographic showing various Case Manager Utilization Review Nurse job openings in the United States as of August 2026, with employment types broken down into 88% Full Time, 11% Part Time, and 1% Contract. Highlights an 85% Physical, 2% Hybrid, and 13% Remote job distribution, with an average salary of $98,869 per year, or $47.5 per hour.

Utilization Review Nurse

Global Force

Las Vegas, NV • On-site

Other

Posted 5 days ago

Job description

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 third party payer requirements. Duties include analyzing medical charts, determining whether care provided is within established parameters.
Job Requirement
Education/Experience:
Graduation from an accredited school of nursing and five (5) years of acute hospital clinical nursing experience, one (1) year of which was in Utilization Management, Case Management, or Clinical Documentation Improvement.
Licensing/Certification Requirements:
Valid license by the State of Nevada to practice as a Registered Nurse.
Additional Position Requirements

  • Minimum three (3) years of Utilization Management experience.
  • Minimum of three (3) year's experience with discharge planning in an acute care facility.
  • Recent documented experience with InterQual, and ability to pass the InterQual exam.
  • Recent documented experience with Milliman experience.

Knowledge, Skills, Abilities, and Physical Requirements
Knowledge of:
Interquel or Milliman utilization review criteria, Medicare/Medicaid guidelines, hospital policies and procedures; Joint Commission Accredited Health care Organizations standards, state statutes governing hospital services and health care, and other relevant regulations and standards; clinical medical and nursing procedures; disease processes; department and hospital safety practices and principles; patient rights; age specific patient care practices; infection control policies and practices; department and hospital emergency response policies and procedures.
Skill in:
Interpreting patient charts to determine whether care given is within best practice, appropriate for the diagnosis and properly documented; excellent ability to collaborate, co-ordinate and communicate findings; interpreting regulations and standards for others; writing reports, meeting minutes and other technical documents; analyzing statistical and other quantitative data; applying investigative and interviewing techniques; using a computer and a variety of software applications; communicating with a wide variety and establishing interpersonal relationships to interact effectively with co-workers, supervisor, staff in other work units and exchange or convey information.
Physical Requirements and Working Conditions:
Mobility to work in a typical office setting and use standard equipment, stamina to remain seated for extended periods of time, vision to read printed materials and a computer screen, and hearing and speech to communicate effectively in person and over the telephone. Strength and agility to exert up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects. May work shifts and weekends. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this classification.

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