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Entry Level Utilization Review Nurse Jobs (NOW HIRING)

Village Care

Utilization Review Nurse

Manhattan, NY · Remote

$95K - $105K/yr

RN- Utilization Review Nurse Inpatient *Hybrid* Must reside within the New York Tri-State Area - NY, NJ, or CT COME WORK FOR THE LEADING, LOCAL MANAGED CARE COMPANY - VILLAGE CARE! VillageCare is ...

Village Care

Utilization Review Nurse

Manhattan, NY · On-site

$95K - $105K/yr

RN- Utilization Review Nurse Inpatient *Hybrid* Must reside within the New York Tri-State Area - NY, NJ, or CT COME WORK FOR THE LEADING, LOCAL MANAGED CARE COMPANY - VILLAGE CARE! VillageCare is ...

Southeast Health

Utilization Review Nurse

Dothan, AL · On-site

Summary The Utilization Review Nurse screens medical records in accordance with contractual agreement and regulatory requirements for medical necessity on admission and continued stay in the acute ...

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 ...

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

Austin area - Travis/Williamson Counties or Richardson area - Dallas/Collin Counties*** RN working ... This position is responsible for performing initial, concurrent review activities; discharge care ...

TEKsystems

Utilization Review Nurse

Los Angeles, CA

$35 - $50/hr

... review activities • Participate in special projects related to claim denials and appeals Required Qualifications: • Active LVN or RN license (California) • 2+ years of experience in Utilization ...

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How much do entry level utilization review nurse jobs pay per hour?

As of May 29, 2026, the average hourly pay for entry level 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 Entry Level Utilization Review Nurse, and why are they important?

To thrive as an Entry Level Utilization Review Nurse, you need a registered nurse (RN) license, knowledge of clinical guidelines, and an understanding of healthcare regulations. Familiarity with utilization management software, electronic health records (EHR), and relevant certifications such as Certified Case Manager (CCM) or Accredited Case Manager (ACM) are often beneficial. Strong analytical thinking, attention to detail, and effective communication skills help you review cases accurately and collaborate with providers. These skills ensure appropriate care decisions, compliance with payer requirements, and optimal patient outcomes.

What are some common challenges faced by entry level Utilization Review Nurses, and how can they overcome them?

Entry level Utilization Review Nurses often encounter challenges such as adapting to complex insurance policies, learning to review medical records efficiently, and communicating effectively with physicians and case managers. To overcome these challenges, new nurses should seek mentorship from experienced colleagues, participate in ongoing training sessions, and familiarize themselves with the organization's review protocols and documentation systems. Building strong communication skills and staying up to date with regulatory changes will also help in navigating the learning curve and ensuring successful case reviews.

What is an Entry Level Utilization Review Nurse?

An Entry Level Utilization Review Nurse is a registered nurse (RN) who is new to the field of utilization review. Their main responsibilities include assessing medical records, ensuring that patients receive appropriate and necessary care, and verifying that health services are delivered according to established guidelines and insurance requirements. They typically work for hospitals, insurance companies, or managed care organizations and collaborate with healthcare providers to support quality patient outcomes while managing costs. This role often serves as a stepping stone to more advanced positions in healthcare administration or case management.

What is the difference between Entry Level Utilization Review Nurse vs Utilization Review Nurse?

AspectEntry Level Utilization Review NurseUtilization Review Nurse
CredentialsRN license, possibly some certificationRN license, often with additional certifications
Work EnvironmentHospitals, insurance companies, healthcare facilitiesInsurance companies, healthcare organizations
Job ResponsibilitiesAssist in reviewing patient cases, gather data, support senior staffEvaluate medical necessity, review patient records, make coverage decisions

The Entry Level Utilization Review Nurse typically supports the more experienced Utilization Review Nurse by gathering information and assisting in case reviews. Both roles require an RN license and work within healthcare or insurance settings, but the entry-level position involves more support tasks, while the Utilization Review Nurse makes critical coverage decisions.

More about Entry Level Utilization Review Nurse jobs
What cities are hiring for Entry Level Utilization Review Nurse jobs? Cities with the most Entry Level Utilization Review Nurse job openings:
What are the most commonly searched types of Utilization Review Nurse jobs? The most popular types of Utilization Review Nurse jobs are:
What states have the most Entry Level Utilization Review Nurse jobs? States with the most job openings for Entry Level Utilization Review Nurse jobs include:
What job categories do people searching Entry Level Utilization Review Nurse jobs look for? The top searched job categories for Entry Level Utilization Review Nurse jobs are:
Entry Level Utilization Review Nurse jobs near you
Infographic showing various Entry Level Utilization Review Nurse job openings in the United States as of May 2026, with employment types broken down into 9% As Needed, 55% Full Time, and 36% Part Time. Highlights an 58% Physical, and 42% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
Utilization Review Nurse

Utilization Review Nurse

Village Care

Manhattan, NY • Remote

$95K - $105K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 24 days ago

Job description

RN- Utilization Review Nurse

Inpatient

*Hybrid*

Must reside within the New York Tri-State Area - NY, NJ, or CT


COME WORK FOR THE LEADING, LOCAL MANAGED CARE COMPANY - VILLAGE CARE!


VillageCare is looking for a self-motivated and passionate RN as Utilization Review Nurse for a Full-Time position. This is an exciting and dynamic position from the comfort of your own home as you will be responsible for the assessment of member needs and identification of solutions that promote high quality and cost effective health care services. Some of your daily activities will include:

  • Reviews planned, in process, or completed health care services to ensure medical necessity and effectiveness according to evidence-based criteria - prospective, concurrent and retrospective review.
  • Frequently collaborates and communicates with physician peer reviewers and medical directors in determining coverage of requested services.
  • Provide intervention and coordination to decrease delays and denials.
  • Maintains timely, complete and accurate documentation in compliance with VCMAX policies and procedures.
  • Support Quality and Performance Improvement Initiatives.
  • Timely follow-up on results of denial and internal appeal reviews.

We would like to speak to those who have a current unrestricted NYS RN license to practice professional nursing, URAC preferred. Seeking those who bring a BSN (advanced degree preferred), along with 2+ years of utilization review experience at a Managed Care Organization or Health Plan required. Working knowledge of Medicaid and/or Medicare regulations as well as coverage guidelines and benefit limitations. The ability to apply Interqual/ Milliman Care Guidelines and other applicable, evidenced-based clinical guidelines will be vital to this role. Must have a minimum of 1 year long term support service experience. Inpatient experience required. MLTC and Hospital/SNF experience required.


Must reside within the New York Tri-State Area - NY, NJ, or CT.


There are many benefits to working for VillageCare. If you are someone who likes being part of a team, enjoys a highly competitive benefits package from world leading carriers and competitive compensation, than we would love to speak with you!

  • PTO package, 10 Paid Holidays, Personal and Sick time, Medical/Dental/Vision, HRA/FSA, Education Reimbursement, Retirement Savings 403(b), Life & Disability, Commuter Benefits, Paid Family Leave, Additional Employee Discounts

VillageCare offers a wide range of at-home and community-based services, as well as managed long-term care options that seek to match each individual's needs to help them attain and maintain the greatest level of independent living possible. We are committed to superior outcomes in quality health care.


VillageCare is an Equal Opportunity Employer.


Job Posted by ApplicantPro