Utilization Review Nurse
Troy, MI · On-site
Must be an RN Utilization Review background in either Managed Care of Provider environment (at least one year) Interqual experience Other basic computer skills necessary: Microsoft Office, Data Entry ...
Troy, MI · On-site
Must be an RN Utilization Review background in either Managed Care of Provider environment (at least one year) Interqual experience Other basic computer skills necessary: Microsoft Office, Data Entry ...
Troy, MI · On-site
Must be an RN Utilization Review background in either Managed Care of Provider environment (at least one year) Interqual experience Other basic computer skills necessary: Microsoft Office, Data Entry ...
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 ...
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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 ...
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 ...
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 ...
West Chester, PA · On-site
The Utilization Review Nurse will provide utilization review for authorization, concurrent review and discharge review services using InterQual criteria guidelines to validate medical necessity and ...
West Chester, PA · On-site
The Utilization Review Nurse will provide utilization review for authorization, concurrent review and discharge review services using InterQual criteria guidelines to validate medical necessity and ...
West Chester, PA · On-site
The Utilization Review Nurse will provide utilization review for authorization, concurrent review and discharge review services using InterQual criteria guidelines to validate medical necessity and ...
West Chester, PA · On-site
The Utilization Review Nurse will provide utilization review for authorization, concurrent review and discharge review services using InterQual criteria guidelines to validate medical necessity and ...
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 ...
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 ...
Chicago, IL · On-site
Do you have experience with Utilization Review? * Do you have an Active Registered Nurse License? About US Tech Solutions: US Tech Solutions is a global staff augmentation firm providing a wide range ...
Chicago, IL · On-site
Do you have experience with Utilization Review? * Do you have an Active Registered Nurse License? About US Tech Solutions: US Tech Solutions is a global staff augmentation firm providing a wide range ...
Hours: 8:30-5:30, Monday - Friday At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent ...
Hours: 8:30-5:30, Monday - Friday At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent ...
Review, analyze, and identify utilization patterns and trends, problems, or inappropriate utilization of resources Qualifications Required * Current and unrestricted RN license * At least 3 years ...
Review, analyze, and identify utilization patterns and trends, problems, or inappropriate utilization of resources Qualifications Required * Current and unrestricted RN license * At least 3 years ...
Big Spring, TX · On-site
Job Summary The Utilization Review (UR) Nurse has acute knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the ...
Big Spring, TX · On-site
Job Summary The Utilization Review (UR) Nurse has acute knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the ...
Big Spring, TX · On-site
Job Summary The Utilization Review (UR) Nurse has acute knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the ...
Big Spring, TX · On-site
Job Summary The Utilization Review (UR) Nurse has acute knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the ...
Bakersfield, CA · On-site
$43.51 - $68.56/hr
Utilization Review Nurse - Full Time Shift: 8:00am - 4:30pm with rotating weekend coverage Compensation: The estimated pay for this position is $43.5114 to $68.5608. The rates shown include a 6% ...
Bakersfield, CA · On-site
$43.51 - $68.56/hr
Utilization Review Nurse - Full Time Shift: 8:00am - 4:30pm with rotating weekend coverage Compensation: The estimated pay for this position is $43.5114 to $68.5608. The rates shown include a 6% ...
Oxford, NC · On-site
Three years clinical nursing experience. One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques ...
Oxford, NC · On-site
Three years clinical nursing experience. One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques ...
Utilization Review Nurse Integrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and ...
Utilization Review Nurse Integrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and ...
$34.73 - $45.15/hr
Nurse, Registered (RN) licensure * BSN preferred. 2-5 years previous Utilization Review experience preferred. * Current CPR * Relevant hospital nursing; hospital case management; insurance case ...
$34.73 - $45.15/hr
Nurse, Registered (RN) licensure * BSN preferred. 2-5 years previous Utilization Review experience preferred. * Current CPR * Relevant hospital nursing; hospital case management; insurance case ...
$43.51 - $68.56/hr
Utilization Review Nurse - Full Time Shift: 8:00am - 4:30pm with rotating weekend coverage Compensation: The estimated pay for this position is $43.5114 to $68.5608 . The rates shown include a 6% ...
$43.51 - $68.56/hr
Utilization Review Nurse - Full Time Shift: 8:00am - 4:30pm with rotating weekend coverage Compensation: The estimated pay for this position is $43.5114 to $68.5608 . The rates shown include a 6% ...
Philadelphia, PA · On-site
PA RN License Required We are seeking an experienced Care Management Coordinator to join our Infusion Therapy team. This role is responsible for performing utilization management reviews to determine ...
Philadelphia, PA · On-site
PA RN License Required We are seeking an experienced Care Management Coordinator to join our Infusion Therapy team. This role is responsible for performing utilization management reviews to determine ...
Las Vegas, NV · On-site
$41 - $60/hr
- Utilization Review Nurse Position Summary The Utilization Review Nurse is responsible for reviewing patient admissions and ongoing hospital stays to ensure the delivery of medically necessary ...
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Las Vegas, NV · On-site
$41 - $60/hr
- Utilization Review Nurse Position Summary The Utilization Review Nurse is responsible for reviewing patient admissions and ongoing hospital stays to ensure the delivery of medically necessary ...
Refers to UR committee any case that surpasses expected LOS, expected cost, or over/under-utilization of resources. * Performs verbal/fax clinical review with payer as determined by nursing judgment ...
Refers to UR committee any case that surpasses expected LOS, expected cost, or over/under-utilization of resources. * Performs verbal/fax clinical review with payer as determined by nursing judgment ...
Utilization Review Experience, the nurse can come from a Hospital, Home Health, or Managed Care company/ health plan Additional Information Hello! My name is Krishna Gapuz and I am a R ecruiting ...
Utilization Review Experience, the nurse can come from a Hospital, Home Health, or Managed Care company/ health plan Additional Information Hello! My name is Krishna Gapuz and I am a R ecruiting ...
$21.39 - $25.72
2% of jobs
$25.72 - $30.05
9% of jobs
$33.01 is the 25th percentile. Wages below this are outliers.
$30.05 - $34.38
21% of jobs
The median wage is $37.88 / hr.
$34.38 - $38.70
23% of jobs
$38.70 - $43.03
13% of jobs
$46.39 is the 75th percentile. Wages above this are outliers.
$43.03 - $47.36
10% of jobs
$47.36 - $51.68
8% of jobs
$51.68 - $56.01
5% of jobs
$56.01 - $60.34
5% of jobs
$60.34 - $64.66
2% of jobs
$64.66 - $68.99
2% of jobs
$21
$42
$68
An Evening Utilization Review Nurse evaluates medical records and treatment plans during evening hours to ensure they meet regulatory and insurance requirements. They work with healthcare providers, insurance companies, and case managers to assess the necessity and efficiency of patient care. This role involves reviewing documentation, identifying discrepancies, and ensuring compliance with healthcare policies. It requires strong analytical skills, clinical expertise, and knowledge of insurance guidelines.
Evening Utilization Review Nurses usually work later shifts, often between the late afternoon and midnight, to ensure continuous coverage for patient reviews outside standard business hours. Their workflow includes assessing medical records, evaluating the appropriateness of admissions and continued stays, and communicating findings to providers and insurance companies. While much of the work is independent, there is frequent collaboration with care managers, physicians, and other team members through calls or digital communication platforms. This schedule is ideal for those who prefer non-traditional hours and are comfortable making important decisions with limited onsite supervision.
To thrive as an Evening Utilization Review Nurse, you need a registered nursing license, strong clinical judgment, and a solid understanding of medical necessity criteria and healthcare regulations. Familiarity with utilization review software, electronic health records (EHRs), and knowledge of regulatory guidelines such as Medicare and Medicaid is highly valued. Exceptional attention to detail, effective communication, and the ability to work independently during evening hours are important soft skills for this role. These competencies are crucial to accurately assess patient care, ensure compliance, and efficiently coordinate with healthcare teams while working outside typical business hours.
Cities with the most Evening Utilization Review Nurse job openings:
The most popular types of Utilization Review Nurse jobs are:
States with the most job openings for Evening Utilization Review Nurse jobs include:
The top searched job categories for Evening Utilization Review Nurse jobs are:

Contractor
Re-posted 28 days ago
HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!
Company: Molina Healthcare
Location: 880 Long Lake Rd Suite 600 Troy, Michigan 48098
Shift: Daytime hours
Employment: Contract: 1-2 months (possibility of going longer depending on business needs)
Company Job Description/Day to Day Duties:
Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review. Assesses services for Molina Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines
Provider appeals and Utilization reviews and assist with Denial Letters
Provides concurrent review and prior authorizations (as needed) according to Molina policy for Molina members as part of the Utilization Management team.
Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures.
Participates in interdepartmental integration and collaboration to enhance the continuity of care for Molina members including Behavioral Health and Long Term Care.
Minimum Education/Qualifications/Licensures:
Must be an RN
Utilization Review background in either Managed Care of Provider environment (at least one year)
Interqual experience
Other basic computer skills necessary: Microsoft Office, Data Entry, etc.
Minimum 2-4 years of clinical practice. Preferably hospital nursing, utilization management, and/or case management.
Also has a background in patient, skilled nurses facilities, rehab, and home healthcare.
Apply now for immediate consideration. After applying, a recruiting consultant will contact you for pre-screening. Please provide your best phone number to contact.
Thanks and look forward to hearing from you!
Sourced by ZipRecruiter
HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.
Recruiting and staffing services
201 - 500 Employees
Maitland, FL, US
2003