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Executive Rn Utilization Review Nurse Jobs (NOW HIRING)

CommonSpirit Health

Job Summary and Responsibilities As our Utilization Review Nurse at the Utilization Management Hub ... Registered Nurse with current California License required. * Minimum two (2) years of acute ...

Pacer Group

RN - UTILIZATION REVIEW

Everett, WA · Remote

$65/hr

Fully Remote Position Job Title : RN - UTILIZATION REVIEW Location: Everett, WA 98201 Start Date: 05/04/2026 Duration: 13 weeks Schedule Shift: Day 5x8-Hour (08:00 - 16:30) Shift Notes: Days (5×8 ...

Sedgwick

RN Utilization Review

Providence, RI

$73K - $75K/yr

Maintains a score of 90% or higher on monthly internal utilization review audits. * Meets productivity goals as outlined by supervisor. Education & Licensing Active unrestricted RN license in a state ...

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Sedgwick

RN Utilization Review

Topeka, KS

$73K - $75K/yr

Maintains a score of 90% or higher on monthly internal utilization review audits. * Meets productivity goals as outlined by supervisor. Education & Licensing Active unrestricted RN license in a state ...

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How much do executive rn utilization review nurse jobs pay per hour?

As of Jun 7, 2026, the average hourly pay for executive rn 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 Executive RN Utilization Review Nurse, and why are they important?

To thrive as an Executive RN Utilization Review Nurse, you need advanced clinical expertise, strong knowledge of utilization management principles, and an active RN license—often complemented by a BSN or higher degree. Familiarity with utilization review software, electronic health records (EHRs), and certifications such as CCM (Certified Case Manager) or URAC accreditation are highly valuable. Exceptional analytical thinking, effective communication, and leadership skills help in collaborating with multidisciplinary teams and advocating for patient care. These competencies ensure effective resource management, regulatory compliance, and optimal patient outcomes within complex healthcare systems.

What are some typical challenges faced by an Executive RN Utilization Review Nurse, and how can they be managed?

Executive RN Utilization Review Nurses often encounter challenges such as balancing the need for cost-effective care with patient advocacy, staying updated on evolving insurance and regulatory requirements, and managing complex caseloads. Effective time management and strong communication skills are essential for collaborating with physicians, case managers, and insurance representatives. Leveraging clinical expertise while utilizing evidence-based guidelines helps in making fair utilization decisions, and ongoing professional development ensures nurses remain informed about best practices and policy changes.

What is the difference between Executive Rn Utilization Review Nurse vs Clinical Nurse Reviewer?

AspectExecutive Rn Utilization Review NurseClinical Nurse Reviewer
CredentialsRegistered Nurse (RN), often with certifications in utilization review or case managementRegistered Nurse (RN), with clinical experience and sometimes certifications in case management
Work EnvironmentInsurance companies, healthcare management firms, or utilization review organizationsHospitals, clinics, or healthcare facilities conducting clinical assessments
Primary FocusOverseeing utilization review processes, policy compliance, and administrative tasksPerforming clinical reviews, assessing patient care needs, and making clinical judgments

The Executive Rn Utilization Review Nurse primarily manages utilization review operations and policy compliance, often in administrative settings. In contrast, the Clinical Nurse Reviewer focuses on direct clinical assessments and patient care evaluations. Both roles require RN credentials and clinical knowledge, but their work environments and responsibilities differ significantly.

What is an Executive RN Utilization Review Nurse?

An Executive RN Utilization Review Nurse is a registered nurse who specializes in evaluating the necessity, appropriateness, and efficiency of healthcare services, often in a leadership or supervisory capacity. They review patient records, apply clinical guidelines, and collaborate with healthcare providers to ensure that care is medically necessary and cost-effective. Executive-level nurses in this field may also oversee utilization review teams, implement quality improvement initiatives, and help develop organizational policies. Their work helps healthcare organizations meet regulatory requirements and optimize the use of resources while maintaining high standards of patient care.
What cities are hiring for Executive Rn Utilization Review Nurse jobs? Cities with the most Executive Rn Utilization Review Nurse job openings:
What are the most commonly searched types of Rn Utilization Review Nurse jobs? The most popular types of Rn Utilization Review Nurse jobs are:
What states have the most Executive Rn Utilization Review Nurse jobs? States with the most job openings for Executive Rn Utilization Review Nurse jobs include:
Executive Rn Utilization Review Nurse jobs near you

Travel Nurse RN - Utilization Review

Integrated Healthcare Services

Bakersfield, CA

Contractor

Posted 27 days ago

Job description

Integrated Healthcare Services is seeking a travel nurse RN Utilization Review for a travel nursing job in Bakersfield, California.

Job Description & Requirements
  • Specialty: Utilization Review
  • Discipline: RN
  • Duration: 13 weeks
  • 40 hours per week
  • Shift: 8 hours, days
  • Employment Type: Travel

Job Title: RN - Case Management (Utilization Review)

Location: California

Employment Type: Full-Time

Contract Length: Permanent

Job Summary: The Utilization Review Nurse II is responsible for evaluating medical records, discharge planning, and ensuring compliance with payor documentation requirements to maximize hospital reimbursement.

Job Responsibilities:

  • Evaluate medical records for inpatient admissions to ensure required documentation is present.
  • Initiate Physician Advisories for unwarranted admissions.
  • Conduct ongoing reviews and discuss care changes with attending physicians.
  • Formulate and document discharge plans.
  • Coordinate with hospital services to ensure efficient resource use.
  • Identify pay source issues and provide appropriate referrals.
  • Collaborate with admitting office to prevent inappropriate admissions.
  • Schedule specialized tests and authorize payments under Medically Indigent Adult programs.
  • Review and approve surgery schedules for elective procedures.
  • Coordinate with correctional facilities regarding elective procedures and medical goods.
  • Answer provider questions about reimbursement and documentation requirements.
  • Teach providers payor documentation requirements to maximize reimbursement.
  • Assist in training Utilization Review Nurse I staff.
  • Perform other job-related duties as assigned.

Required Qualifications:

  • Two (2) years of experience as an RN in an acute care hospital, including one (1) year on a medical/surgical ward or unit.
  • One (1) year of utilization review/discharge planning experience in an acute care hospital or two (2) years as a Case Manager in a clinic or physician’s office.
  • Knowledge of payor source documentation requirements and governmental regulations.
  • Understanding of acute care nursing principles, patient disease processes, medical terminology, and hospital routines.
  • Ability to evaluate medical records, assess clinical performance, and communicate documentation needs effectively.
  • Proficiency in gathering and analyzing data for reports and recommendations.

Required Certifications & Licensure:

  • Valid Registered Nurse license in the State of California.
  • Current American Heart Association Healthcare Provider Basic Life Support (BLS) card.

Preferred Qualifications:

  • None specified.

Additional Information: This role requires strong interpersonal skills to collaborate with physicians, health providers, payor sources, and the general public.


QUALIFICATION/LICENSURE
Work Authorization : US Citizen
Preferred years of experience : 2 years
Travel required : No travel required
Shift timings : Days

RightSourcing IHS Job ID #37276836. Pay package is based on 8 hour shifts and 40 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: RN - Utilization Review

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