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Executive Rn Utilization Review Nurse Jobs (NOW HIRING)

AbsoluteCare

Utilization Review Nurse

New Orleans, LA · On-site

The Utilization Review Nurse ensures appropriate utilization of health services by performing ... Active Registered Nurse license by the State of Louisiana and/or the state(s) in which the nurse is ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · Remote

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR ... Active, unrestricted RN license (BSN or MSN) in Oregon or a compact state * Graduation from an ...

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

As of Jul 22, 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:
Executive Rn Utilization Review Nurse jobs near you
Utilization Review- RN

Utilization Review- RN

Healthcare Support Staffing

Troy, MI • On-site

Other

Posted 24 days ago

Job description

Company Description

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!

Job Description

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. 

Qualifications

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.

Additional Information

Are you an experienced RN looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career In Nursing by joining a rapidly growing company? If you answered "yes" to any of these questions - this is the RN position for you!

If you are interested, reach out to me (Krishna) at 321-574-6926

The greatest compliment to our business is a referral.If you know of someone looking for a new opportunity, please pass along my contact information!


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About Healthcare Support

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.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Maitland, FL, US

Year founded

2003

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