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Executive Rn Utilization Review Nurse Jobs (NOW HIRING)

Seh

Summary The Utilization Review Nurse screens medical records in accordance with contractual ... Current Registered Nurse license in the State of Alabama Minimum Education Preferred * Bachelor ...

Cobalt Benefits Group

Utilization Review Nurse

Current, unrestricted RN license (State license required). * Minimum 3 years of clinical nursing experience. * Minimum 1 year of Utilization Management (UM) or Utilization Review (UR) experience.

Midland Health

Nurse Utilization Review

Midland, TX · On-site

The utilization review (UR) nurse serves to maximize the quality and cost efficiency of health care ... The UR nurse will also assist Registered Nurse (RN) Case Managers and Social Workers with helping ...

Houston Methodist

At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent medical record review for medical ...

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

As of Jun 30, 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
Utilization Review Nurse

Utilization Review Nurse

Baptist Health

Elizabethtown, KY • Hybrid

Full-time

Medical, Retirement, PTO

Posted 5 days ago

Key responsibilities

  • Complete utilization reviews on all assigned patients.

  • Conduct reviews of admissions, length of stay, discharge, and services ordered and provided on a concurrent and retrospective basis.

  • Foster effective communication and collaboration among members of the healthcare team to ensure seamless transitions of care and promote patient-centered care delivery.

Baptist Health South Florida rating

8.0

Company rating: 8.0 out of 10

Based on 97 frontline employees who took The Breakroom Quiz

1st of 23 rated health and beauty retailers

Job description

Summary

Job Description:

Utilization Review Nurse - Case Management

Full-time, day shift (varies 7:30a-4:00p or 8:00a-4:30p)

Hybrid (remote with rotating in house coverage)

72-hour position - Rotating 4/5 days, works every 5th weekend

Job Description:

Ensure the efficient and effective utilization of resources within a hospital setting. Complete utilization review on all assigned patients. Conduct review of admissions, length of stay, discharge, and services ordered and provided on a concurrent and retrospective basis. Foster effective communication and collaboration among members of the healthcare team to ensure seamless transitions of care and promote patient-centered care delivery.

Requirements:

  • Bachelor's degree in nursing (BSN) required. (Combination of education and clinical experience will be accepted in lieu of bachelor's degree).

  • Minimum of 2 years of clinical nursing experience in an acute care setting required.

  • Active RN license through the Kentucky Board of Nursing required.

  • Must obtain Case Management certification (ANCC, CCM or ACM-RN) preferred upon hire, required within 2 years.

Benefits:

  • Tuition Assistance reimbursement program

  • Paid Time Off available for use upon hire

  • Company paid Maternity and Paternity Leave

  • Bereavement Leave (includes pets)

  • Employee Assistance Program

  • Retirement plans with company match

Work Experience

Education

If you would like to be part of a growing family focused on supporting clinical excellence, teamwork and innovation, we urge you to apply now! Baptist Health is an Equal Employment Opportunity employer.

What Baptist Health South Florida employees say

Pay

Benefits

Hours and flexibility

Workplace

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About Baptist Health South Florida

Sourced by ZipRecruiter

Baptist Health South Florida is the largest healthcare organization in the region, with 12 hospitals, more than 27,000 employees, 4,000 physicians and 100 outpatient centers, urgent care facilities and physician practices spanning across Miami-Dade, Monroe, Broward and Palm Beach counties. Baptist Health has internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences. A not-for-profit organization supported by philanthropy and committed to its faith-based charitable mission of medical excellence, Baptist Health has been recognized by Fortune as one of the 100 Best Companies to Work For in America and by Ethisphere as one of the World's Most Ethical Companies.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Miami, FL, US

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