ZipRecruiter

Log In

1

Executive Rn Utilization Review Nurse Jobs (NOW HIRING)

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 ...

Ascension

Registered Nurse Utilization Review

Austin, TX · Remote

$78K - $110K/yr

... utilization review reports and performance metrics as needed. What You Will Need Licensure / Certification / Registration: * Licensed Registered Nurse credentialed from the Texas Board of Nursing or ...

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 ...

next page

Showing results 1-20

All JobsRn Utilization Review Nurse JobsExecutive Rn Utilization Review Nurse Jobs

Executive Rn Utilization Review Nurse information

See salary details

$21

$42

$68

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 Nurse (RN)

Utilization Review Nurse (RN)

Madera Community Hospital

Madera, CA • On-site

Full-time

Re-posted 4 days ago

Job description

Salary: $55.34-$66.41/hourly

Madera Community Hospital

Located in the heart of Central California, Madera Community Hospital is a General Acute Care, private, not-for-profit hospital dedicated to improving and maintaining the health and wellness of residents throughout the Central Valley. We are committed to identifying and serving our community's needs with compassion, concern, care and safety for every patient. Madera Community Hospital is a growing acute care facility seeking talented individuals with a drive to provide quality care and dedicated to making a difference in our community.

Position Summary: The Utilization Review Nurse assesses, plans, implements and evaluates the needs of patients for discharge planning and utilization review. This includes those who may have Medicare, Medicaid, HMO or private insurance to cover their stay at various units. Discharge planning is coordinated with physicians, Nursing, patient and family who have an ongoing caring relationship with the patient. Utilization review procedures include those stated for discharge planning in addition to knowledge of criteria for Medicare, Medicaid coverage and that of HMO or private insurers.

Qualifications:

  • Minimum of 13 years of related acute care nursing experience and completion of an accredited nursing program required.
  • Experience with Meditech Electronic Health Record (EHR) system preferred.
  • Must have working knowledge of criteria for Medicare, Medicaid, HMO and private insurance coverage.
  • Ability to maintain collaborative working relationships to ensure a positive and productive work environment.
  • Ability to plan and prioritize work with frequent interruptions.
  • Ability to provide exceptional customer service.
  • Effective verbal and written communication skills.
  • Knowledge and proficiency of hospital information technology applications.
  • Requires Current California Board of Nursing Registered Nurse License.
  • Current American Heart Association BCLS certificate required; ACLS certificate preferred.
  • CCM in Case Management preferred.

Madera Community Hospital provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.