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Executive Rn Utilization Review Nurse Jobs (NOW HIRING)

Utilization Review Schedule: Days | Full - Time Pay range: $84,060.91 - $118,668.99 How you'll make ... Licensed Registered Nurse credentialed from the Florida Board of Nursing obtained prior to hire ...

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 ...

Supports utilization review processes by planning, analyzing data, and setting goals to ensure ... Certifications & Licensures Current and active Registered Nurse (RN) license Working Conditions A.

Utilization Management Schedule: PRN | Days Salary Range: $33.99 - $63.98 per hour Life at ... Licensed Registered Nurse credentialed from the Tennessee Board of Nursing or current home state ...

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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:
Registered Nurse Utilization Review

Registered Nurse Utilization Review

Ascension

Pensacola, FL • Remote

$84K - $118K/yr

Full-time

Medical, PTO

Posted 10 days ago


Ascension Healthcare rating

7.0

Company rating: 7.0 out of 10

Based on 1,029 frontline employees who took The Breakroom Quiz

417th of 888 rated healthcare providers


Job description

Your future role at a glance

Location: Remote

Facility: Ascension Sacred Heart Hospital 

Department: Utilization Review

Schedule: Days | Full - Time

Pay range: $84,060.91 - $118,668.99

How you'll make an impact in this role
  • Perform prospective, concurrent, and retrospective reviews of admissions and service requests using evidence-based criteria (e.g., InterQual, MCG) to ensure medical necessity and adherence to reimbursement policies.

  •  Manage and consult on high-acuity or complex cases, coordinating with the multidisciplinary team to ensure the level of care matches the patient's clinical status and facility protocols.

  • Mitigate financial risk by overseeing compliance with federal (CMS) and third-party payer regulations, assisting staff with precertification, accurate coding, and the management of claim denials or appeals.

  • Lead the healthcare team in assessing and coordinating discharge needs, ensuring safe patient transitions while preparing statistical reports to identify trends in resource utilization.

What minimum qualifications you'll need

Licensure / Certification / Registration:

  • Licensed Registered Nurse credentialed from the Florida Board of Nursing obtained prior to hire dateor job transfer date required. Licensed as a Registered Nurse in Florida required. Credentialed from State Board ofNursing or current home state license for multi-state license recognition "Compact State" obtainedprior to hire date or job transfer date required.

Education:

  • Diploma from an accredited school/college of nursing OR Required professional licensure at time ofhire.
What additional requirements you'll need
  • 3+ years of clinical experience required, Observation experience 
  • Experience in Utilization Management, Case Management, or Care Coordination 
  • Experience working in a remote environment
Life at Ascension: Where purpose meets opportunity

Ascension is a leading nonprofit Catholic health system with a culture and associate experience grounded in service, growth, care and connection. We empower our 97,000+ associates to bring their skills and expertise every day to reimagining healthcare, together. Recognized as one of the Best 150+ Places to Work in Healthcare and a Military-Friendly Gold Employer, you'll find an inclusive and supportive environment where your contributions truly matter.

Equal employment opportunity employer

Equal employment opportunity employer

Ascension provides Equal Employment Opportunities (EEO) to all associates and applicants for employment without regard to race, color, religion, sex/gender, sexual orientation, gender identity or expression, pregnancy, childbirth, and related medical conditions, lactation, breastfeeding, national origin, citizenship, age, disability, genetic information, veteran status, marital status, all as defined by applicable law, and any other legally protected status or characteristic in accordance with applicable federal, state and local laws. For further information, view the EEO Know Your Rights (English) poster or EEO Know Your Rights (Spanish) poster.

Fraud prevention notice

Prospective applicants should be vigilant against fraudulent job offers and interview requests. Scammers may use sophisticated tactics to impersonate Ascension employees. To ensure your safety, please remember: Ascension will never ask for payment or to provide banking or financial information as part of the job application or hiring process. Our legitimate email communications will always come from an @ascension.org email address; do not trust other domains, and an official offer will only be extended to candidates who have completed a job application through our authorized applicant tracking system.

E-Verify statement

Employer participates in the Electronic Employment Verification Program. Please click here for more information.

Benefits

Paid time off (PTO)Various health insurance options & wellness plansRetirement benefits including employer match plansLong-term & short-term disabilityEmployee assistance programs (EAP)Parental leave & adoption assistanceTuition reimbursementWays to give back to your community

Benefit options and eligibility vary by position. Compensation varies based on factors including, but not limited to, experience, skills, education, performance, location and salary range at the time of the offer.

Employment Type: FULL_TIME

What Ascension Healthcare employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom


Ascension logo

About Ascension

Sourced by ZipRecruiter

Ascension is a leading non-profit, faith-based national health system made up of over 150,000 associates and 2,600 sites of care, including more than 140 hospitals and 40 senior living communities in 19 states.

Industry

Health care and social assistance and outpatient health care

Company size

10,000+ Employees

Headquarters location

St. Louis, MO, US