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Flexible Utilization Review Nurse Jobs (NOW HIRING)

Sentara Health Plans

UTILIZATION REVIEW NURSE

Norfolk, VA · On-site

$65 - $85/hr

The Utilization Review Nurse is responsible for utilization management services within the scope of licensure. Conducts primary functions of prior authorization, retrospective review, medical ...

New

Sentara Health Plans

$65 - $85/hr

The Utilization Review Nurse is responsible for utilization management services within the scope of licensure. Conducts primary functions of prior authorization, retrospective review, medical ...

New

Acrisure

Utilization Review Nurse

Bradenton, FL · On-site

Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure ... Health Savings Account (HSA) and Flexible Spending Account (FSA) options; commuter benefits; and ...

Acrisure, LLC

Utilization Review Nurse

Bradenton, FL · On-site

$55 - $90/hr

Utilization Review Nurse, LPN** to evaluate treatment requests and help ensure injured workers ... Health Savings Account (HSA) and Flexible Spending Account (FSA) options; commuter benefits; and ...

Acrisure, LLC

$55 - $90/hr

Utilization Review Nurse, LPN** to evaluate treatment requests and help ensure injured workers ... Health Savings Account (HSA) and Flexible Spending Account (FSA) options; commuter benefits; and ...

New

Acrisure

Utilization Review Nurse

Bradenton, FL

Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure ... Health Savings Account (HSA) and Flexible Spending Account (FSA) options; commuter benefits; and ...

AbsoluteCare

Utilization Review Nurse

New Orleans, LA · On-site

The Utilization Review Nurse ensures appropriate utilization of health services by performing initial, concurrent and retrospective clinical case reviews. This role collaborates and communicates with ...

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How much do flexible utilization review nurse jobs pay per hour?

As of Sep 4, 2026, the average hourly pay for flexible 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 is a flexible utilization review nurse?

A Flexible Utilization Review Nurse is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services, procedures, and facilities, often with the ability to work flexible hours or remotely. These nurses typically review patient records, coordinate with healthcare providers, and ensure that treatments meet established guidelines and insurance requirements. The 'flexible' aspect refers to their adaptable work schedules or settings, making this role appealing for those seeking work-life balance.

What are the key skills and qualifications needed to thrive as a flexible utilization review nurse?

To thrive as a Flexible Utilization Review Nurse, you need a nursing degree, active RN license, and experience in clinical settings, along with a strong understanding of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of CMS or NCQA standards is typically required. Exceptional critical thinking, time management, and communication skills help you excel in remote or variable environments and collaborate effectively with providers and payers. These competencies ensure accurate care assessments, regulatory compliance, and efficient resource utilization in a dynamic healthcare landscape.

What are some common challenges faced by flexible utilization review nurses, and how can they be addressed?

Flexible Utilization Review Nurses often navigate challenges such as managing fluctuating caseloads, adapting to varied healthcare settings, and staying current with changing regulations. Time management and organization are essential, as work hours may shift and patient volume can vary. Building strong communication skills helps in collaborating remotely with physicians, case managers, and insurance representatives. Proactively seeking ongoing education and connecting with supportive colleagues can make these challenges more manageable and enhance job satisfaction.

What cities are hiring for Flexible Utilization Review Nurse jobs?

Cities with the most Flexible Utilization Review Nurse job openings:

What are the most commonly searched types of Utilization Review Nurse jobs?

The most popular types of Utilization Review Nurse jobs are:

What states have the most Flexible Utilization Review Nurse jobs?

States with the most job openings for Flexible Utilization Review Nurse jobs include:

Flexible Utilization Review Nurse jobs near you

Utilization Review Nurse

Health Business Solutions LLC

Cooper City, FL • On-site

Full-time

Re-posted 27 days ago

Job description

Job Summary: We are seeking a highly motivated and experienced Utilization Review Nurse to join our team. The Utilization Review Nurse will play a crucial role in supporting our clients in the healthcare industry by providing expert clinical guidance, facilitating effective utilization management, and ensuring revenue cycle efficiency. This position offers a unique opportunity to combine clinical expertise with revenue cycle management knowledge.

Key Responsibilities:

·       Clinical Assessment: Conduct comprehensive clinical assessments of medical records to ensure patients are receiving appropriate care at the correct level of service.

  • Care Coordination: Collaborate with interdisciplinary healthcare teams to coordinate patient care and treatment plans, ensuring the most cost-effective and clinically appropriate care is provided.
  • Revenue Cycle Management: Utilize clinical expertise to support revenue cycle processes, including accurate coding, documentation improvement, and compliance with healthcare regulations.
  • Utilization Review:

a) Apply medical necessity screening criteria and clinical knowledge to ensure appropriateness of admissions and length of stays

b) Conduct initial admission, continuing stay, and 23-hour observations reviews for all patients

c) Support Utilization Review Coordinator team members on cases escalated for level of care determinations

d) Screen cases for Physician Advisor review

e) Collaborate with insurance companies on concurrently denied and high risk for denial cases

  •  Documentation Improvement: Identify opportunities for improving clinical documentation to support accurate coding and billing processes, ultimately improving reimbursement.


  • Data Analysis: Analyze clinical and financial data to identify trends, opportunities for improvement, and areas of potential cost savings for clients.


  • Compliance: Stay up-to-date with healthcare regulations, guidelines, and policies to ensure all patient care and revenue cycle processes are in compliance with industry standards and regulatory requirements to ensure appropriate reimbursement.

Qualifications:

·       Registered Nurse (RN) licensure required; must hold a USRN multi-state/compact nursing license.

·       Bachelor of Science in Nursing (BSN) preferred.

·       Case Management Certification (e.g., CCM) is a plus.

·       Minimum of 3 years of clinical nursing experience, preferably in a hospital or acute care setting.

·       Minimum 2 years of work experience in Utilization Review

·       Strong understanding of revenue cycle management and healthcare reimbursement.

·       Proficiency in medical coding and clinical documentation improvement.

·       Excellent communication, interpersonal, and teamwork skills.

·       Ability to work independently and make sound clinical and financial decisions.

·       Strong analytical and problem-solving skills.

·       Proficient in using healthcare information systems and technology.

·       Commitment to maintaining patient confidentiality and ethical standards.