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Home Health Utilization Review Rn Jobs (NOW HIRING)

Prime Healthcare

Utilization Review RN

Ontario, CA · On-site

$71K - $104K/yr

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime ... Minimum 3 years RN Utilization Manager working for a Health Plan. * At least 3 years of experience ...

CH and Trinity, P.C.

$80 - $100/hr

BSN degree or RN with a BS in health-related field and working knowledge/experience in documentation utilization review in an acute care/inpatient setting * Unrestricted NYS RN license * Holds, or ...

New

Sentara Healthcare

UTILIZATION REVIEW NURSE

Norfolk, VA · On-site +1

Talroo- Health, Utilization Review Nurse, RN, Care Coordination, or Discharge Planning, Case Management, Milliman, NCQA Benefits: Caring For Your Family and Your Career • Medical, Dental, Vision ...

CareConnect

Utilization Review RN

Greenvale, NY · On-site

Company Description The first commercial provider-owned health plan in New York State, CareConnect ... Reviews and coordinates prospective, concurrent and retrospective activities related to utilization.

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Home Health Utilization Review Rn information

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How much do home health utilization review rn jobs pay per hour?

As of Sep 9, 2026, the average hourly pay for home health utilization review rn 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 home health utilization review RN?

A Home Health Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of home health care services. They review patient records, treatment plans, and clinical documentation to ensure care meets established guidelines and regulatory requirements. Their role is crucial in ensuring that patients receive the most appropriate care while helping agencies comply with insurance and Medicare standards. They also collaborate with care teams to optimize patient outcomes and manage healthcare costs.

How does a home health utilization review RN collaborate with other healthcare team members to ensure effective patient care?

A Home Health Utilization Review RN works closely with clinicians, case managers, and administrative staff to coordinate care and evaluate the necessity and efficiency of home health services. This collaboration often involves reviewing documentation, discussing care plans, and ensuring compliance with payer requirements. Regular meetings and communication help the team identify gaps in care, optimize resource use, and maintain high standards of patient outcomes. This teamwork is essential for balancing quality care with regulatory and reimbursement guidelines.

What are the key skills and qualifications needed to thrive as a home health utilization review RN, and why are they important?

To thrive as a Home Health Utilization Review RN, you need a current RN license, strong clinical assessment skills, and experience in home health care or case management. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of Medicare/insurance guidelines is essential. Excellent critical thinking, attention to detail, and effective communication skills help you interpret medical records and collaborate with interdisciplinary teams. These competencies ensure proper care coordination, cost-effective service delivery, and compliance with regulatory standards in home health settings.

What states have the most Home Health Utilization Review Rn jobs?

States with the most job openings for Home Health Utilization Review Rn jobs include:

What are popular job titles related to Home Health Utilization Review Rn jobs?

For Home Health Utilization Review Rn jobs, the most frequently searched job titles are:

Infographic showing various Home Health Utilization Review Rn job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 17% Part Time, and 5% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Registered Nurse Utilization Review SCH

Buffalo, NY • On-site

Catholic Health System
Health Care and Social Assistance • 10K+ employees
Learn more about Catholic Health Systemexternal

Other

Posted 6 days ago

Catholic Health rating

7.9

Company rating: 7.9 out of 10

Based on 181 frontline employees who took The Breakroom Quiz

111th of 898 rated healthcare providers

Job description

Facility: Sisters of Charity Hospital

Shift: Shift 1

Status: Full Time FTE: 1.000000

Bargaining Unit: ACE Associates

Exempt from Overtime: Exempt: Yes

Work Schedule: Days with Weekend and Holiday Rotation

Hours:

8am -4 pm

Summary:

The Registered Nurse (RN), Utilization Review, as an active member of the Middle Revenue Cycle and interdisciplinary care team, provides comprehensive Utilization Review to patients and families in the hospital setting. Utilizing foundational nursing clinical skills Utilization Review nurse collaborates with the interdisciplinary team to maintain appropriate levels of care and to facilitate movement of the patient through the continuum. The Utilization Review RN identifies and removes barriers for delays of treatment. This individual also works to maintain third-party payer relationships related to Utilization Review Activities. This includes, but is not limited to, concurrent review, responding to inquiries, complaints, and other correspondence, and may include setting up discussions between parties. Knowledge of state and federal laws relating to contracts and utilization review process processes is vital.

Responsibilities:

EDUCATION

  • BSN degree or RN with a BS in health-related field and working knowledge/experience in documentation utilization review in an acute care/inpatient setting

  • Unrestricted NYS RN license

  • Holds, or will obtain within one year of hire, Certified Case Manager (CCM)

  • Certification in a Nationally Recognized Utilization Review Criteria set is preferred

  • At least one (1) year of experience in working with third party payers strongly preferred

EXPERIENCE

  • Minimum of three (3) years of experience working in an Acute Care Hospital Setting

  • Proficiency in utilization management and regulatory requirements preferred

  • Experience in working with people who are geographically dispersed preferred

  • Experience in working with third party payers strongly preferred

KNOWLEDGE, SKILL AND ABILITY

  • Strong clinical assessment skills and ability to articulate findings in a fast-paced environment. Possess the ability to make independent decisions within the professional scope of practice

  • Possess ability to educate, inform, advocate, promote and facilitate health care options, and demonstrate the willingness to work harmoniously with a team approach

  • Possesses ability to effectively and efficiently utilize technology within daily work with the care team and ability to quickly learn and adapt to new technology tools and software

  • Extensive knowledge of third-party payer guidelines, accreditation and regulatory requirements preferred

  • Knowledge of Managed Care Organization contracts/agreements preferred

WORKING CONDITIONS

  • Willingness to work beyond normal working hours, and in other positions temporarily, and/or at other locations when necessary

  • Variable schedule which may include weekends and holidays. May be requested to travel to multiple hospital and community sites

ENVIRONMENT

  • Normal heat, light space, and safe working environment; typical of most office jobs

  • Occasional exposure to one or more mildly unpleasant physical conditions

  • Minimum physical effort required, typical of most office work

  • Significant amount of walking within the acute care facility

What Catholic Health employees say

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Benefits

Hours and flexibility

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About Catholic Health

Sourced by ZipRecruiter

Formed in 1998 under four religious sponsors, Catholic Health in Buffalo, NY is a non-profit healthcare system that provides care to Western New Yorkers across a network of hospitals, nursing homes, home care agencies, physician practices, and other community based ministries. Today, the system has two religious sponsors, the Diocese of Buffalo and the Franciscan Sisters of St. Joseph, who carried on its Mission across the Buffalo-Niagara region. Our mission sets us apart. It's the human side of healthcare – the touch, smile or comforting word that can help make your healthcare experience better. It's treating all people with respect and dignity, and providing comfort in times of greatest need. Catholic Health is making the largest investment in its history, dedicating more than $100 million in state-of-the- art technology that will connect our hospitals, home care, long-term care, clinician offices, health centers and ancillary services with patients throughout the area. This transformational investment marks a major milestone for our healing ministry, which dates back more than 165 years.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Buffalo, NY, US

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