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Home Health Utilization Review Rn Jobs (NOW HIRING)

PACE

$60 - $80/hr

Registered Nurse in State of MI with unencumbered license, BSN preferred; Minimum 2 years' experience in a managed care environment, preferably in a utilization related role. * Must have one year of ...

Randolph Health

Utilization Review Nurse

Asheboro, NC · On-site

$21.47 - $35/hr

... the Utilization Review Plan for Randolph Hospital. Review patient record and plan of care at ... home health services, facility placement, oxygen or IV antibiotics, as requested by the RN Case ...

Bestica Healthcare

RN Utilization Review

Tuba City, AZ · On-site

Utilization Review Nurse Full compliance is required 2 weeks prior to the start date. Hospital ... home health (direct care) {clinical experience qualification may be determined by hiring manager ...

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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.

Case Manager - Utilization Review RN

Chicago, IL • On-site

Community First Medical Center
Health Care and Social Assistance • 501 - 1,000 employees
Learn more about Community First Medical Centerexternal

$53/hr

Full-time, Part-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 13 days ago

Community First Medical Center rating

3.9

Company rating: 3.9 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

1,055th of 1,066 rated hospitals

Job description

Under the general direction of the Director of Behavioral Health, the Case Manager - Utilization Review RN provides clinically based case management and utilization review services to support the delivery of high-quality, cost-effective patient care. The RN is responsible for concurrent utilization review, medical necessity determination, denial prevention, discharge planning, care coordination, and resource management across the continuum of care.
The Case Manager - Utilization Review RN collaborates with physicians, interdisciplinary team members, physician advisors, social workers, revenue cycle staff, and third-party payers to ensure appropriate utilization of hospital resources, regulatory compliance, optimal reimbursement, and safe patient transitions.
Community First Medical Center offers benefits to all its full-time and part-time employees:
  • United Healthcare Medical PPO/HMO/HSA Plans, premiums as low as $50.00/full time, $85.00/Part Time
  • Met Life Dental and Vision
  • Paid Time Off (PTO) with annual accruals up to 168 hrs./year
  • Six paid holidays
  • Company Paid Life insurance and Short-term Disability
  • 401(k) after 90 days
  • Continuing Education reimbursement and 2 days paid off separate from PTO
  • Free Parking Garage
  • Internal Growth Opportunities

Requirements
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
QUALIFICATIONS
Education
  • Associate Degree in Nursing required.
  • Bachelor of Science in Nursing (BSN) preferred.

Experience
  • Minimum three (3) years of acute care nursing experience required.
  • Minimum two (2) years of Case Management and/or Utilization Review experience preferred.
  • Experience with discharge planning, utilization review, denial management, and payer authorization preferred.

Licensure
  • Current Illinois Registered Nurse license required.
  • ACM, CCM, or CMAC certification preferred.

KNOWLEDGE, SKILLS & ABILITIES
  • Knowledge of Medicare, Medicaid, and commercial insurance regulations.
  • Working knowledge of InterQual and/or MCG criteria.
  • Behavioral Health background knowledge
  • Access to Behavioral Health Networks
  • Understanding of utilization management and care coordination principles.
  • Knowledge of discharge planning and post-acute care resources.
  • Strong analytical and critical thinking skills.
  • Excellent verbal and written communication skills.
  • Ability to prioritize multiple complex patient cases.
  • Ability to build collaborative relationships with physicians and interdisciplinary teams.
  • Computer proficiency and electronic medical record experience.

PERFORMANCE EXPECTATIONS
Success in this role is measured by:
  • Appropriate admission status determination
  • Denial prevention and appeal success
  • Timely discharge planning
  • Reduction in avoidable days
  • Average Length of Stay management
  • Readmission reduction
  • Documentation compliance
  • Regulatory compliance
  • Patient throughput
  • Patient and physician satisfaction

Salary Description
43.47-$53.00

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