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Insurance Review Nurse Jobs (NOW HIRING)

Sentara Healthcare

UTILIZATION REVIEW NURSE

Norfolk, VA · On-site +1

The Utilization Review Nurse is responsible for utilization management services within the scope of ... Insurance • 401k/403B with Employer Match • Tuition Assistance - 5,250/year and discounted ...

Sentara Health Plans

$60 - $80/hr

The Utilization Review Nurse is responsible for utilization management services within the scope of ... Pet Insurance * Legal Resources Plan Colleagues have the opportunity to earn an annual ...

Ova Technologies

Utilization Review Nurse

Alpharetta, GA · On-site

Utilization Review Nurse Location: [City, State / Remote] Employment Type: Full-Time Experience: 2 ... Communicate with insurance companies, managed care organizations, and third-party payers regarding ...

Integrated Resources

Care Review Nurse

Columbus, OH · On-site

Insurance Utilization Manager/Review and Millemen Experience (MCG). No case managers if that is ... Nurses who are used to doing both production and review work All your information will be kept ...

Cobalt Benefits Group

Utilization Review Nurse

As a Utilization Review Nurse, you'll play an important role in helping us offer customized, self-funded insurance options to our clients and members. The UR Nurse is responsible for reviewing ...

US Tech Solutions

Utilization Review Nurse

Canton, MA · On-site

$55 - $60/hr

... Nurse to support outpatient utilization review and prior authorization activities for a leading ... Previous Managed Care, Health Plan, Medicare, Medicaid, or Commercial Insurance experience.

Acrisure

Utilization Review Nurse

Bradenton, FL · On-site

... of insurance, reinsurance, payroll, benefits, cybersecurity, mortgage services, and more. In the ... Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure ...

Pride Health

Utilization Review Nurse

Queens, NY · On-site

$2.5K - $2.8K/wk

Job title: RN - Utilization Review Job location : East Elmhurst, NY 11370-1381 Shift : 8:30 AM-5:00 ... insurance, pet insurance, and employee discounts with preferred vendors. Equal Employment ...

Pride Health

Utilization Review Nurse

Manhattan, NY · On-site

$60 - $61/hr

... nursing experience * Experience in Care Coordination, Utilization Review, and Discharge Planning ... coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k) ...

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Insurance Review Nurse information

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$23.5K

$59.1K

$97.5K

How much do insurance review nurse jobs pay per year?

As of Sep 9, 2026, the average yearly pay for insurance review nurse in the United States is $59,095.00, according to ZipRecruiter salary data. Most workers in this role earn between $40,500.00 and $77,500.00 per year, depending on experience, location, and employer.

What is an insurance review nurse?

Insurance Review Nurses are registered nurses who evaluate medical records and treatment plans to determine if healthcare services are medically necessary and covered by insurance policies. They act as a liaison between healthcare providers, patients, and insurance companies to ensure that claims meet policy guidelines. Their work helps prevent unnecessary treatments and controls healthcare costs while ensuring patients receive appropriate care.

What skills and qualifications are needed to be an insurance review nurse?

To thrive as an Insurance Review Nurse, you need a registered nursing license, strong clinical knowledge, and experience in case management or utilization review. Familiarity with medical coding systems (such as ICD-10 and CPT), healthcare regulations, and insurance software platforms is typically required. Attention to detail, analytical thinking, and effective communication are crucial soft skills for evaluating medical records and collaborating with providers. These skills ensure accurate, efficient reviews that support appropriate coverage decisions and compliance with regulatory standards.

What challenges do insurance review nurses face when evaluating medical necessity for insurance claims?

Insurance Review Nurses often encounter challenges such as interpreting complex medical records, staying current with evolving insurance policies and clinical guidelines, and balancing the interests of patients, providers, and insurers. They must exercise critical thinking to make impartial decisions while navigating tight deadlines and high caseloads. Collaborating effectively with physicians, case managers, and claims adjusters is crucial to ensure accurate and fair assessments.

What is the difference between Insurance Review Nurse vs Claims Nurse?

AspectInsurance Review NurseClaims Nurse
CredentialsRN license, possibly certifications in case management or insuranceRN license, certifications in case management or insurance
Work EnvironmentReviewing insurance claims, assessing coverage, working with insurance companiesHandling patient claims, coordinating with insurance providers, clinical assessments
Employer & IndustryInsurance companies, third-party administratorsHospitals, insurance companies, healthcare providers

Both roles require RN licensure and similar certifications, often working within insurance or healthcare settings. Insurance Review Nurses primarily evaluate insurance claims for coverage and compliance, while Claims Nurses handle patient claims, ensuring proper processing and coordination. Although their tasks differ, both roles focus on insurance and healthcare integration, making them closely related in the industry.

More about Insurance Review Nurse jobs

What cities are hiring for Insurance Review Nurse jobs?

Cities with the most Insurance Review Nurse job openings:

What states have the most Insurance Review Nurse jobs?

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

What are popular job titles related to Insurance Review Nurse jobs?

For Insurance Review Nurse jobs, the most frequently searched job titles are:

Insurance Review Nurse jobs near you
Infographic showing various Insurance Review Nurse job openings in the United States as of September 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution, with an average salary of $59,095 per year, or $28.4 per hour.

UTILIZATION REVIEW NURSE

Norfolk, VA • On-site

Sentara Health Administration, Inc.
See more jobs at Sentara Health Administration, Inc.external

$80 - $100/hr

Other

Medical, Dental, Vision, Life, Retirement, PTO

Posted 7 days ago

Job description

City/StateNorfolk, VAWork ShiftFirst (Days)Overview:Sentara Health Plans Community Care is looking to hire a Utilization Review Nurse.The Utilization Review Nurse is responsible for utilization management services within the scope of licensure. Conducts primary functions of prior authorization, retrospective review, medical director referrals and execution of member/provider approval and/or denial letter. Reviews provider requests for services requiring authorization. Conducts pre-certification, care coordination for appropriateness of treatment, set reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.Responsible for written and/or verbal notification to members and providers. Ensures medical director written decision is consistent with criteria (CMS, state, medical policy, clinical criteria). Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.Education:· BSN (preferred)Certification:· Registered Nurse (required)Experience:· 3 years of acute care clinical experience (required)· Previous Utilization Review experience (preferred)· Milliman experience (preferred)· Knowledge of NCQA (preferred)· Microsoft suite (Word, Excel, Outlook) (preferred)· Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skillsKeywords: Talroo- Health, Utilization Review Nurse, RN, Care Coordination, or Discharge Planning, Case Management, Milliman, NCQABenefits: Caring For Your Family and Your Career• Medical, Dental, Vision plans• Adoption, Fertility and Surrogacy Reimbursement up to $10,000• Paid Time Off and Sick Leave• Paid Parental & Family Caregiver Leave• Emergency Backup Care• Long-Term, Short-Term Disability, and Critical Illness plans• Life Insurance• 401k/403B with Employer Match• Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education• Student Debt Pay Down – $10,000•Pet Insurance•Legal Resources Plan•Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.In support of our mission “to improve health every day,” this is a tobacco-free environment.For positions that are available as remote work, Sentara Health employs associates in the following states:Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming. #J-18808-Ljbffr

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