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Insurance Review Nurse Jobs (NOW HIRING)

Acrisure, LLC

Utilization Review Nurse

Bradenton, FL · On-site

$60 - $80/hr

... of insurance, reinsurance, payroll, benefits, cybersecurity, mortgage services, and more.In the ... Utilization Review Nurse, LPN** to evaluate treatment requests and help ensure injured workers ...

silvercross

Utilization Review Nurse

$34.73 - $45.15/hr

Performs medical record review for severity of illness and intensity of service; liaison function ... Relevant hospital nursing; hospital case management; insurance case management or utilization ...

Randolph Health

Utilization Review Nurse

Asheboro, NC · On-site

$21.47 - $35/hr

Review patient record and plan of care at admission or placement into observation utilizing the ... Facilitate insurance approval for services needed at discharge such as home health services ...

Acrisure LLC

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 ...

Acrisure, LLC

$60 - $80/hr

... of insurance, reinsurance, payroll, benefits, cybersecurity, mortgage services, and more.In the ... Utilization Review Nurse, LPN** to evaluate treatment requests and help ensure injured workers ...

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 ...

Randolph Health

Utilization Review Nurse

Asheboro, NC · On-site

Review patient record and plan of care at admission or placement into observation utilizing the ... Facilitate insurance approval for services needed at discharge such as home health services ...

Medix

Utilization Review Nurse

Fort Worth, TX · On-site

$38.46 - $43.27/hr

Job Summary Our client is seeking a skilled Utilization Review Nurse to join their team. This role ... Term Life Insurance Plan. Required Employment / Compliance Language * We will consider for ...

Medix

Utilization Review Nurse

Southfield, MI · On-site

$42 - $46/hr

Job Summary Our client is seeking a Utilization Review Nurse to manage the full lifecycle of ... Term Life Insurance Plan. * We will consider for employment all qualified Applicants, including ...

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Insurance Review Nurse information

See salary details

$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

Asheboro, NC • On-site

Randolph Hospital
501 - 1,000 employees
Learn more about Randolph Hospitalexternal

Other

Posted 5 days ago

Job description

Utilization Management Nurse

Complete utilization management functions for assigned patients as outlined in the Utilization Review Plan for Randolph Hospital. Review patient record and plan of care at admission or placement into observation utilizing the criteria set approved and adopted by the Medical Executive Committee. Facilitate any second level reviews for patients not meeting the criteria set for the assigned level of care. Conduct continued stay reviews on periodic basis to ensure level of care appropriateness. Identify outlier cases and refer for second level continued stay review. Timely notification of the admitting physician on any issues of status that need discussion and facilitation of changes required. Serve as resource to hospital staff and medical staff on issues related to utilization management and level of care decisions. Assist with case reviews for payer denials concurrently and retrospectively as needed. Facilitate insurance approval for services needed at discharge such as home health services, facility placement, oxygen or IV antibiotics, as requested by the RN Case Manager or Discharge Planning Case Manager. Graduate from an accredited school of nursing. BSN preferred. Current license to practice as a Registered Nurse in North Carolina required. Previous training in utilization management or case management preferred. Excellent assessment skills required. Excellent communication skills required. Ability to set priorities and work independently is required. Knowledge of treatment modalities and alternate healthcare delivery systems is preferred. Three years working experience in an acute care setting is required. Prior experience in medical/surgical nursing, critical care, emergency care or home health is preferred.

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