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Insurance Review Nurse Jobs (NOW HIRING)

Oscar Health

Utilization Review Nurse

Atlanta, GA · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI ...

silvercross

Utilization Review Nurse

$34.73 - $45.15/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

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 ...

McBee Associates

Utilization Review Nurse

Enter clinical review information into system for transmission to insurance companies for ... Current and unrestricted RN license * At least 3 years clinical experience in acute care setting in ...

Medix

Utilization Review Nurse

Southfield, MI · On-site

$42 - $46/hr

  • Medical

  • Dental

  • Vision

  • Retirement

Job Summary Our client is seeking a Utilization Review Nurse. This role involves managing the full ... Term Life Insurance Plan. * We will consider for employment all qualified Applicants, including ...

Umpqua Health

Utilization Review Nurse

$85K - $105K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Utilization Review Nurse Remote Ability to travel on-site to 3031 NE Stephens St., Roseburg OR ... Medical, dental, and vision insurance * 401(k) with company match (fully vested immediately)

Silver Cross Hospital

Utilization Review Nurse

New Lenox, IL · On-site

$34.73 - $45.15/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

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 ...

Medix

Utilization Review Nurse

Fort Worth, TX · On-site

$38.46 - $43.27/hr

  • Medical

  • Dental

  • Vision

  • Retirement

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 ...

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI ...

Silver Cross Hospital

Utilization Review Nurse

New Lenox, IL · On-site

$34.73 - $45.15/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

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 ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · On-site +1

$85K - $105K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR ... Medical, dental, and vision insurance * 401(k) with company match (fully vested immediately)

Umpqua Health

Utilization Review Nurse

$85K - $105K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR ... Medical, dental, and vision insurance * 401(k) with company match (fully vested immediately)

Umpqua Health

Utilization Review Nurse

Roseburg, OR · Remote

$85K - $105K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR ... Medical, dental, and vision insurance * 401(k) with company match (fully vested immediately)

Medix

Utilization Review Nurse

Southfield, MI · On-site

$42 - $46/hr

  • Medical

  • Dental

  • Vision

  • Retirement

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 Aug 19, 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 job categories do people searching Insurance Review Nurse jobs look for?

The top searched job categories for Insurance Review Nurse jobs are:

Insurance Review Nurse jobs near you
Infographic showing various Insurance Review Nurse job openings in the United States as of August 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

Oscar Health

Atlanta, GA • Remote

$35 - $45.94/hr

Full-time

Posted 27 days ago

Oscar Health rating

6.9

Company rating: 6.9 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

259th of 310 rated insurance

Job description

Hi, we're Oscar. We're hiring a Utilization Review Nurse to join our Utilization Review team.

About the role:

You will perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed. You will make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions.

You will report into the Supervisor, Utilization Review.

Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois; Iowa; Kansas; Michigan; Missouri; Nebraska; New Jersey; North Carolina; Ohio; Oklahoma; Pennsylvania; South Carolina; Tennessee; Texas; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events.

Pay Transparency: The base pay for this role is: $35.00 - $45.94 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Responsibilities:

  • Complete medical necessity reviews and level of care reviews for requested services using clinical judgment and Oscar Clinical Guidelines, Milliman Care Guidelines
  • Obtain the information necessary (via telephone and fax) to assess a member's clinical condition, and apply the appropriate evidence-based guidelines
  • Meet required decision-making SLAs
  • Refer members for further care engagement when needed
  • Compliance with all applicable laws and regulations
  • Other duties as assigned

Requirements:

  • Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)
  • Associate Degree - Nursing or Graduate of Accredited School of Nursing Or Successful completion of Nursing Diploma Program in Accredited School of Nursing
  • Ability to obtain additional state licenses to meet business needs
  • 1+ year of utilization review experience in a managed care setting
  • Strong experience utilizating MCG (Milliman Care Gudielines)
  • 1+ years of clinical experience (including at least 1+ year clinical practice in an acute care setting, i.e., ER or hospital)
  • Weekend availability is required; all applicants must be able to work at least one weekend day (Saturday or Sunday) each week.

Bonus points:

  • BSN
  • Previous experience conducting concurrent or inpatient reviews for a managed care plan

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

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