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Manager Anthem Utilization Review Nurse Jobs (NOW HIRING)

Fusion HCR

Utilization Review Nurse

Las Vegas, NV · On-site

Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in ... Collaborate with physicians, case management, and care teams * Support discharge planning and care ...

Global Force

Utilization Review Nurse

Las Vegas, NV · On-site

About the job Utilization Review Nurse Sign on bonus may apply up to $15,000 Position Summary ... Minimum three (3) years of Utilization Management experience. * Minimum of three (3) year ...

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 ... Previous experience conducting concurrent or inpatient reviews for a managed care plan This is an ...

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 ... Perform outpatient utilization management (UM) and medical necessity reviews for prior ...

New

Oscar Health

Utilization Review Nurse

Miami, FL · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... Previous experience conducting concurrent or inpatient reviews for a managed care plan This is an ...

Oscar Health

Utilization Review Nurse

Dallas, TX · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... Previous experience conducting concurrent or inpatient reviews for a managed care plan This is an ...

AbsoluteCARE

Utilization Review Nurse

New Orleans, LA · On-site

We use population health management tools to employ a holistic approach to caring for the highest ... The Utilization Review Nurse ensures appropriate utilization of health services by performing ...

AbsoluteCare

Utilization Review Nurse

New Orleans, LA · On-site

We use population health management tools to employ a holistic approach to caring for the highest ... The Utilization Review Nurse ensures appropriate utilization of health services by performing ...

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 ... Previous experience conducting concurrent or inpatient reviews for a managed care plan This is an ...

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All JobsAnthem Utilization Review Nurse JobsManager Anthem Utilization Review Nurse Jobs

Manager Anthem Utilization Review Nurse information

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$42

$68

How much do manager anthem utilization review nurse jobs pay per hour?

As of Aug 9, 2026, the average hourly pay for manager anthem utilization review nurse 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 the difference between Manager Anthem Utilization Review Nurse vs Anthem Utilization Review Nurse?

AspectManager Anthem Utilization Review NurseAnthem Utilization Review Nurse
CertificationsRN license, possibly management certificationsRN license, utilization review certifications
Work EnvironmentSupervisory role, team managementPerforming reviews, case assessments
Employer & IndustryHealth insurance companies, healthcare industryHealth insurance companies, healthcare industry

The Manager Anthem Utilization Review Nurse oversees review teams and manages processes, while the Anthem Utilization Review Nurse focuses on conducting individual case reviews. Both roles require RN licensure and utilization review certifications, but the manager position involves leadership responsibilities. Understanding these differences helps job seekers identify the right role based on experience and career goals.

What is a Manager Anthem Utilization Review nurse?

A Manager Anthem Utilization Review Nurse is a registered nurse who oversees the utilization review process at Anthem, a major health insurance provider. This role involves supervising a team of nurses who assess the medical necessity and appropriateness of healthcare services for members. The manager ensures compliance with company policies, federal and state regulations, and industry standards. Additionally, they collaborate with healthcare providers, manage workflow, and contribute to quality improvement initiatives to optimize patient outcomes and cost efficiency.

What are some common challenges faced by a Manager Anthem Utilization Review nurse, and how can they be addressed?

One common challenge for a Manager Anthem Utilization Review Nurse is balancing the need for timely, effective decision-making with the complexities of evolving healthcare regulations and payer requirements. Managing a team of review nurses also requires strong leadership to ensure consistency in clinical determinations and to support staff development. Building effective communication channels with providers and internal teams can help resolve disputes and streamline workflow. Staying updated on policy changes and offering ongoing training can ensure compliance and maintain high-quality utilization review standards.

What are the key skills and qualifications needed to thrive as a Manager Anthem Utilization Review nurse?

To thrive as a Manager Anthem Utilization Review Nurse, you need a valid RN license, strong clinical experience, and expertise in utilization review processes. Familiarity with utilization management software, case management systems, and knowledge of regulatory requirements such as NCQA and CMS guidelines are typically required, along with certifications like CCM or URAC accreditation. Leadership, critical thinking, and effective communication are essential soft skills for managing teams and collaborating with internal and external stakeholders. These skills ensure efficient review processes, regulatory compliance, and the delivery of high-quality, cost-effective care.
What cities are hiring for Manager Anthem Utilization Review Nurse jobs? Cities with the most Manager Anthem Utilization Review Nurse job openings:
What are the most commonly searched types of Anthem Utilization Review Nurse jobs? The most popular types of Anthem Utilization Review Nurse jobs are:
What states have the most Manager Anthem Utilization Review Nurse jobs? States with the most job openings for Manager Anthem Utilization Review Nurse jobs include:
Manager Anthem Utilization Review Nurse jobs near you

Utilization Review Nurse

Fusion HCR

Las Vegas, NV • On-site

Other

Re-posted 3 days ago

Job description

Fusion HCR is hiring!Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in Acute Care.
Overview
Seeking an experienced Utilization Review Nurse (RN) to review patient admissions for medical necessity, appropriate level of care, and compliance with payer guidelines. This role works closely with clinical teams to ensure efficient resource utilization and quality patient outcomes.
Responsibilities
  • Review admissions using InterQual and/or Milliman criteria
  • Evaluate medical necessity, level of care, and documentation accuracy
  • Ensure compliance with Medicare, Medicaid, and regulatory guidelines
  • Collaborate with physicians, case management, and care teams
  • Support discharge planning and care coordination
  • Document findings and communicate recommendations

Requirements
  • Active RN license (Nevada)
  • 5+ years acute care nursing experience
  • 3+ years Utilization Review experience
  • 3+ years discharge planning experience (acute care)
  • Experience with InterQual (must be able to pass exam)
  • Experience with Milliman guidelines

Preferred
  • Background in Case Management or CDI
  • Strong knowledge of Joint Commission and CMS guidelines

Why Apply
  • Competitive pay
  • Stable, high-demand role
  • Collaborative healthcare environment

Apply Now
If you have strong Utilization Review, InterQual, and acute care experience, we want to hear from you!

Apply