Utilization Review Nurse
Lawrence, MA · On-site
Responsible for working with the Clinical Care Coordinator and Complex Care Manager to facilitate ... care, care management, and utilization review. * Five years clinical nursing experience
Utilization Review Nurse
Lawrence, MA · On-site
Responsible for working with the Clinical Care Coordinator and Complex Care Manager to facilitate ... care, care management, and utilization review. * Five years clinical nursing experience
Utilization Review Nurse
Methuen, MA · On-site
Responsible for working with the Clinical Care Coordinator and Complex Care Manager to facilitate ... care, care management, and utilization review. * Five years clinical nursing experience
Utilization Review Nurse
Methuen, MA · On-site
Responsible for working with the Clinical Care Coordinator and Complex Care Manager to facilitate ... care, care management, and utilization review. * Five years clinical nursing experience
Utilization Review Nurse
West Chester, PA · On-site
Summary: * The Utilization Review Nurse will provide utilization review for authorization ... Is the liaison between third party payors and actively participates in denial management activities.
Utilization Review Nurse
West Chester, PA · On-site
Summary: * The Utilization Review Nurse will provide utilization review for authorization ... Is the liaison between third party payors and actively participates in denial management activities.
Utilization Review Nurse
Big Spring, TX · On-site
Job Summary The Utilization Review (UR) Nurse has acute knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the ...
Utilization Review Nurse
Big Spring, TX · On-site
Job Summary The Utilization Review (UR) Nurse has acute knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the ...
The Utilization Reviewer has the unique ability to follow the patient from admission to discharge and provide the physician and nursing staff with the best possible options for post hospital care for ...
The Utilization Reviewer has the unique ability to follow the patient from admission to discharge and provide the physician and nursing staff with the best possible options for post hospital care for ...
Utilization Review Nurse | Full Time
Las Vegas, NV · On-site
$41 - $60/hr (+ commission)
- Utilization Review Nurse Position Summary The Utilization Review Nurse is responsible for reviewing ... Participate in utilization management activities, including concurrent reviews, appeals, and denial ...
Quick apply
Utilization Review Nurse | Full Time
Las Vegas, NV · On-site
$41 - $60/hr (+ commission)
- Utilization Review Nurse Position Summary The Utilization Review Nurse is responsible for reviewing ... Participate in utilization management activities, including concurrent reviews, appeals, and denial ...
Works with the Utilization Management team primarily responsible for inpatient medical necessity ... Must be an RN Utilization Review background in either Managed Care of Provider environment (at ...
Works with the Utilization Management team primarily responsible for inpatient medical necessity ... Must be an RN Utilization Review background in either Managed Care of Provider environment (at ...
Utilization Review Nurse
Kotzebue, AK · On-site
$90 - $110/hr
Yes POSITION SUMMARY The Utilization Management Nurse (UMN) is responsible for performing Utilization Review and managing risk, coordinates and facilitates with departmental staff on Durable Medical ...
New
Utilization Review Nurse
Kotzebue, AK · On-site
$90 - $110/hr
Yes POSITION SUMMARY The Utilization Management Nurse (UMN) is responsible for performing Utilization Review and managing risk, coordinates and facilitates with departmental staff on Durable Medical ...
New
Hours: 8:30-5:30, Monday - Friday At Houston Methodist, the Utilization Review Nurse (URN) position ... This position collaborates with case management in the development and implementation of the plan ...
Hours: 8:30-5:30, Monday - Friday At Houston Methodist, the Utilization Review Nurse (URN) position ... This position collaborates with case management in the development and implementation of the plan ...
Utilization Review Nurse
Methuen, MA · On-site
Responsible for working with the Clinical Care Coordinator and Complex Care Manager to facilitate ... care, care management, and utilization review. * Five years clinical nursing experience
Utilization Review Nurse
Methuen, MA · On-site
Responsible for working with the Clinical Care Coordinator and Complex Care Manager to facilitate ... care, care management, and utilization review. * Five years clinical nursing experience
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 ...
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 ...
Utilization Review Nurse
Methuen, MA · On-site
Responsible for working with the Clinical Care Coordinator and Complex Care Manager to facilitate ... care, care management, and utilization review. * Five years clinical nursing experience
Utilization Review Nurse
Methuen, MA · On-site
Responsible for working with the Clinical Care Coordinator and Complex Care Manager to facilitate ... care, care management, and utilization review. * Five years clinical nursing experience
Job Summary The Utilization Review (UR) Nurse has acute knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the ...
Job Summary The Utilization Review (UR) Nurse has acute knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the ...
Utilization Review Nurse
Warner Robins, GA · On-site
$90 - $110/hr
The Utilization Reviewer has the unique ability to follow the patient from admission to discharge and provide the physician and nursing staff with the best possible options for post hospital care for ...
New
Utilization Review Nurse
Warner Robins, GA · On-site
$90 - $110/hr
The Utilization Reviewer has the unique ability to follow the patient from admission to discharge and provide the physician and nursing staff with the best possible options for post hospital care for ...
New
The Utilization Reviewer has the unique ability to follow the patient from admission to discharge and provide the physician and nursing staff with the best possible options for post hospital care for ...
The Utilization Reviewer has the unique ability to follow the patient from admission to discharge and provide the physician and nursing staff with the best possible options for post hospital care for ...
Utilization Review Nurse
Oxford, NC · On-site
Three years clinical nursing experience. One year utilization and review experience. Experience ... Self direction with the ability to work with minimal supervision and manage multiple tasks.
Utilization Review Nurse
Oxford, NC · On-site
Three years clinical nursing experience. One year utilization and review experience. Experience ... Self direction with the ability to work with minimal supervision and manage multiple tasks.
Utilization Review Nurse
Plano, TX · Remote
Provides information regarding utilization management requirements and operational procedures to ... Registered Nurse (RN) with a valid, current, unrestricted license in the state of operations. * 3 ...
Quick apply
Utilization Review Nurse
Plano, TX · Remote
Provides information regarding utilization management requirements and operational procedures to ... Registered Nurse (RN) with a valid, current, unrestricted license in the state of operations. * 3 ...
Utilization Review Nurse
Manhattan, NY · On-site
$60 - $61/hr
Care Manager (RN) - Non-Patient-Facing - MLTC Location: New York, NY 10004 Schedule: Monday-Friday ... Perform utilization review and discharge planning. * Collaborate with providers and ...
Utilization Review Nurse
Manhattan, NY · On-site
$60 - $61/hr
Care Manager (RN) - Non-Patient-Facing - MLTC Location: New York, NY 10004 Schedule: Monday-Friday ... Perform utilization review and discharge planning. * Collaborate with providers and ...
Utilization Review Nurse
Oxford, NC · On-site
Three years clinical nursing experience. One year utilization and review experience. Experience ... Self direction with the ability to work with minimal supervision and manage multiple tasks.
Utilization Review Nurse
Oxford, NC · On-site
Three years clinical nursing experience. One year utilization and review experience. Experience ... Self direction with the ability to work with minimal supervision and manage multiple tasks.
Utilization Review Nurse - Full Time
Bakersfield, CA · On-site
$43.51 - $68.56/hr
Utilization Review Nurse - Full Time Shift: 8:00am - 4:30pm with rotating weekend coverage ... Manager in an alternate medical setting such as a clinic or physician's office performing ...
Utilization Review Nurse - Full Time
Bakersfield, CA · On-site
$43.51 - $68.56/hr
Utilization Review Nurse - Full Time Shift: 8:00am - 4:30pm with rotating weekend coverage ... Manager in an alternate medical setting such as a clinic or physician's office performing ...
Manager Anthem Utilization Review Nurse information
See salary details
$21.39 - $25.72
2% of jobs
$25.72 - $30.05
9% of jobs
$33.01 is the 25th percentile. Wages below this are outliers.
$30.05 - $34.38
21% of jobs
The median wage is $37.88 / hr.
$34.38 - $38.70
23% of jobs
$38.70 - $43.03
13% of jobs
$46.39 is the 75th percentile. Wages above this are outliers.
$43.03 - $47.36
10% of jobs
$47.36 - $51.68
8% of jobs
$51.68 - $56.01
5% of jobs
$56.01 - $60.34
5% of jobs
$60.34 - $64.66
2% of jobs
$64.66 - $68.99
2% of jobs
$21
$42
$68
How much do manager anthem utilization review nurse jobs pay per hour?
As of Sep 4, 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 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 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 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 is the difference between Manager Anthem Utilization Review Nurse vs Anthem Utilization Review Nurse?
| Aspect | Manager Anthem Utilization Review Nurse | Anthem Utilization Review Nurse |
|---|---|---|
| Certifications | RN license, possibly management certifications | RN license, utilization review certifications |
| Work Environment | Supervisory role, team management | Performing reviews, case assessments |
| Employer & Industry | Health insurance companies, healthcare industry | Health 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 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:
Full-time
Posted 8 days ago
Job description
Position Summary
Responsible for determining the appropriateness of hospital admission, utilization of resources and medical necessity for continued stay. Responsible for working with the Clinical Care Coordinator and Complex Care Manager to facilitate timely discharge, assure medical documentation accurately reflects the patient’s severity of illness; and ensures compliance with the conditions of participation as they relate to utilization review and discharge planning and payer regulations.
MINIMUM EDUCATION AND EXPERIENCE:
Required:
- Graduate of an accredited professional nursing school
- Current Massachusetts Nursing license
- Bachelor’s degree. - Preferred
- 5 years case management experience in an acute care setting with discharge planning, continuing care, care management, and utilization review.
- Five years clinical nursing experience
- Demonstrated verbal, written skills
- Computer skills
Preferred:
- Master’s degree.