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Maternity Utilization Review Nurse Rn Jobs (NOW HIRING)

Albany Medical College

$77K - $119K/yr

## Utilization Review NurseApplylocations: 43 New Scotland Avenue Albany, NY 12208time type: Full ... Minimum Qualifications:** • Registered nurse with a New York State current license. • Associate ...

Orison Solutions

RN - Utilization Review

New York, NY · On-site

$65 - $70/hr

Job Summary We are seeking an experienced Registered Nurse (RN) - Utilization Review to evaluate the medical necessity, appropriateness, and level of care for patients. The RN will review clinical ...

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 ... Current licensure as a Registered Nurse in the state of employment. * A minimum of 5 years of ...

Albany Medical Center

Utilization Review Nurse

Albany, NY · On-site

$77K - $119K/yr

Minimum Qualifications: • Registered nurse with a New York State current license. • Associate ... utilization review process. • Excellent written and verbal communication skills. • Working ...

Albany Med

Utilization Review Nurse

Albany, NY · On-site

$77K - $119K/yr

... utilization review identifies areas for clinical documentation improvement and contacts appropriate ... Minimum Qualifications: • Registered nurse with a New York State current license. • Associate ...

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Maternity Utilization Review Nurse Rn information

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How much do maternity utilization review nurse rn jobs pay per hour?

As of Sep 14, 2026, the average hourly pay for maternity utilization review nurse rn 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 does a maternity utilization review nurse RN do?

A Maternity Utilization Review Nurse RN is a registered nurse who specializes in reviewing and evaluating the medical necessity and appropriateness of maternity-related healthcare services. They assess patient records, collaborate with healthcare providers, and ensure compliance with insurance guidelines and best practices. Their goal is to ensure that expectant mothers receive the necessary care while managing costs and preventing unnecessary procedures. This role often involves case management, patient education, and communication with insurance companies.

What are the key skills and qualifications needed to thrive as a maternity utilization review nurse RN?

To thrive as a Maternity Utilization Review Nurse RN, you need a solid background in obstetric nursing, case management, and utilization review, typically supported by an RN license and experience in maternal-child health. Familiarity with medical management software, electronic health records (EHRs), and knowledge of insurance guidelines and utilization review certifications like CCM or URAC is often required. Strong analytical thinking, attention to detail, and effective communication are crucial soft skills for evaluating care plans and collaborating with healthcare providers and insurers. These skills ensure medically appropriate, cost-effective care for patients while maintaining compliance with regulations and optimizing resource use.

What are some common challenges faced by maternity utilization review nurse RNs and how can they be managed?

Maternity Utilization Review Nurse RNs often face challenges such as balancing clinical judgment with insurance guidelines, staying current with evolving maternity care standards, and managing communication between healthcare providers and insurance companies. To manage these challenges, it’s important to stay updated through ongoing education, develop strong organizational and negotiation skills, and foster collaborative relationships with both clinical and administrative teams. Utilizing clinical software and reference tools can also help streamline the review process and ensure accuracy in decision-making.

What is the difference between Maternity Utilization Review Nurse Rn vs Labor and Delivery Nurse?

AspectMaternity Utilization Review Nurse RnLabor and Delivery Nurse
CertificationsRN license, possibly case management or utilization review certificationRN license, childbirth and neonatal certifications
Work EnvironmentInsurance companies, healthcare review organizationsHospitals, maternity wards, delivery rooms
Job FocusReviewing medical necessity for maternity services, ensuring appropriate utilizationProviding direct patient care during labor and delivery

The Maternity Utilization Review Nurse Rn primarily evaluates the necessity of maternity services from an insurance and case management perspective, working behind the scenes. In contrast, the Labor and Delivery Nurse provides hands-on care to mothers during childbirth. While both roles require RN licensure and knowledge of maternity care, their work environments and daily responsibilities differ significantly.

What are popular job titles related to Maternity Utilization Review Nurse Rn jobs?

For Maternity Utilization Review Nurse Rn jobs, the most frequently searched job titles are:

Infographic showing various Maternity Utilization Review Nurse Rn job openings in the United States as of September 2026, with employment types broken down into 6% As Needed, 64% Full Time, 12% Part Time, and 18% Contract. Highlights an 76% In-person, and 24% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Nurse in Renton, WA

Renton, WA • On-site

Vivian Health
Recruiting and Staffing Services • 51 - 200 employees
Learn more about Vivian Healthexternal

Other

Posted 5 days ago

Job description

Utilization Review Nurse III
**  UTILIZATION REVIEW NURSE III  - WASHINGTON STATE - PRE-SERVICE CLINICAL UR/UM ** **  PRIOR UTILIZATION REVIEW/UTILIZATION MANAGEMENT RN WORK EXPERIENCE HIGHLY PREFERRED!  ** **  MUST LIVE IN WASHINGTON OR IDAHO, COMMUTABLE DISTANCE TO KAISER PERMANENTE WASHINGTON MEDICAL CENTER  **  Job Summary:

In addition to the responsibilities listed below, this position is also responsible for applying advanced clinical and regulatory knowledge of evidence-based guidelines, insurance policies, and clinical criteria to consult on the medical necessity, level of care, and duration of treatment required for moderately complex reviews, and collaborating with the health care team, members, and caregivers to assist in discharge planning, cost of care options, and/or coordinating and/or adjudicating referrals to appropriate services based on medical necessity.

Essential Responsibilities:
  • Pursues effective relationships with others by proactively providing resources, information, advice, and expertise with coworkers and members. Listens to, seeks, and addresses performance feedback; provides mentoring to team members. Pursues self-development; creates plans and takes action to capitalize on strengths and develop weaknesses; influences others through technical explanations and examples. Adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; helps others adapt to new tasks and processes. Supports and responds to the needs of others to support a business outcome.
  • Completes work assignments autonomously by applying up-to-date expertise in subject area to generate creative solutions; ensures all procedures and policies are followed; leverages an understanding of data and resources to support projects or initiatives. Collaborates cross-functionally to solve business problems; escalates issues or risks as appropriate; communicates progress and information. Supports, identifies, and monitors priorities, deadlines, and expectations. Identifies, speaks up, and implements ways to address improvement opportunities for team.
  • Provides high-quality consultation by: facilitating and communicating with physicians, managers, staff, members, and/or caregivers regarding requirements related to medical necessity and benefit denials across the continuum of care; and leveraging comprehensive knowledge to ensure the correct and consistent application, interpretation, and utilization of member health care benefits, cost of care options, and coverage by members and physicians.
  • Supports education and compliance initiatives by: remaining up-to-date and sharing information with the team on the relevant state and federal regulations, guidelines, criteria, and documentation requirements that affect utilization management; and supporting the development and delivery of education and training programs for staff and physicians at the local level to promote best practices in utilization management.
  • Assists in quality improvement efforts by: conducting standard data analyses and developing reports to identify utilization patterns, trends, and opportunities for improvement; providing input and participating in the implementation of corrective action plans to address deficiencies in utilization review workflows/processes; actively adhering to utilization policies, procedures, and guidelines to ensure compliant and cost-effective care; and developing and refining desk-level procedures (e.g., workflows).
  • Performs utilization reviews by: following standard policies and procedures when conducting reviews of medical records and treatment plans to evaluate the medical necessity, appropriateness, and efficiency of requested health care services; and assessing the ongoing need for services, proactively identifying, anticipating, and escalating potential issues/delays to internal team members, and recommending appropriate actions for moderately complex member cases.
Minimum Qualifications:
  • Bachelors Degree in Nursing AND minimum three (3) years of experience in direct patient care, utilization review/management, or discharge planning in a managed care setting or a directly related field.

  • Registered Nurse License (Washington) required at hire OR Compact License: Registered Nurse required at hire

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