Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in ... Ensure compliance with Medicare, Medicaid, and regulatory guidelines * Collaborate with physicians ...
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Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in ... Ensure compliance with Medicare, Medicaid, and regulatory guidelines * Collaborate with physicians ...
Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in ... Ensure compliance with Medicare, Medicaid, and regulatory guidelines * Collaborate with physicians ...
Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in ... Ensure compliance with Medicare, Medicaid, and regulatory guidelines * Collaborate with physicians ...
Participate in ongoing education related to managed care policies, Medicare/Medicaid guidelines ... Experience Proven experience in utilization review or utilization management within hospital or ...
Participate in ongoing education related to managed care policies, Medicare/Medicaid guidelines ... Experience Proven experience in utilization review or utilization management within hospital or ...
Utilization Review Nurse
Las Vegas, NV · On-site
Utilization review criteria (InterQual/Milliman), Medicare/Medicaid guidelines * Chart review and clinical documentation analysis * Regulatory compliance and hospital standards * Strong communication ...
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Utilization Review Nurse
Las Vegas, NV · On-site
Utilization review criteria (InterQual/Milliman), Medicare/Medicaid guidelines * Chart review and clinical documentation analysis * Regulatory compliance and hospital standards * Strong communication ...
Registered Nurse - Utilization Review (Remote) Contract Length: 13 Weeks (Extension Possible ... Medicare Coverage Status Notices (MCSNs)
New
Registered Nurse - Utilization Review (Remote) Contract Length: 13 Weeks (Extension Possible ... Medicare Coverage Status Notices (MCSNs)
New
Utilization Review RN
Eureka, CA · On-site
$1.9K/wk
... Medicare regulations, and hospital guidelines in an acute care setting. Client Details City Eureka State CA Zip Code 95501
Utilization Review RN
Eureka, CA · On-site
$1.9K/wk
... Medicare regulations, and hospital guidelines in an acute care setting. Client Details City Eureka State CA Zip Code 95501
The Utilization Review Specialist asses, plans, implements and evaluates the internal processes to limit possible recoupment from third party pay sources including Medicare, Medicaid, HMO or private ...
The Utilization Review Specialist asses, plans, implements and evaluates the internal processes to limit possible recoupment from third party pay sources including Medicare, Medicaid, HMO or private ...
Utilization Review Specialist
Tulsa, OK · On-site
The Utilization Review Specialist asses, plans, implements and evaluates the internal processes to limit possible recoupment from third party pay sources including Medicare, Medicaid, HMO or private ...
Utilization Review Specialist
Tulsa, OK · On-site
The Utilization Review Specialist asses, plans, implements and evaluates the internal processes to limit possible recoupment from third party pay sources including Medicare, Medicaid, HMO or private ...
Utilization Review Nurse | Full Time
Las Vegas, NV · On-site
$41 - $60/hr
- Utilization Review Nurse Position Summary The Utilization Review Nurse is responsible for reviewing ... Ensure compliance with Medicare, Medicaid, commercial insurance, and regulatory requirements.
New
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Utilization Review Nurse | Full Time
Las Vegas, NV · On-site
$41 - $60/hr
- Utilization Review Nurse Position Summary The Utilization Review Nurse is responsible for reviewing ... Ensure compliance with Medicare, Medicaid, commercial insurance, and regulatory requirements.
New
Utilization Review Specialist
$27.74 - $41.61/hr
Utilization Review Specialist REPORTS TO POSITION: Manager - Utilization Management DEPARTMENT ... Identifies and escalates all 1MN Medicare and 2MN Obs stays for review at committee through use of ...
Utilization Review Specialist
$27.74 - $41.61/hr
Utilization Review Specialist REPORTS TO POSITION: Manager - Utilization Management DEPARTMENT ... Identifies and escalates all 1MN Medicare and 2MN Obs stays for review at committee through use of ...
Knowledge of Medicare, Medicaid, and Managed Care requirements * Progressive knowledge of community ... utilization. * Reviews H&Ps and admitting orders of all direct, transfer, and emergency care ...
Knowledge of Medicare, Medicaid, and Managed Care requirements * Progressive knowledge of community ... utilization. * Reviews H&Ps and admitting orders of all direct, transfer, and emergency care ...
Utilization Review Specialist
Bend, OR · On-site
$27.74 - $41.61/hr
Utilization Review Specialist REPORTS TO POSITION: Manager - Utilization Management DEPARTMENT ... Identifies and escalates all 1MN Medicare and 2MN Obs stays for review at committee through use of ...
Utilization Review Specialist
Bend, OR · On-site
$27.74 - $41.61/hr
Utilization Review Specialist REPORTS TO POSITION: Manager - Utilization Management DEPARTMENT ... Identifies and escalates all 1MN Medicare and 2MN Obs stays for review at committee through use of ...
Nurse Utilization Review
Midland, TX · On-site
The utilization review (UR) nurse serves to maximize the quality and cost efficiency of health care ... their Medicare, Medicaid or private health care coverage. SHIFT AND SCHEDULE Full Time, Monday ...
Nurse Utilization Review
Midland, TX · On-site
The utilization review (UR) nurse serves to maximize the quality and cost efficiency of health care ... their Medicare, Medicaid or private health care coverage. SHIFT AND SCHEDULE Full Time, Monday ...
Utilization Review Nurse
Chicago, IL · On-site
Works Potential Quality of Care cases across all lines of business (Commercial and Medicare ... MUST HAVE UM experience, inpatient utilization management review. * MUST HAVE 1 YEAR OF UTILIZATION ...
Utilization Review Nurse
Chicago, IL · On-site
Works Potential Quality of Care cases across all lines of business (Commercial and Medicare ... MUST HAVE UM experience, inpatient utilization management review. * MUST HAVE 1 YEAR OF UTILIZATION ...
Nurse Utilization Review
Midland, TX · On-site
The utilization review (UR) nurse serves to maximize the quality and cost efficiency of health care ... their Medicare, Medicaid or private health care coverage. SHIFT AND SCHEDULE Full Time, Monday ...
Nurse Utilization Review
Midland, TX · On-site
The utilization review (UR) nurse serves to maximize the quality and cost efficiency of health care ... their Medicare, Medicaid or private health care coverage. SHIFT AND SCHEDULE Full Time, Monday ...
... utilization review functions to ensure appropriate, cost-effective use of healthcare services. This ... Medicare, Medicaid) and regulatory requirements (CMS, state regulations) i, Proficiency in Excel ...
... utilization review functions to ensure appropriate, cost-effective use of healthcare services. This ... Medicare, Medicaid) and regulatory requirements (CMS, state regulations) i, Proficiency in Excel ...
RN - Utilization Review
Hayward, CA · On-site
RN - Utilization Review Shift: 08:00 AM - 04:00 PM Shifts Per Week: 5 Scheduled Hours: 40 Start ... Centers for Medicare and Medicaid Services, Continued Stay Reviews, Data Abstraction, Emergency ...
RN - Utilization Review
Hayward, CA · On-site
RN - Utilization Review Shift: 08:00 AM - 04:00 PM Shifts Per Week: 5 Scheduled Hours: 40 Start ... Centers for Medicare and Medicaid Services, Continued Stay Reviews, Data Abstraction, Emergency ...
Utilization Review Nurse
Manhattan, NY · Remote
$95K - $105K/yr
RN- Utilization Review Nurse Inpatient *Hybrid* Must reside within the New York Tri-State Area - N ... Working knowledge of Medicaid and/or Medicare regulations as well as coverage guidelines and ...
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Utilization Review Nurse
Manhattan, NY · Remote
$95K - $105K/yr
RN- Utilization Review Nurse Inpatient *Hybrid* Must reside within the New York Tri-State Area - N ... Working knowledge of Medicaid and/or Medicare regulations as well as coverage guidelines and ...
Utilization Review Manager
Cookeville, TN · On-site
... commercial, Medicare, Medicaid) and regulatory requirements (CMS, state regulations) • ... utilization review methodologies and medical necessity criteria (e.g., InterQual, MCG) across ...
Utilization Review Manager
Cookeville, TN · On-site
... commercial, Medicare, Medicaid) and regulatory requirements (CMS, state regulations) • ... utilization review methodologies and medical necessity criteria (e.g., InterQual, MCG) across ...
... Utilization Review Committee * Facilitate timely discharges, transfers, and recertifications when ... Partner with Medicare, Medicaid, and private insurers to ensure accurate documentation and ...
... Utilization Review Committee * Facilitate timely discharges, transfers, and recertifications when ... Partner with Medicare, Medicaid, and private insurers to ensure accurate documentation and ...
Medicare Utilization Review 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 medicare utilization review jobs pay per hour?
As of Jul 1, 2026, the average hourly pay for medicare utilization review 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 are the typical daily responsibilities of someone working in Medicare Utilization Review?
In a Medicare Utilization Review role, your day-to-day tasks often include reviewing patient medical records to ensure services meet Medicare coverage criteria, evaluating the necessity and efficiency of proposed treatments, and communicating findings with healthcare providers. You’ll also submit detailed reports, coordinate with physicians, case managers, and insurance representatives, and follow up on documentation requests. Frequently, you’ll participate in interdisciplinary team meetings to discuss patient care plans and recommend alternative treatments if needed. This role requires balancing regulatory compliance with effective healthcare delivery, making each day dynamic and rewarding.
What are the key skills and qualifications needed to thrive in the Medicare Utilization Review position, and why are they important?
To thrive as a Medicare Utilization Review professional, you need a solid background in healthcare (often as an RN or LPN), strong analytical skills, and familiarity with Medicare regulations and guidelines. Experience using utilization management software, electronic health records (EHRs), and claim review systems like InterQual or MCG is typically required. Strong attention to detail, effective communication, and negotiation skills help set candidates apart. These competencies are crucial to ensure compliance, promote accurate claims processing, and support optimal patient care decisions within Medicare standards.
What is a Medicare Utilization Review job?
A Medicare Utilization Review job involves evaluating healthcare services to ensure they meet Medicare guidelines for medical necessity, cost-effectiveness, and quality of care. Professionals in this role review patient records, treatment plans, and insurance claims to determine appropriate coverage and prevent fraud or overutilization. They work closely with healthcare providers and insurance companies to ensure compliance with federal regulations. This role helps maintain the integrity of Medicare services while optimizing patient care and cost efficiency. Strong analytical skills and knowledge of medical coding, billing, and Medicare policies are essential for success in this position.
More about Medicare Utilization Review jobs
What cities are hiring for Medicare Utilization Review jobs? Cities with the most Medicare Utilization Review job openings:
What states have the most Medicare Utilization Review jobs? States with the most job openings for Medicare Utilization Review jobs include:
What job categories do people searching Medicare Utilization Review jobs look for? The top searched job categories for Medicare Utilization Review jobs are:
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
Requirements
Preferred
Why Apply
Apply Now
If you have strong Utilization Review, InterQual, and acute care experience, we want to hear from you!
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.
- 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
- 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
- Background in Case Management or CDI
- Strong knowledge of Joint Commission and CMS guidelines
- Competitive pay
- Stable, high-demand role
- Collaborative healthcare environment
If you have strong Utilization Review, InterQual, and acute care experience, we want to hear from you!
About Fusion HCR
Sourced by ZipRecruiter
Industry
Human resources consulting services
Company size
11 - 50 Employees
Headquarters location
Springboro, OH, US
Year founded
2012