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No Experience Utilization Review Nurse Jobs (NOW HIRING)

Acrisure LLC

Utilization Review Nurse

Bradenton, FL · On-site

Experience in utilization review or case management is highly beneficial, particularly within ... Strong clinical nursing experience with the ability to review medical records and evaluate ...

Acrisure

Utilization Review Nurse

Bradenton, FL

Experience in utilization review or case management is highly beneficial, particularly within ... Strong clinical nursing experience with the ability to review medical records and evaluate ...

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 ... Strong experience utilizating MCG (Milliman Care Gudielines) or InterQual * 1+ years of clinical ...

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 ... Strong experience utilizating MCG (Milliman Care Gudielines) or InterQual * 1+ years of clinical ...

Albany Medical Center

Utilization Review Nurse

Albany, NY · On-site

$77K - $119K/yr

Bachelor's degree preferred. • Minimum of three years clinical experience in an assigned service ... with no copay at Albany Medical Center providers · A wide array of services and programs to ...

silvercross

Utilization Review Nurse

$34.73 - $45.15/hr

BSN preferred. 2-5 years previous Utilization Review experience preferred. * Current CPR * Relevant hospital nursing; hospital case management; insurance case management or utilization management ...

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

Austin area - Travis/Williamson Counties or Richardson area - Dallas/Collin Counties*** RN working ... MCG or InterQual experience * Utilization management experience LOCATION: REMOTE in Texas ...

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How much do no experience utilization review nurse jobs pay per hour?

As of Sep 2, 2026, the average hourly pay for no experience 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 no experience utilization review nurse?

A No Experience Utilization Review Nurse job is an entry-level position where a registered nurse (RN) reviews medical records and insurance claims to ensure that healthcare services are appropriately utilized. This role typically involves assessing the necessity and efficiency of treatments based on insurance policies and clinical guidelines. Many employers provide on-the-job training for nurses transitioning from bedside care. Strong analytical skills, attention to detail, and knowledge of medical terminology help nurses succeed in this role. While prior utilization review experience isn't required, having case management or insurance knowledge can be beneficial.

What support or training can I expect when starting as a no experience utilization review nurse?

Most employers provide comprehensive onboarding and training for No Experience Utilization Review Nurses, which may include mentorship from experienced colleagues, instruction on case review processes, and guidance on relevant software systems. You'll typically receive support in learning how to interpret clinical documentation and apply insurance guidelines. The training period can last several weeks, during which you'll gradually take on more responsibility as you build confidence. Team members and supervisors are often available to answer questions and help smooth your transition into this specialized nursing role.

What are the key skills and qualifications needed to thrive as a no experience utilization review nurse, and why are they important?

To succeed as a No Experience Utilization Review Nurse, you need to hold an active RN license, possess strong analytical abilities, and understand basic healthcare terminology. Familiarity or willingness to learn medical coding, electronic health record (EHR) systems, and utilization management software is valuable. Excellent communication, attention to detail, and adaptability help you work effectively with healthcare providers and insurance teams. These skills ensure accurate case reviews, efficient workflow, and effective collaboration in managed care environments.

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No Experience Utilization Review Nurse jobs near you
Infographic showing various No Experience Utilization Review Nurse job openings in the United States as of August 2026, with employment types broken down into 75% Full Time, and 25% Contract. Highlights an 49% In-person, 13% Hybrid, and 38% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Nurse

Health Business Solutions LLC

Cooper City, FL

Full-time

Re-posted 25 days ago

Job description

Job Summary: We are seeking a highly motivated and experienced Utilization Review Nurse to join our team. The Utilization Review Nurse will play a crucial role in supporting our clients in the healthcare industry by providing expert clinical guidance, facilitating effective utilization management, and ensuring revenue cycle efficiency. This position offers a unique opportunity to combine clinical expertise with revenue cycle management knowledge.

Key Responsibilities:

·       Clinical Assessment: Conduct comprehensive clinical assessments of medical records to ensure patients are receiving appropriate care at the correct level of service.

  • Care Coordination: Collaborate with interdisciplinary healthcare teams to coordinate patient care and treatment plans, ensuring the most cost-effective and clinically appropriate care is provided.
  • Revenue Cycle Management: Utilize clinical expertise to support revenue cycle processes, including accurate coding, documentation improvement, and compliance with healthcare regulations.
  • Utilization Review:

a) Apply medical necessity screening criteria and clinical knowledge to ensure appropriateness of admissions and length of stays

b) Conduct initial admission, continuing stay, and 23-hour observations reviews for all patients

c) Support Utilization Review Coordinator team members on cases escalated for level of care determinations

d) Screen cases for Physician Advisor review

e) Collaborate with insurance companies on concurrently denied and high risk for denial cases

  •  Documentation Improvement: Identify opportunities for improving clinical documentation to support accurate coding and billing processes, ultimately improving reimbursement.


  • Data Analysis: Analyze clinical and financial data to identify trends, opportunities for improvement, and areas of potential cost savings for clients.


  • Compliance: Stay up-to-date with healthcare regulations, guidelines, and policies to ensure all patient care and revenue cycle processes are in compliance with industry standards and regulatory requirements to ensure appropriate reimbursement.

Qualifications:

·       Registered Nurse (RN) licensure required; must hold a USRN multi-state/compact nursing license.

·       Bachelor of Science in Nursing (BSN) preferred.

·       Case Management Certification (e.g., CCM) is a plus.

·       Minimum of 3 years of clinical nursing experience, preferably in a hospital or acute care setting.

·       Minimum 2 years of work experience in Utilization Review

·       Strong understanding of revenue cycle management and healthcare reimbursement.

·       Proficiency in medical coding and clinical documentation improvement.

·       Excellent communication, interpersonal, and teamwork skills.

·       Ability to work independently and make sound clinical and financial decisions.

·       Strong analytical and problem-solving skills.

·       Proficient in using healthcare information systems and technology.

·       Commitment to maintaining patient confidentiality and ethical standards.

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