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Nurse Manager Utilization Review information

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

As of Sep 12, 2026, the average hourly pay for nurse manager 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 does a nurse manager utilization review do?

A Nurse Manager Utilization Review oversees the process of evaluating the necessity, efficiency, and appropriateness of healthcare services provided to patients. They lead a team of nurses who review patient records, coordinate with medical staff, and ensure that care meets clinical guidelines and regulatory standards. Their goal is to optimize patient outcomes while controlling costs and preventing unnecessary treatments. Additionally, they often serve as a liaison between clinical staff, insurance companies, and hospital administration to facilitate proper care authorization and reimbursement.

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

To thrive as a Nurse Manager Utilization Review, you need a solid nursing background (BSN or higher), RN licensure, and expertise in utilization management and healthcare regulations. Familiarity with utilization review software, electronic health records (EHRs), and authorization systems, as well as certifications like CCM or ACM, are often required. Strong leadership, analytical thinking, and effective communication are critical soft skills for coordinating teams and ensuring compliance. These competencies are vital for optimizing patient care, managing healthcare costs, and maintaining regulatory standards.

How does a nurse manager utilization review typically collaborate with interdisciplinary teams to improve patient care and resource management?

A Nurse Manager Utilization Review works closely with physicians, case managers, social workers, and insurance coordinators to ensure patients receive appropriate, cost-effective care. They facilitate regular case review meetings, communicate findings from utilization data, and provide education on best practices to reduce unnecessary resource use. This collaboration not only helps optimize patient outcomes but also supports compliance with regulatory and payer requirements. By acting as a liaison between clinical staff and administrative teams, the Nurse Manager Utilization Review plays a key role in balancing quality care with efficient resource utilization.

What is the difference between Nurse Manager Utilization Review vs Nurse Case Manager?

AspectNurse Manager Utilization ReviewNurse Case Manager
Primary FocusOverseeing utilization review processes to ensure appropriate healthcare resource useCoordinating patient care plans and advocating for patient needs
Work EnvironmentHospitals, insurance companies, healthcare organizationsHospitals, clinics, insurance companies
CredentialsRN license, possibly certifications in utilization review or case managementRN license, case management certification often preferred

While both roles require RN licensure and involve patient care, Nurse Manager Utilization Review primarily focuses on evaluating healthcare resource use and ensuring compliance, whereas Nurse Case Managers coordinate individual patient care plans and advocate for patient needs. Understanding these differences helps clarify career paths and employer expectations in healthcare settings.

What cities are hiring for Nurse Manager Utilization Review jobs?

Cities with the most Nurse Manager Utilization Review job openings:

What states have the most Nurse Manager Utilization Review jobs?

States with the most job openings for Nurse Manager Utilization Review jobs include:

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

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

Infographic showing various Nurse Manager Utilization Review job openings in the United States as of June 2026, with employment types broken down into 2% As Needed, 91% Full Time, 5% Part Time, 1% Temporary, and 1% Nights. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Registered Nurse-Utilization Review

Remote

3B Healthcare, Inc.
Health Care and Social Assistance • 51 - 200 employees
Learn more about 3B Healthcare, Inc.external

Other

Re-posted 14 days ago

Job description

Registered Nurse – Utilization Review (Remote)

This is a fully remote Utilization Review RN role supporting multiple service lines and levels of care, including Inpatient, Extended Hospital Outpatient, and Observation (OBS).

Minimum of 3 years acute medical Care Management/Utilization Review experience in a hospital setting (experience in health plans or medical groups is not applicable).

InterQual experience is mandatory; candidates without this will not be considered.

Proficient in Epic, with recent use within the last 6–12 months.

Experience working with HMOs, IPAs, and similar managed care organizations.

Strong knowledge of Medicare regulations and associated utilization management processes, including:

  • Condition Code 44 (CC44)
  • Advance Beneficiary Notices (ABNs)
  • Hospital-Issued Notices of Noncoverage (HINNs)
  • Medicare Coverage Status Notices (MCSNs)

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