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Nursing Utilization Review Jobs (NOW HIRING)

talent4health

RN - Utilization Review

Cleveland, OH · On-site

$2.2K/wk

Details Client Name Southwest General Hospital Center Southwest General Health Center Job Type Travel Offering Nursing Profession RN Specialty Utilization Review Job ID 18807560 Job Title RN - ...

Prime Time Healthcare

Utilization Review

Baltimore, MD · On-site

Now Hiring: RN Utilization Review - Baltimore, MD Are you a passionate RN professional looking for a new adventure? Prime Time Healthcare is seeking dynamic individuals like you to join our team in ...

New

Prime Time Healthcare

Utilization Review

Cleveland, OH · On-site

Now Hiring: RN Utilization Review - Middleburg Heights, OH Are you a passionate RN professional looking for a new adventure? Prime Time Healthcare is seeking dynamic individuals like you to join our ...

New

Meda Health, LLC

RN - Utilization Review

Tuba City, AZ · On-site

$2.5K/wk

Details Client Name Tuba City Regional Healthcare Job Type Travel Offering Nursing Profession RN Specialty Utilization Review Job ID 18896874 Job Title RN - Utilization Review Weekly Pay $2552.28 ...

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Nursing Utilization Review information

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How much do nursing utilization review jobs pay per hour?

As of Aug 7, 2026, the average hourly pay for nursing 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 key skills and qualifications needed to thrive as a nursing utilization review nurse?

To thrive as a Nursing Utilization Review Nurse, you need strong clinical knowledge, critical thinking, and a current RN license, often complemented by experience in case management or utilization review. Familiarity with healthcare coding systems (ICD-10, CPT), utilization management software, and regulatory compliance tools is typical. Excellent communication, attention to detail, and negotiation skills make someone stand out in this position. These skills ensure accurate assessment of medical necessity, optimize resource use, and support patient care quality within regulatory guidelines.

What is nursing utilization review?

Nursing Utilization Review is a process where nurses evaluate the necessity, efficiency, and appropriateness of healthcare services provided to patients. These nurses review medical records, treatment plans, and patient progress to ensure that care meets established guidelines and is cost-effective. They play a key role in helping healthcare organizations maintain quality care while controlling costs and ensuring regulatory compliance. Utilization review nurses often work for hospitals, insurance companies, or government agencies.

What are some common challenges faced by nurses working in utilization review, and how can they be managed?

Nurses in utilization review often face challenges such as balancing the need for cost-effective care with advocating for patients' clinical needs and navigating complex insurance guidelines. They must critically review medical records while ensuring compliance with evolving regulatory standards. Effective time management and strong communication skills are essential for liaising between healthcare providers, insurance companies, and patients. Ongoing education and collaboration with interdisciplinary teams can help address these challenges and ensure high-quality, patient-centered care.

What is the difference between Nursing Utilization Review vs Nursing Case Management?

AspectNursing Utilization ReviewNursing Case Management
Primary FocusAssessing medical necessity and appropriateness of care for insurance or healthcare providersCoordinating patient care plans and ensuring optimal health outcomes
Work EnvironmentInsurance companies, healthcare facilities, utilization review organizationsHospitals, clinics, community health settings
CredentialsRN license, often with certifications in utilization review or case managementRN license, case management certification often preferred

While both roles involve nursing expertise, Nursing Utilization Review primarily focuses on evaluating the necessity of care for insurance purposes, whereas Nursing Case Management emphasizes coordinating patient care to improve health outcomes. Both roles require RN licensure and related certifications, but their daily tasks and work environments differ.

More about Nursing Utilization Review jobs
What cities are hiring for Nursing Utilization Review jobs? Cities with the most Nursing Utilization Review job openings:
What states have the most Nursing Utilization Review jobs? States with the most job openings for Nursing Utilization Review jobs include:
What job categories do people searching Nursing Utilization Review jobs look for? The top searched job categories for Nursing Utilization Review jobs are:
Nursing Utilization Review jobs near you
Infographic showing various Nursing Utilization Review job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Nursing / Utilization Review

Premier Healthcare Professionals

Tuba City, AZ • On-site

Other

Medical, Dental, Vision, Retirement

Posted 5 days ago

Job description

Description
We are seeking a detail-oriented, analytical, and patient-advocating Utilization Review (UR) Nurse to join our care management team. In this pivotal role, you will ensure that patients receive medically appropriate, high-quality care while supporting compliance with regulatory, payer, and organizational standards. Your expertise will help balance clinical needs with efficient resource utilization, ultimately improving outcomes and supporting responsible healthcare delivery.
Your primary responsibilities will include conducting thorough clinical reviews of inpatient and outpatient cases, analyzing documentation for medical necessity, and applying evidence-based criteria such as InterQual or MCG Guidelines. You will collaborate with physicians, nursing staff, case managers, and insurance representatives to clarify clinical information, resolve authorization issues, and facilitate timely level-of-care decisions. Additional duties include preparing appeals for denied claims, identifying trends affecting utilization, and contributing to process improvements that enhance documentation accuracy and care coordination.
Success in this role requires strong critical-thinking abilities, excellent communication skills, and the capacity to interpret complex clinical information with precision. You will work in a fast-paced but structured environment that values accountability, collaboration, and patient advocacy. If you excel at clinical assessment, enjoy problem-solving, and are motivated to support cost-effective, patient-centered care, we invite you to join our utilization review nursing team.
Requirements and Qualifications
- Active RN license
- BLS certification (American Heart)
- Minimum of one (1) year of experience required for Olaro; individual facilities may require additional experience
About Us
At Olaro, we prioritize your professional growth and work-life balance. We provide competitive compensation, comprehensive benefits, and access to diverse clinical experiences that broaden your skillset. Our dedicated support team ensures you're equipped with the tools and resources you need to succeed in each assignment, offering 24/7 support and a streamlined onboarding process.
At Olaro, we prioritize your professional growth and work-life balance. We provide competitive compensation, comprehensive benefits, and access to diverse clinical experiences that broaden your skillset. Our dedicated support team ensures you're equipped with the tools and resources you need to succeed in each assignment, offering 24/7 support and a streamlined onboarding process.
Whether you're looking to explore new locations or gain valuable clinical experience, Olaro provides the flexibility and support to help you thrive in your healthcare career. Join a team that values your expertise and is committed to your success at every step.
Benefits
Medical, Dental and Vision Coverage
Health Savings Account
401(k) Retirement Plan
Hospital Indemnity Insurance
Critical Illness Insurance
Accident Insurance
Referral bonuses

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