ZipRecruiter

Log In

1

Online Utilization Review Jobs (NOW HIRING)

Fusion HCR

Utilization Review Nurse

Las Vegas, NV

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 ...

Fusion HCR

Utilization Review Nurse

Las Vegas, NV

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 ...

ICBD

Utilization Review Specialist

Lauderdale Lakes, FL · On-site

$55K - $70K/yr

Utilization Review Specialist - Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No Remote Salary: $55K - $70K Who We Are Exact Billing Solutions is a unique team of revenue cycle ...

ICBD

Utilization Review Specialist

Lauderdale Lakes, FL · On-site

$55K - $70K/yr

Utilization Review Specialist - Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No Remote Salary: $55K - $70K Who We Are Exact Billing Solutions is a unique team of revenue cycle ...

Midland Health

Nurse Utilization Review

Midland, TX · On-site

The utilization review (UR) nurse serves to maximize the quality and cost efficiency of health care services. Through regular utilization reviews and audits, the UR nurse ensures that patients ...

Midland Health

Nurse Utilization Review

Midland, TX

The utilization review (UR) nurse serves to maximize the quality and cost efficiency of health care services. Through regular utilization reviews and audits, the UR nurse ensures that patients ...

The Recovery Village

Utilization Review Specialist

$50K/yr

We are looking for a Remote Utilization Review Specialist Advanced Recovery Systems is an integrated behavioral healthcare management company dedicated to the treatment of addiction, substance abuse ...

Midland Health

Nurse Utilization Review

Midland, TX · On-site

The utilization review (UR) nurse serves to maximize the quality and cost efficiency of health care services. Through regular utilization reviews and audits, the UR nurse ensures that patients ...

next page

Showing results 1-20

People also search for

All JobsOnline Utilization Review Jobs

Online Utilization Review information

See salary details

$21

$42

$68

How much do online utilization review jobs pay per hour?

As of May 28, 2026, the average hourly pay for online 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 an Online Utilization Review Specialist, and why are they important?

To thrive as an Online Utilization Review Specialist, you need a solid background in nursing or healthcare, with credentials such as an RN or LPN license and experience in clinical review processes. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of insurance guidelines and medical necessity criteria are typically required. Strong analytical thinking, attention to detail, and clear written communication help you effectively assess cases and interact with healthcare providers. These skills ensure accurate case reviews, compliance with regulations, and optimal patient care while controlling healthcare costs.

What are some common challenges faced by professionals in Online Utilization Review, and how can they be addressed?

One common challenge in Online Utilization Review is staying up-to-date with changing regulations and payer requirements, which can impact approval criteria and documentation standards. Another challenge is effectively managing a high volume of cases while maintaining accuracy and meeting turnaround times. Building strong communication skills for collaborating with providers and interdisciplinary teams is also crucial. To address these challenges, professionals often participate in ongoing training, utilize clinical decision support tools, and foster open communication with team members and stakeholders.

What is an Online Utilization Review?

An Online Utilization Review is a process in which healthcare professionals evaluate the necessity, efficiency, and appropriateness of medical services, procedures, or hospital admissions using digital platforms. This review is typically conducted remotely, using electronic health records and online communication tools to assess patient care. The goal is to ensure that patients receive the most effective care while avoiding unnecessary treatments and controlling healthcare costs. Online Utilization Review professionals may work for hospitals, insurance companies, or third-party administrators to maintain quality standards and compliance with regulations.

What is the difference between Online Utilization Review vs Utilization Review Coordinator?

AspectOnline Utilization ReviewUtilization Review Coordinator
CredentialsTypically requires healthcare or insurance certifications, such as RN, CPC, or CCMOften requires similar certifications, with additional administrative or coordination training
Work EnvironmentRemote or office-based, reviewing patient records and insurance claims onlineOffice setting, coordinating reviews and communicating with providers and patients
Employer & IndustryHospitals, insurance companies, healthcare organizationsInsurance companies, healthcare facilities, third-party review agencies

Online Utilization Review involves assessing medical necessity and coverage remotely using digital records, while Utilization Review Coordinator manages the review process, coordinating between providers and insurers. Both roles require similar credentials and are integral to healthcare and insurance industries, but Online Utilization Review is more focused on remote case assessments, whereas the Coordinator handles administrative oversight.

More about Online Utilization Review jobs
What cities are hiring for Online Utilization Review jobs? Cities with the most Online Utilization Review job openings:
What are the most commonly searched types of Utilization Review jobs? The most popular types of Utilization Review jobs are:
What states have the most Online Utilization Review jobs? States with the most job openings for Online Utilization Review jobs include:
What job categories do people searching Online Utilization Review jobs look for? The top searched job categories for Online Utilization Review jobs are:
Online Utilization Review jobs near you
Infographic showing various Online Utilization Review job openings in the United States as of May 2026, with employment types broken down into 87% Full Time, and 13% Part Time. Highlights an 85% Physical, 1% Hybrid, and 14% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Nurse

Fusion HCR

Las Vegas, NV

Full-time

Posted 19 days ago

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
  • 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
Requirements
  • 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
Preferred
  • Background in Case Management or CDI
  • Strong knowledge of Joint Commission and CMS guidelines
Why Apply
  • Competitive pay
  • Stable, high-demand role
  • Collaborative healthcare environment
Apply Now
If you have strong Utilization Review, InterQual, and acute care experience, we want to hear from you!