ZipRecruiter

Log In

1

Overnight Rn Utilization Review Nurse Jobs (NOW HIRING)

Seh

Summary The Utilization Review Nurse screens medical records in accordance with contractual ... Current Registered Nurse license in the State of Alabama Minimum Education Preferred * Bachelor ...

Southeast Health

Utilization Review Nurse

Dothan, AL · On-site

Summary The Utilization Review Nurse screens medical records in accordance with contractual ... Current Registered Nurse license in the State of Alabama Minimum Education Preferred * Bachelor ...

Houston Methodist

At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent medical record review for medical ...

next page

Showing results 1-20

All JobsRn Utilization Review Nurse JobsOvernight Rn Utilization Review Nurse Jobs

Overnight Rn Utilization Review Nurse information

See salary details

$21

$42

$68

How much do overnight rn utilization review nurse jobs pay per hour?

As of Jul 21, 2026, the average hourly pay for overnight rn 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 are some common challenges faced by an Overnight RN Utilization Review Nurse, and how can they be managed?

Overnight RN Utilization Review Nurses often work independently, reviewing medical records and ensuring appropriate patient care while adhering to insurance guidelines. Common challenges include limited access to on-site support staff and the need to make timely decisions with fewer resources available during night shifts. To manage these challenges, strong communication skills, detailed documentation, and familiarity with hospital protocols are essential. Leveraging remote communication tools and establishing clear escalation procedures can also help ensure effective collaboration with day teams and physicians.

What are the key skills and qualifications needed to thrive as an Overnight RN Utilization Review Nurse, and why are they important?

To thrive as an Overnight RN Utilization Review Nurse, you need a current RN license, strong clinical judgment, and experience in case management or utilization review. Familiarity with healthcare documentation systems, utilization management software, and knowledge of regulatory guidelines such as Medicare and Medicaid are typically required. Excellent analytical thinking, communication, and decision-making skills help you collaborate with providers and advocate effectively for patients. These skills ensure accurate assessments, regulatory compliance, and optimal resource use during overnight hours when independent decision-making is critical.

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

AspectOvernight Rn Utilization Review NurseOvernight Rn Case Manager
CertificationsRN license, Utilization Review certification (if applicable)RN license, Case Management certification (e.g., CCM)
Work EnvironmentHospitals, insurance companies, healthcare facilities, primarily reviewing patient cases overnightHospitals, clinics, insurance companies, coordinating patient care and discharge planning overnight
Job FocusReviewing medical necessity, insurance coverage, and utilization of resourcesManaging patient care plans, discharge planning, and coordinating services

While both roles require RN licensure and involve patient care, the Overnight Rn Utilization Review Nurse primarily focuses on reviewing medical necessity and insurance coverage overnight, whereas the Overnight Rn Case Manager concentrates on coordinating patient care and discharge planning during overnight shifts. Both roles are essential in healthcare settings but serve different functions within patient management and resource utilization.

What does an Overnight RN Utilization Review Nurse do?

An Overnight RN Utilization Review Nurse is a registered nurse who evaluates the necessity, appropriateness, and efficiency of medical services, procedures, and hospital admissions during the overnight shift. They review patient records, apply clinical guidelines, and collaborate with healthcare teams to ensure that care meets established standards and payer requirements. Their goal is to promote quality care while preventing unnecessary costs or hospital stays, often working with insurance companies and case management teams.
What cities are hiring for Overnight Rn Utilization Review Nurse jobs? Cities with the most Overnight Rn Utilization Review Nurse job openings:
What are the most commonly searched types of Rn Utilization Review Nurse jobs? The most popular types of Rn Utilization Review Nurse jobs are:
What states have the most Overnight Rn Utilization Review Nurse jobs? States with the most job openings for Overnight Rn Utilization Review Nurse jobs include:
Overnight Rn Utilization Review Nurse jobs near you
Utilization Review Nurse

Utilization Review Nurse

Seh

Full-time

Re-posted 11 days ago

Job description

Southeast. Always the right career direction.Job Description SummaryThe Utilization Review Nurse screens medical records in accordance with contractual agreement and regulatory requirements for medical necessity on admission and continued stay in the acute care setting. The Utilization Review case manager collaborates with all components of the healthcare system, managing appropriate use of acute care to aid in the achievement of quality outcomes, fiscal responsibility, and patient satisfaction.
Job Description

Essential Functions

  • Performs admissions and continued stay reviews of all inpatients and outpatient/observation patients in a bed; at times, this may be retrospective.
  • Performs precertification on procedures ordered while patients are hospitalized.
  • Issues required Medicare/Medicaid notifications of medical necessity changes to patients while hospitalized.
  • Issues notifications of non-coverage letters to patients if received during hospital stay.
  • Documents clear billing notes into the Electronic Medical Record (EMR) payer communications navigator to avoid billing denials.
  • Performs medical necessity denial appeals.
  • Maintains a close, collaborative relationship with the medical staff to promote continuity of care and avoid delays in service.
  • Performs other duties as requested by primary manager that do not compromise moral code of conduct or protocols set in place for patient or employee safety
Supervised Positions
  • None

Qualifications

Minimum Education Required
  • Associates degree in Nursing
  • Current Registered Nurse license in the State of Alabama
Minimum Education Preferred
  • Bachelor's degree or higher in Nursing
Minimum Experience Required
  • Two (2) years acute care experience
  • Must pass Blue Cross Blue Shield Iterator Reliability Test with 90% within six (6) months of hire
Minimum Experience Preferred
  • Three (3) years acute care experience
  • One (1) year utilization review experience

Required Knowledge/ Skills/ Abilities

  • Maintain current licensure in the State of Alabama
  • Demonstrates appropriate utilization of the skills of the Registered Nurse as approved by the Alabama Board of Nursing
  • Ability to quickly adapt to changing circumstances in fast-paced environment
  • Actively accepts, understands, and practices appropriate standards of nursing practice.
  • Must demonstrate basic knowledge of discharge planning needs
  • Demonstrates advanced computer skills (ability to generate reports, graph trends).
  • Clinical knowledge and experience in the care of patients with multiple and complex diagnoses, disease process, and care needs.
  • Ability to prioritize work and meet deadlines.
  • Ability to problem solve in a proactive, creative manner, using sound judgment based on factual information and clinical knowledge.
  • Ability to develop leadership skills and to serve as a role model for clinical staff.
  • Ability to lead and actively participate in multidisciplinary teams.
  • Ability to work independently within a team structure.
  • Demonstrates responsibility for educational requirements as evidenced by reading all assigned related references, and attending all required educational meetings, or webinars, and completing annual Symplr requirements.
  • Demonstrates commitment to organizations five (5) priorities and Six Ground Rules
  • Person in this position is required to understand, agree upon and follow our Six Ground Rules:
    • No excuses.
    • We are a team.
    • Bring up your ideas.
    • Poor performance will be addressed.
    • 'That's not my job' is not acceptable
    • Manage Up.

ShiftDayShift Details8:00 am - 4:30 pm
FTE1
TypeRegular
Join one of Forbes 500 best mid-sized employers in America.Equal Employment EmployerSoutheast Health is committed to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, Southeast Health will provide reasonable accommodations for qualified individuals with disabilities.

Apply