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Overnight Rn Utilization Review Nurse Jobs (NOW HIRING)

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

Austin area - Travis/Williamson Counties or Richardson area - Dallas/Collin Counties*** RN working ... This position is responsible for performing initial, concurrent review activities; discharge care ...

US Tech Solutions

Utilization Review Nurse

Chicago, IL · On-site

Active and unrestricted RN licensure in state of residence Questionnaire: * Do you have experience ... Do you have experience with Utilization Review? * Do you have an Active Registered Nurse License?

Magnet Medical

RN - Utilization Review

Kinston, NC · On-site

$28/hr

Travel Nursing Position Nursing Profession: RN Specialty: Utilization Review Pay Rate: $28 Shift Details: 8 hour days Job Order Details: Start Date: 07/06/2026 End Date: 10/05/2026 Duration: 13 Week ...

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

As of Jun 30, 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:
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Overnight Rn Utilization Review Nurse jobs near you
Registered Nurse, Utilization Review

Registered Nurse, Utilization Review

Nascentia Health

Syracuse, NY • On-site

$72K - $83K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 8 days ago

Key responsibilities

  • Assist with the review of member usage patterns for medical necessity and appropriateness.

  • Perform continuing review of medical records and supporting documentation for medical necessity.

  • Track and analyze service utilization patterns and compare to regional benchmarks.

Nascentia Health rating

7.3

Company rating: 7.3 out of 10

Based on 9 frontline employees who took The Breakroom Quiz

Job description

The Utilization Review Nurse assists the utilization review process taking on various tasks including data collection of demographic, claim and medical information; analysis; and outcomes reporting. Utilizes standards of care, evidence based practices, Medicare and Medicaid and organizational coverage guidelines to assure members receive high quality, cost efficient health care and services to meet their long term home and community based needs. Performs utilization review in accordance with all state mandated regulations.
Performance Responsibilities and Standards:
  1. Assist with the review of member usage patterns for medical necessity and appropriateness.
  2. Performs continuing review of medical records and supporting documentation for medical necessity where appropriate.
  3. Tracks and analyzes service utilization patterns monthly and compares to regional benchmarks
  4. Reviews appeals and provides notice of determination.
  5. Receives and responds to Office of Temporary and Disability Assistance (OTDA) notifications of Fair Hearings
  6. Prepares for and attends Fair Hearings.
  7. Assist with the development of coverage policy guidelines for MLTC services.
  8. Participates in interdisciplinary collaboration with professional staff.
  9. Creates and facilitates educational programs.
  10. Identifies and collaborates with UR Manager on individual cases
  11. Identifies and collaborates with UR Manager on trends in usage patterns.
  12. Process Notice of Action letters
  13. Performs concurrent, prior service authorizations and retrospective reviews
  14. Analyze per member per month (PMPM) data
  15. Other duties as assigned

Job Qualifications:
  1. Current NYS RN licensure, BSN preferred.
  2. Five or more years of home health care or long term care experience strongly preferred.
  3. Three or more years of utilization management or quality improvement experience preferred.

Professional competencies, skills and abilities:
  1. Excellent relationship management skills
  2. Demonstrated ability to problem solve complex, multifaceted situations
  3. Successfully manage conflict and negotiate a win win solution
  4. Strong organizational, prioritizing and delegation skills
  5. Abstract thinking
  6. Strong communication skills written and verbal
  7. Advocacy focused
  8. Ability to be non-judgmental
  9. Computer literacy with Microsoft office products

Physical Requirements:
  1. Speech, visual, and hearing ability sufficient to express and comprehend written and verbal communication
  2. Ability to sit 90% of the day
  3. Frequent sitting, standing, walking
  4. Pushing, pulling, reaching, kneeling
  5. Bloodborne Pathogens Exposure Determination Category: Category III

Compensation & Benefits:
Competitive Salary [This position is an S03 exempt position with a min-max rate of: $72,415-$83,922/annually] with:
  • 401K with generous Employer match
  • Medical, Dental, Vision plans
  • Tuition Reimbursement for BSN after 6 months of employment
  • Exceptional work/life balance - no rotating shifts
  • Partially funded HSA
  • Employee Recognition Platform
  • Paid Time Off, Holidays, and Extended Sick Leave
  • Short/Long term Disability
  • Employee Assistance Program (EAP)
  • Much More!!

About Nascentia Health:
Nascentia Health is leading the way in home care, post acute care and long-term community health. A healthcare system without walls, Nascentia is an innovator in the concept of healthcare, truly focused on the patient as a whole. By serving people in their homes, Nascentia Health is able to provide true holistic care. We can address immediate needs, help support positive long term medical and lifestyle choices that provide for better outcomes, leverage cutting edge in-home care technologies, and help avoid unnecessary visits to busy healthcare facilities.
Our employees are our greatest asset. They work hard every day to make our system amazing and are dedicated to our mission of being the premier home and community-based care system for the regions we serve. We want everyone to love what they do, be excited about coming to work, and take pride in being part of our team.
Nascentia Health is an Equal Opportunity Employer (EOE)
Employment is contingent upon negative results of a pre-hire drug screen

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