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How much do pediatric utilization review jobs pay per hour?

As of Aug 20, 2026, the average hourly pay for pediatric 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 is pediatric utilization review?

Pediatric utilization review is a process in healthcare where specialists assess the necessity, appropriateness, and efficiency of medical services provided to children. The goal is to ensure that pediatric patients receive the right care at the right time, while avoiding unnecessary treatments or procedures. Utilization review professionals review medical records, treatment plans, and insurance information to make informed decisions about coverage and care. This process helps control healthcare costs and maintain high standards of care for young patients.

What are some common challenges faced by pediatric utilization review professionals, and how are they addressed?

Pediatric utilization review professionals often encounter challenges such as balancing the need for cost-effective care with advocating for the unique clinical needs of children. They must navigate complex insurance guidelines while collaborating closely with physicians, case managers, and families to ensure children receive appropriate and timely care. Staying updated on evolving pediatric treatment protocols and regulatory requirements is also essential. Strong communication skills and a thorough understanding of pediatric standards help address these challenges and promote positive patient outcomes.

What are the key skills and qualifications needed to thrive as a pediatric utilization review nurse, and why are they important?

To excel as a Pediatric Utilization Review nurse, you need a solid clinical background in pediatrics, a current RN license, and knowledge of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and industry certifications like Certified Case Manager (CCM) are often required. Strong analytical skills, attention to detail, and effective communication help you collaborate with healthcare teams and advocate for appropriate care. These competencies ensure that pediatric patients receive necessary, cost-effective treatment while maintaining compliance with regulatory standards.

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

AspectPediatric Utilization ReviewPediatric Case Manager
CredentialsTypically requires nursing or healthcare-related certificationsRequires nursing, social work, or healthcare certifications
Work EnvironmentReviewing medical records and insurance claims, often remotely or in officeDirect patient interaction, coordinating care, often in clinical or community settings
Employer & IndustryHospitals, insurance companies, healthcare organizationsHospitals, clinics, community health agencies

While both roles focus on pediatric healthcare, Pediatric Utilization Review primarily involves evaluating medical necessity and insurance claims, whereas Pediatric Case Managers coordinate ongoing patient care and support families directly. Understanding these differences helps in choosing the right career path or job search focus.

More about Pediatric Utilization Review jobs

What cities are hiring for Pediatric Utilization Review jobs?

Cities with the most Pediatric Utilization Review job openings:

What states have the most Pediatric Utilization Review jobs?

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

What job categories do people searching Pediatric Utilization Review jobs look for?

The top searched job categories for Pediatric Utilization Review jobs are:

Pediatric Utilization Review jobs near you
Infographic showing various Pediatric Utilization Review job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 13% Part Time, 3% Contract, and 1% Nights. 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.

Utilization Management Registered Nurse

Valley Children's Healthcare

Madera, CA • On-site

$57.29 - $81.72/day

Full-time

Re-posted 21 days ago

Valley Children's Hospital rating

6.4

Company rating: 6.4 out of 10

Based on 14 frontline employees who took The Breakroom Quiz

755th of 1,060 rated hospitals

Job description

Job Summary:The Utilization Management Nurse supports the case management department by providing a variety of utilization management functions including but not limited to daily screening of patient admission relative to specified criteria, active involvement in denial management, acting as a resource to staff regarding clinical criteria, communication with payors to address concerns and other duties as assigned. The Utilization Management Nurse will work collaboratively with the Utilization Nurse Program Coordinator to ensure compliance with regulatory, organizational and department requirements. The Utilization Review Nurse will receive direction from the Utilization Review Program Coordinator for daily and long term tasks and projects.

Qualifications:


Education

  • Associates Degree Nursing (required)
  • Bachelors Degree Nursing or related field (preferred)


Licenses and Certifications

  • RN - Registered Nurse License - CA-BRN - California Board of Registered Nursing (required)


Work Experience

  • Minimum three (3) years Full time equivalent RN experience in an acute care hospital. (required)
  • Pediatric experience and experience in Case Management and/or Utilization Review. (preferred)


Skills and Abilities

  • Knowledge of UM regulations.
    Knowledge of private and public payer reimbursement practices and procedures.
    Excellent organizational and communication skills and ability to work with a variety of health care professionals.
    Ability to work independently.
  • Computer Skills Proficiency with word processing, spreadsheets and database software.


To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Compensation Range:

$57.29 - $81.72

Workshift:

Day (United States of America)

Position Exempt:

No

FTE %:

90

Scheduled Weekly Hours:

36

Daily Hours:

8

Have Questions?

Call Recruitment Services at 559-353-7071 or email us at recruiting@valleychildrens.org
Disclaimer: Final compensation will be dependent upon skills and experience.

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