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Pre Authorization Utilization Review Nurse Jobs

Sentara Healthcare

UTILIZATION REVIEW NURSE

Norfolk, VA · On-site +1

The Utilization Review Nurse is responsible for utilization management services within the scope of ... Reviews provider requests for services requiring authorization. Conducts pre-certification, care ...

Sentara Health Plans

$10K/mo

The Utilization Review Nurse is responsible for utilization management services within the scope of ... Reviews provider requests for services requiring authorization. Conducts pre-certification, care ...

Sentara Health Plans

UTILIZATION REVIEW NURSE

Norfolk, VA · On-site

$10K/mo

The Utilization Review Nurse is responsible for utilization management services within the scope of ... Reviews provider requests for services requiring authorization. Conducts pre-certification, care ...

Cobalt Benefits Group

Utilization Review Nurse

Conduct medical necessity reviews for services requiring prior authorization, applying utilization ... Review medical claims and pre-determinations for medical necessity and appropriateness. * Identify ...

US Tech Solutions

Utilization Review Nurse

Canton, MA · On-site

$55 - $60/hr

... Nurse to support outpatient utilization review and prior authorization activities for a leading ... Communicate authorization decisions with physicians, provider offices, hospitals, and healthcare ...

Fusion HCR

Utilization Review Nurse

Las Vegas, NV · On-site

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 ...

Acrisure

Utilization Review Nurse

Bradenton, FL · On-site

... authorized at the nurse level, and refers requests for physician review when additional clinical ... Experience in utilization review or case management is highly beneficial, particularly within ...

Acrisure, LLC

## Utilization Review NurseApplyremote type: Hybridlocations: 1301 6th Ave W - BRADENTON, FLposted on ... authorized at the nurse level, and refers requests for physician review when additional clinical ...

Merrimack Health

Utilization Review Nurse

Lawrence, MA · On-site

Utilization Review Nurse Responsible for determining the appropriateness of hospital admission, utilization of resources and medical necessity for continued stay. Responsible for working with the ...

Acrisure, LLC

Utilization Review Nurse

Bradenton, FL · On-site

## Utilization Review NurseApplyremote type: Hybridlocations: 1301 6th Ave W - BRADENTON, FLposted on ... authorized at the nurse level, and refers requests for physician review when additional clinical ...

Acrisure

Utilization Review Nurse

Bradenton, FL

... authorized at the nurse level, and refers requests for physician review when additional clinical ... Experience in utilization review or case management is highly beneficial, particularly within ...

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Pre Authorization Utilization Review Nurse information

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How much do pre authorization utilization review nurse jobs pay per hour?

As of Sep 15, 2026, the average hourly pay for pre authorization 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 is the difference between Pre Authorization Utilization Review Nurse vs Utilization Review Nurse?

AspectPre Authorization Utilization Review NurseUtilization Review Nurse
CertificationsRN license, possibly certifications in case management or utilization reviewRN license, certifications in utilization review or case management often preferred
Work EnvironmentPrimarily involved in reviewing authorization requests before services are providedReviews medical records and authorizations, may also evaluate ongoing care
Employer & IndustryInsurance companies, health plans, or third-party administratorsHospitals, insurance companies, or healthcare organizations

While both roles involve reviewing healthcare cases, the Pre Authorization Utilization Review Nurse focuses on approving services before they are rendered, whereas the Utilization Review Nurse may also evaluate ongoing care and medical necessity during or after treatment. Understanding these differences helps in choosing the right career path or job search focus.

What cities are hiring for Pre Authorization Utilization Review Nurse jobs?

Cities with the most Pre Authorization Utilization Review Nurse job openings:

What states have the most Pre Authorization Utilization Review Nurse jobs?

States with the most job openings for Pre Authorization Utilization Review Nurse jobs include:

What are popular job titles related to Pre Authorization Utilization Review Nurse jobs?

For Pre Authorization Utilization Review Nurse jobs, the most frequently searched job titles are:

Infographic showing various Pre Authorization Utilization Review Nurse 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 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

UTILIZATION REVIEW NURSE

Norfolk, VA • On-site

Sentara Health Administration, Inc.
See more jobs at Sentara Health Administration, Inc.external

$10K/mo

Other

Medical, Dental, Vision, Life, Retirement, PTO

Posted 13 days ago

Job description

City/StateNorfolk, VAWork ShiftFirst (Days)Overview:Sentara Health Plans Community Care is looking to hire a Utilization Review Nurse.The Utilization Review Nurse is responsible for utilization management services within the scope of licensure. Conducts primary functions of prior authorization, retrospective review, medical director referrals and execution of member/provider approval and/or denial letter. Reviews provider requests for services requiring authorization. Conducts pre-certification, care coordination for appropriateness of treatment, set reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.Responsible for written and/or verbal notification to members and providers. Ensures medical director written decision is consistent with criteria (CMS, state, medical policy, clinical criteria). Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.Education:· BSN (preferred)Certification:· Registered Nurse (required)Experience:· 3 years of acute care clinical experience (required)· Previous Utilization Review experience (preferred)· Milliman experience (preferred)· Knowledge of NCQA (preferred)· Microsoft suite (Word, Excel, Outlook) (preferred)· Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skillsKeywords: Talroo- Health, Utilization Review Nurse, RN, Care Coordination, or Discharge Planning, Case Management, Milliman, NCQABenefits: Caring For Your Family and Your Career• Medical, Dental, Vision plans• Adoption, Fertility and Surrogacy Reimbursement up to $10,000• Paid Time Off and Sick Leave• Paid Parental & Family Caregiver Leave• Emergency Backup Care• Long-Term, Short-Term Disability, and Critical Illness plans• Life Insurance• 401k/403B with Employer Match• Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education• Student Debt Pay Down – $10,000•Pet Insurance•Legal Resources Plan•Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.In support of our mission “to improve health every day,” this is a tobacco-free environment.For positions that are available as remote work, Sentara Health employs associates in the following states:Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming. #J-18808-Ljbffr

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