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Pre Service Review Nurse Jobs (NOW HIRING)

Astrana Health, Inc.

UM Review Nurse

Monterey Park, CA · On-site +1

$34 - $47/hr

... Review Nurse to assist our Health Services Department. In this position, you will utilize your ... clinical judgement to approve or deny outpatient medical services for patients based on Medical ...

AbsoluteCARE

Utilization Review Nurse

New Orleans, LA · On-site

Absolute Care offers concierge health services using a risk-bearing, PCP-driven care model. We ... The Utilization Review Nurse ensures appropriate utilization of health services by performing ...

AbsoluteCare

Utilization Review Nurse

New Orleans, LA · On-site

Description Absolute Care offers concierge health services using a risk-bearing, PCP-driven care ... The Utilization Review Nurse ensures appropriate utilization of health services by performing ...

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Pre Service Review Nurse information

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$28

$37

$42

How much do pre service review nurse jobs pay per hour?

As of Jul 15, 2026, the average hourly pay for pre service review nurse in the United States is $37.04, according to ZipRecruiter salary data. Most workers in this role earn between $34.13 and $41.35 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in the Pre Service Review Nurse position, and why are they important?

To excel as a Pre Service Review Nurse, you need a current RN license, strong clinical judgment, expertise in medical necessity review, and deep knowledge of medical terminology and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and standardized coding systems like ICD-10 and CPT is commonly required. Exceptional attention to detail, strong organizational skills, and effective communication help a nurse stand out in this role. These capabilities are crucial for accurately assessing pre-service requests, ensuring compliance, and fostering collaboration between providers and payers.

What is a Pre Service Review Nurse job?

A Pre Service Review Nurse is responsible for evaluating medical service requests before they are provided to ensure they meet insurance coverage criteria and medical necessity guidelines. They review clinical documentation, apply healthcare policies, and collaborate with physicians and healthcare teams to determine approval or denial. This role helps ensure that patients receive appropriate, cost-effective care while adhering to regulatory and organizational requirements. Strong communication, critical thinking, and knowledge of medical guidelines are essential for success in this position.

How to make $300,000 as a nurse?

Pre Service Review Nurses typically do not earn $300,000 annually; high earnings in nursing usually come from advanced roles such as nurse anesthetists, nurse practitioners, or nurse executives, often requiring additional certifications, specialized skills, and experience. Achieving such income levels may involve working in high-demand settings, taking on overtime, or pursuing leadership positions. Salary varies by location, employer, and specialization.

What does a preservice review nurse do?

A preservice review nurse evaluates insurance claims and medical documentation to determine coverage eligibility before services are provided. They review patient records, ensure compliance with policies, and collaborate with healthcare providers to facilitate approval processes, often using specialized software and adhering to regulatory standards.

How to make an extra 2000 a month as a nurse?

Pre Service Review Nurses can increase their income by taking on overtime shifts, working in high-demand specialties, or obtaining additional certifications such as case management or telehealth. Freelance consulting or teaching nursing courses can also provide extra income outside regular hours.

What is a pre-service nurse?

A pre-service nurse is a nursing student or trainee who is preparing to enter the workforce, often completing clinical rotations or internships to gain practical experience before becoming licensed. This stage involves supervised training, skill development, and meeting educational requirements necessary for certification and employment as a registered nurse. It is a critical phase for gaining hands-on experience in healthcare settings.

What are the typical daily responsibilities of a Pre Service Review Nurse?

As a Pre Service Review Nurse, your day usually involves reviewing healthcare service requests for medical necessity and appropriateness based on clinical guidelines and insurance policies. You will communicate with physicians, healthcare providers, and insurance representatives to gather necessary information or clarify documentation. The role may also require documenting findings in electronic health record systems, processing authorization requests, and participating in team meetings to discuss complex cases. You’ll need to balance efficiency and accuracy while supporting timely patient care decisions and ensuring regulatory compliance.

More about Pre Service Review Nurse jobs
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Pre Service Review Nurse jobs near you
Infographic showing various Pre Service Review Nurse job openings in the United States as of July 2026, with employment types broken down into 95% Full Time, and 5% Part Time. Highlights an 63% In-person, and 37% Remote job distribution, with an average salary of $77,034 per year, or $37 per hour.
Utilization Review Nurse

Utilization Review Nurse

Health Business Solutions LLC

Cooper City, FL

Full-time

Posted 6 days ago

Job description

Job Summary: We are seeking a highly motivated and experienced Utilization Review Nurse to join our team. The Utilization Review Nurse will play a crucial role in supporting our clients in the healthcare industry by providing expert clinical guidance, facilitating effective utilization management, and ensuring revenue cycle efficiency. This position offers a unique opportunity to combine clinical expertise with revenue cycle management knowledge.

Key Responsibilities:

· Clinical Assessment: Conduct comprehensive clinical assessments of medical records to ensure patients are receiving appropriate care at the correct level of service.

  • Care Coordination: Collaborate with interdisciplinary healthcare teams to coordinate patient care and treatment plans, ensuring the most cost-effective and clinically appropriate care is provided.
  • Revenue Cycle Management: Utilize clinical expertise to support revenue cycle processes, including accurate coding, documentation improvement, and compliance with healthcare regulations.
  • Utilization Review:

a) Apply medical necessity screening criteria and clinical knowledge to ensure appropriateness of admissions and length of stays

b) Conduct initial admission, continuing stay, and 23-hour observations reviews for all patients

c) Support Utilization Review Coordinator team members on cases escalated for level of care determinations

d) Screen cases for Physician Advisor review

e) Collaborate with insurance companies on concurrently denied and high risk for denial cases

  • Documentation Improvement: Identify opportunities for improving clinical documentation to support accurate coding and billing processes, ultimately improving reimbursement.


  • Data Analysis: Analyze clinical and financial data to identify trends, opportunities for improvement, and areas of potential cost savings for clients.


  • Compliance: Stay up-to-date with healthcare regulations, guidelines, and policies to ensure all patient care and revenue cycle processes are in compliance with industry standards and regulatory requirements to ensure appropriate reimbursement.

Qualifications:

· Registered Nurse (RN) licensure required; must hold a USRN multi-state/compact nursing license.

· Bachelor of Science in Nursing (BSN) preferred.

· Case Management Certification (e.g., CCM) is a plus.

· Minimum of 3 years of clinical nursing experience, preferably in a hospital or acute care setting.

· Minimum 2 years of work experience in Utilization Review

· Strong understanding of revenue cycle management and healthcare reimbursement.

· Proficiency in medical coding and clinical documentation improvement.

· Excellent communication, interpersonal, and teamwork skills.

· Ability to work independently and make sound clinical and financial decisions.

· Strong analytical and problem-solving skills.

· Proficient in using healthcare information systems and technology.

· Commitment to maintaining patient confidentiality and ethical standards.

Apply