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Pre Service Review Nurse Jobs (NOW HIRING)

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

Reviews provider requests for services requiring authorization. Conducts pre-certification, care ... Registered Nurse (required) Experience * 3 years of acute care clinical experience (required)

Universal Hospital Services Inc.

... that offers mental health services to the communities of surrounding Augusta, Georgia. The ... Utilization Review/Business Office Coordinator will ensure input of pre-certifications and ...

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

As of Sep 14, 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 is a pre service review nurse?

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.

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.

What are the key skills and qualifications needed to thrive in the pre service review nurse position?

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.

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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 September 2026, with employment types broken down into 1% As Needed, 77% Full Time, 20% Part Time, and 2% Contract. Highlights an 88% Physical, 1% Hybrid, and 11% Remote job distribution, with an average salary of $77,034 per year, or $37 per hour.

Utilization Review Nurse in Renton, WA

Renton, WA • On-site

Vivian Health
Recruiting and Staffing Services • 51 - 200 employees
Learn more about Vivian Healthexternal

Other

Posted 5 days ago

Job description

Utilization Review Nurse III
**  UTILIZATION REVIEW NURSE III  - WASHINGTON STATE - PRE-SERVICE CLINICAL UR/UM ** **  PRIOR UTILIZATION REVIEW/UTILIZATION MANAGEMENT RN WORK EXPERIENCE HIGHLY PREFERRED!  ** **  MUST LIVE IN WASHINGTON OR IDAHO, COMMUTABLE DISTANCE TO KAISER PERMANENTE WASHINGTON MEDICAL CENTER  **  Job Summary:

In addition to the responsibilities listed below, this position is also responsible for applying advanced clinical and regulatory knowledge of evidence-based guidelines, insurance policies, and clinical criteria to consult on the medical necessity, level of care, and duration of treatment required for moderately complex reviews, and collaborating with the health care team, members, and caregivers to assist in discharge planning, cost of care options, and/or coordinating and/or adjudicating referrals to appropriate services based on medical necessity.

Essential Responsibilities:
  • Pursues effective relationships with others by proactively providing resources, information, advice, and expertise with coworkers and members. Listens to, seeks, and addresses performance feedback; provides mentoring to team members. Pursues self-development; creates plans and takes action to capitalize on strengths and develop weaknesses; influences others through technical explanations and examples. Adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; helps others adapt to new tasks and processes. Supports and responds to the needs of others to support a business outcome.
  • Completes work assignments autonomously by applying up-to-date expertise in subject area to generate creative solutions; ensures all procedures and policies are followed; leverages an understanding of data and resources to support projects or initiatives. Collaborates cross-functionally to solve business problems; escalates issues or risks as appropriate; communicates progress and information. Supports, identifies, and monitors priorities, deadlines, and expectations. Identifies, speaks up, and implements ways to address improvement opportunities for team.
  • Provides high-quality consultation by: facilitating and communicating with physicians, managers, staff, members, and/or caregivers regarding requirements related to medical necessity and benefit denials across the continuum of care; and leveraging comprehensive knowledge to ensure the correct and consistent application, interpretation, and utilization of member health care benefits, cost of care options, and coverage by members and physicians.
  • Supports education and compliance initiatives by: remaining up-to-date and sharing information with the team on the relevant state and federal regulations, guidelines, criteria, and documentation requirements that affect utilization management; and supporting the development and delivery of education and training programs for staff and physicians at the local level to promote best practices in utilization management.
  • Assists in quality improvement efforts by: conducting standard data analyses and developing reports to identify utilization patterns, trends, and opportunities for improvement; providing input and participating in the implementation of corrective action plans to address deficiencies in utilization review workflows/processes; actively adhering to utilization policies, procedures, and guidelines to ensure compliant and cost-effective care; and developing and refining desk-level procedures (e.g., workflows).
  • Performs utilization reviews by: following standard policies and procedures when conducting reviews of medical records and treatment plans to evaluate the medical necessity, appropriateness, and efficiency of requested health care services; and assessing the ongoing need for services, proactively identifying, anticipating, and escalating potential issues/delays to internal team members, and recommending appropriate actions for moderately complex member cases.
Minimum Qualifications:
  • Bachelors Degree in Nursing AND minimum three (3) years of experience in direct patient care, utilization review/management, or discharge planning in a managed care setting or a directly related field.

  • Registered Nurse License (Washington) required at hire OR Compact License: Registered Nurse required at hire

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