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Pre Service Review Nurse Jobs (NOW HIRING)

Astrana Health, Inc.

UM Review Nurse

$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

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 ...

Global Force

Utilization Review Nurse

Las Vegas, NV · On-site

About the job Utilization Review Nurse Sign on bonus may apply up to $15,000 Position Summary ... services and health care, and other relevant regulations and standards; clinical medical and ...

US Tech Solutions

Utilization Review Nurse

Canton, MA · On-site

$55 - $60/hr

Associate Degree in Nursing (ADN) required. * Minimum 5 years of RN clinical experience. * Minimum ... Experience reviewing outpatient clinical services. * Excellent clinical assessment and critical ...

Oscar Health

Utilization Review Nurse

Atlanta, GA · Remote

$35 - $45.94/hr

Complete medical necessity reviews and level of care reviews for requested services using clinical ... Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate ...

CorVel

CA Utilization Review Nurse I

$30.64 - $45.80/hr

Promotes utilization review services with stakeholders * Complies with all safety rules and ... Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.

Silver Cross Hospital

Utilization Review Nurse

New Lenox, IL · On-site

$34.73 - $45.15/hr

Performs medical record review for severity of illness and intensity of service; liaison function ... Nurse, Registered (RN) licensure * BSN preferred. 2-5 years previous Utilization Review experience ...

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Pre Service Review Nurse information

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$37

$42

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

As of Aug 12, 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?

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?

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.

More about Pre Service Review Nurse jobs
What states have the most Pre Service Review Nurse jobs? States with the most job openings for Pre Service Review Nurse jobs include:
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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 August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 19% Part Time, and 3% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $77,034 per year, or $37 per hour.

UM Review Nurse

Astrana Health, Inc.

Remote

$34 - $47/hr

Other

Re-posted 20 days ago

Job description

UM Review Nurse
Department: HS - UM
Employment Type: Full Time
Location: 1600 Corporate Center Dr., Monterey Park, CA 91754
Reporting To: Phillip Vasquez
Compensation: $34.00 - $47.00 / hour
Description
Astrana Health is looking for a CA-licensed Utilization 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 Necessity Criteria, respective to various Health Plans.
This position requires open availability between Monday through Sunday, 8 A - 8 P. You would be scheduled for 5 shifts per week. This is a remote position for CA-licensed nurses. Candidates must live in California.
We are seeking nurses with at least one year of outpatient Utilization Management experience in a fast-paced setting.
Our Values:
  • Put Patients First
  • Empower Entrepreneurial Provider and Care Teams
  • Operate with Integrity & Excellence
  • Be Innovative
  • Work As One Team
What You'll Do
  • Complete prior authorization/retrospective review of elective inpatient admissions, outpatient procedures, post-homecare services, and durable medical equipment
  • Refer cases to Medical Directors as needed/appropriate
  • Maintain knowledge of state and federal regulations and accreditation standards
  • Comply with internal policies and procedures
  • Perform any other job duties as requested
Qualifications
  • Active and unrestricted LVN license in CA.
  • At least 1 years of outpatient UM experience
  • Experience with Microsoft applications such as Word, Excel, and Outlook
You'll be Great for this Role If:
  • At least two (2) years of health plan, IPA or MSO experience
  • Strong interpersonal skills
  • Ability to collaborate with co-workers, senior leadership, and other management
  • Experience educating and training staff
Environmental Job Requirements and Working Conditions
  • This is a remote position. Our office is located at 1600 Corporate Center Drive in Monterey Park, CA. Candidates who live within a 30 mile radius of the office may be expected to work hybrid.
  • Typical business hours are Monday - Friday from 8:30 AM to 5 PM, however, this position requires open availability between 8 AM - 8 PM PST, M-Su. Your schedule will be compromised of 5 shifts per week. Nurses rotate weekend and holiday coverage. Overtime is required in this position.
  • The national target pay range for this role is $34.00 - $47.00 per hour. Actual compensation will be based on job level, geographic location (current or future), experience, and other job-related factors.

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided based on qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

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