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Professional Review Nurse Jobs (NOW HIRING)

Acrisure

Utilization Review Nurse

Bradenton, FL · On-site

Collaborate with physicians, healthcare providers, claims professionals, and internal team members ... Strong clinical nursing experience with the ability to review medical records and evaluate ...

Penn Medicine

Utilization Review Nurse

West Chester, PA · On-site

Promotes individual professional growth and development by meeting requirements for mandatory ... Nursing/BSN3+ years nursing experience1+ years utilization review We believe that the best care for ...

Integrated Resources INC

Care Review Nurse

Columbus, OH · On-site

We've stayed true to our focus of finding qualified and experienced professionals in our specialty ... Review cases for in patients/in hospital: skilled care, acute rehab and long term acute care Nurses ...

Medix

Utilization Review Nurse

Fort Worth, TX · On-site

$38.46 - $43.27/hr

Job Summary Our client is seeking a skilled Utilization Review Nurse to join their team. This role ... With over 20 years of experience connecting organizations with highly qualified professionals ...

Alliant Health Group

Review Nurse-PA/UM

Atlanta, GA · On-site

The Review Nurse conducts prior approval and precertification reviews for Georgia Fee-for-Service ... Promote core values of teamwork, professionalism, effective communication skills and positive ...

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Professional Review Nurse information

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$38

$72

How much do professional review nurse jobs pay per hour?

As of Sep 2, 2026, the average hourly pay for professional review nurse in the United States is $38.50, according to ZipRecruiter salary data. Most workers in this role earn between $27.88 and $42.79 per hour, depending on experience, location, and employer.

What is a professional review nurse?

Professional Review Nurses are registered nurses who specialize in evaluating patient care, medical records, and healthcare services to ensure quality and compliance with regulations. They assess the necessity, appropriateness, and efficiency of medical treatments and procedures, often for insurance companies, hospitals, or healthcare organizations. Their work helps control healthcare costs and ensures patients receive suitable care according to established guidelines. Professional Review Nurses also play a key role in utilization review and case management.

What are the key skills and qualifications needed to thrive as a professional review nurse?

To thrive as a Professional Review Nurse, you need a current RN license, strong clinical assessment skills, and a thorough understanding of healthcare regulations and medical terminology. Familiarity with utilization management software, electronic medical records (EMRs), and case management tools is typically required. Excellent analytical thinking, attention to detail, and effective written and verbal communication are crucial soft skills for success in this role. These competencies ensure accurate case reviews, compliance with healthcare standards, and clear communication with providers and insurers.

What are some common challenges faced by professional review nurses when evaluating medical necessity for insurance claims?

Professional Review Nurses often encounter challenges such as navigating complex medical records, keeping up with changing healthcare regulations, and managing tight review deadlines. They must carefully balance clinical judgment with insurance guidelines to ensure fair and accurate determinations. Clear communication with physicians, case managers, and insurance representatives is essential, as misunderstandings can delay claim processing or lead to appeals. Adapting to evolving technology platforms and maintaining up-to-date knowledge of evidence-based practices are also key aspects of the role.

What is the difference between Professional Review Nurse vs Case Manager Nurse?

AspectProfessional Review NurseCase Manager Nurse
CredentialsRN license, certification in review or utilization managementRN license, certification in case management or utilization review
Work EnvironmentReviewing medical records, insurance claims, and provider documentationCoordinating patient care, managing treatment plans, liaising with providers
Employer & IndustryInsurance companies, utilization review organizations, healthcare agenciesHospitals, insurance companies, healthcare organizations

Professional Review Nurses primarily focus on evaluating medical records and insurance claims to ensure appropriate care and coverage. In contrast, Case Manager Nurses coordinate patient care, develop treatment plans, and facilitate communication among healthcare providers. Both roles require RN licensure and relevant certifications but differ in daily responsibilities and work settings.

How to become a professional review nurse?

To become a professional review nurse, you typically need to earn a nursing degree such as an Associate Degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN), pass the NCLEX-RN licensing exam, and gain clinical experience. Additional certifications in case management or healthcare review can enhance qualifications for roles involving medical record review and quality assurance.
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Professional Review Nurse jobs near you
Infographic showing various Professional Review Nurse job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 73% Full Time, 22% Part Time, and 4% Contract. Highlights an 90% Physical, 1% Hybrid, and 9% Remote job distribution, with an average salary of $80,071 per year, or $38.5 per hour.

Utilization Review Nurse

Merrimack Health

Methuen, MA • On-site

Full-time

Posted 7 days ago

Job description

Position Summary
Responsible for determining the appropriateness of hospital admission, utilization of resources and medical necessity for continued stay. Responsible for working with the Clinical Care Coordinator and Complex Care Manager to facilitate timely discharge, assure medical documentation accurately reflects the patient's severity of illness; and ensures compliance with the conditions of participation as they relate to utilization review and discharge planning and payer regulations.
MINIMUM EDUCATION AND EXPERIENCE:
Required:
  • Graduate of an accredited professional nursing school
  • Current Massachusetts Nursing license
  • Bachelor's degree. - Preferred
  • 5 years case management experience in an acute care setting with discharge planning, continuing care, care management, and utilization review.
  • Five years clinical nursing experience
  • Demonstrated verbal, written skills
  • Computer skills

Preferred:
  • Master's degree.

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