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Professional Review Nurse Jobs (NOW HIRING)

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 ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · Remote

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR ... Work/Life Balance We promote flexibility and well-being so employees can thrive both professionally ...

Turning Point Plans

Clinical Review Nurse

Lake Mary, FL · On-site

As a Utilization Review Nurse, you will utilize your critical thinking skills, clinical expertise ... Serves and protects the company by adhering to accreditation standards, professional standards ...

Alliant Health Solutions

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 ...

Hunterdon Health

Documentation Review Nurse

Flemington, NJ · On-site

$93K - $116K/yr

Documentation Review Nurse Position Summary The Documentation Review Nurse will apply expertise and ... Work closely with coding professionals to address discrepancies and clarify documentation for ...

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Professional Review Nurse information

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$15

$38

$72

How much do professional review nurse jobs pay per hour?

As of Aug 10, 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 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 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 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.

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.
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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, 72% Full Time, 22% Part Time, and 5% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution, with an average salary of $80,071 per year, or $38.5 per hour.

Care Review Nurse

Integrated Resources INC

Columbus, OH

Contractor

Re-posted 29 days ago

Job description

Company Description

Integrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively. Since launching in 1996, IRI has attracted, assembled and retained key employees who are experts in their fields. This has helped us expand into new sectors and steadily grow.

We've stayed true to our focus of finding qualified and experienced professionals in our specialty areas. Our partner-employers know that they can rely on us to find the right match between their needs and the abilities of our top-tier candidates. By continually exceeding their expectations, we have built successful ongoing partnerships that help us stay true to our commitments of performance and integrity.

Our team works hard to deliver a tailored approach for each and every client, critical in matching the right employers with the right candidates. We forge partnerships that are meant for the long term and align skills and cultures. At IRI, we know that our success is directly tied to our clients' success.

Job Description

Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review. Assesses services for Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.

Medicaid Division

Duties: Review cases for in patients/in hospital: skilled care, acute rehab and long term acute care
Nurses working at the facilities Members are being care for, will be sending over clinical information to be reviewed by the Care Review Clinician. Therefore, this agent will not be traveling and will be reviewing information at the office.

Qualifications

Background 
Hospital Utilization Management. Insurance Utilization Manager/Review and Millemen Experience (MCG). No case managers if that is their only experience. Must have Utilization Review or Management. Utilization Review (1 year +), Past hospital experience (3-4 years of experience, less experience is ok if they have more Utilization Review experience) 
Potential for longer term dependent on enrollment 
Workers will be doing Concurrent Inpatient Review 
MUST have one of the following AT LEAST 
-Utilization Review in hospital setting 
Nurses who are used to doing both production and review work

Additional Information

All your information will be kept confidential according to EEO guidelines.

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About Integrated Resources

Sourced by ZipRecruiter

Integrated Resources Inc (IRI), based in Edison, NJ, US, is an esteemed player in the staffing solutions industry with a credible presence on their official website irionline.com. Notably, IRI provides a range of professional staffing services including contract, contract-to-hire, and direct hire solutions to a wide spectrum of industries such as healthcare, life sciences, manufacturing, financial, insurance, and others. Since its inception, IRI has been committed to delivering top-talent and optimum solutions to meet its clients' diverse needs.

Industry

Recruiting and staffing services

Company size

51 - 200 Employees

Headquarters location

Edison, NJ, US

Year founded

1996

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