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Quality Review Nurse Jobs (NOW HIRING)

AbsoluteCARE Inc

Utilization Review Nurse

New Orleans, LA · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

The Utilization Review Nurse ensures appropriate utilization of health services by performing ... Ensures medically appropriate, high quality, cost effective care through assessing the medical ...

Leon Health, Inc.

Concurrent Review Nurse

Miami, FL · On-site

Oversee the quality, accuracy, and timeliness of prior authorization reviews and ensure appropriate ... Bachelor's degree in Nursing required Experience * Minimum of two (2) years of experience in ...

Leon Health Plan

Concurrent Review Nurse

Doral, FL

Oversee the quality, accuracy, and timeliness of prior authorization reviews and ensure appropriate ... Bachelor's degree in Nursing required Experience * Minimum of two (2) years of experience in ...

Leon Health, Inc.

Concurrent Review Nurse

Doral, FL · On-site

Oversee the quality, accuracy, and timeliness of prior authorization reviews and ensure appropriate ... Bachelor's degree in Nursing required Experience * Minimum of two (2) years of experience in ...

Leon Medical Centers

Concurrent Review Nurse

Doral, FL · On-site

Oversee the quality, accuracy, and timeliness of prior authorization reviews and ensure appropriate ... Bachelor's degree in Nursing required Experience * Minimum of two (2) years of experience in ...

US Tech Solutions

Utilization Review Nurse

Chicago, IL · On-site

Improve quality products and services, by using measurement and analysis to process, evaluate and ... Do you have experience with Utilization Review? * Do you have an Active Registered Nurse License?

US Tech Solutions

Utilization Review Nurse

Canton, MA · On-site

$55 - $60/hr

... Nurse to support outpatient utilization review and prior authorization activities for a leading ... Monitor cases for quality, compliance, and adherence to organizational policies. * Identify ...

Silver Cross Hospital

Utilization Review Nurse

New Lenox, IL · On-site +1

$34.73 - $45.15/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Refers to designated physician advisor those patients not meeting criteria as well as quality of ... Nurse, Registered (RN) licensure * BSN preferred. 2-5 years previous Utilization Review experience ...

Medix

Utilization Review Nurse

Southfield, MI · On-site

$42 - $46/hr

  • Medical

  • Dental

  • Vision

  • Retirement

Job Summary Our client is seeking a Utilization Review Nurse. This role involves managing the full ... Perform quality assurance (QA) on physician reports to ensure accuracy, clarity, completeness, and ...

Umpqua Health

Utilization Review Nurse

$85K - $105K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Utilization Review Nurse Remote Ability to travel on-site to 3031 NE Stephens St., Roseburg OR ... Our collaborative approach ensures members receive high-quality, personalized care while supporting ...

silvercross

Utilization Review Nurse

$34.73 - $45.15/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Refers to designated physician advisor those patients not meeting criteria as well as quality of ... Nurse, Registered (RN) licensure * BSN preferred. 2-5 years previous Utilization Review experience ...

Silver Cross Hospital

Utilization Review Nurse

New Lenox, IL · On-site

$34.73 - $45.15/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Refers to designated physician advisor those patients not meeting criteria as well as quality of ... Nurse, Registered (RN) licensure * BSN preferred. 2-5 years previous Utilization Review experience ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · On-site +1

$85K - $105K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR ... Our collaborative approach ensures members receive high-quality, personalized care while supporting ...

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Quality Review Nurse information

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$29.5K

$90.3K

$170K

How much do quality review nurse jobs pay per year?

As of Aug 20, 2026, the average yearly pay for quality review nurse in the United States is $90,275.00, according to ZipRecruiter salary data. Most workers in this role earn between $66,500.00 and $102,500.00 per year, depending on experience, location, and employer.

What is a quality review nurse?

A Quality Review Nurse is responsible for evaluating patient care to ensure it meets clinical standards, regulatory requirements, and organizational policies. They review medical records, analyze data, and identify areas for improvement to enhance healthcare quality and patient safety. These professionals often collaborate with healthcare teams to develop best practices, ensure compliance, and recommend corrective actions when needed. Their role is essential in maintaining high standards of care and improving overall healthcare outcomes.

What does a quality review nurse do?

A typical day for a Quality Review Nurse involves reviewing patient medical records to ensure compliance with healthcare regulations and organizational quality standards, identifying areas of improvement, and documenting findings for reporting. You will often collaborate with clinical staff, quality assurance teams, and management to recommend process improvements and provide feedback on care delivery practices. Quality Review Nurses may also participate in case reviews, audits, and staff training, making the work both analytical and interactive. This role requires balancing independent record analysis with teamwork to drive effective quality initiatives throughout the healthcare facility.

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

To thrive as a Quality Review Nurse, you need a solid clinical background in nursing, critical thinking skills, and strong attention to detail, typically supported by an active RN license and several years of nursing experience. Familiarity with quality assurance protocols, electronic health records (EHR) systems, and healthcare accreditation standards (such as The Joint Commission) is commonly required. Excellent communication, problem-solving abilities, and a collaborative mindset help distinguish top performers in this role. These skills are crucial for ensuring compliance, promoting patient safety, and driving continuous improvement in healthcare quality standards.

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Cities with the most Quality Review Nurse job openings:

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Quality Review Nurse jobs near you
Infographic showing various Quality Review Nurse job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 13% Part Time, 4% Contract, and 1% Nights. Highlights an 86% Physical, 2% Hybrid, and 12% Remote job distribution, with an average salary of $90,275 per year, or $43.4 per hour.

Utilization Review Nurse

AbsoluteCARE Inc

New Orleans, LA • On-site

Other

Medical, Dental, Vision, Life, Retirement

Re-posted 10 days ago

Job description

Description
AbsoluteCare offers concierge health services using a risk-bearing, PCP-driven care model. We treat the most clinically complex and vulnerable members of the communities we serve, many of whom suffer from behavioral health, substance use, and SDoH challenges. We use population health management tools to employ a holistic approach to caring for the highest utilizers of healthcare services in our comprehensive care centers and in the community. AbsoluteCare tends exclusively to the needs of the top four to six percent of the population who persistently represent a disproportionate amount of unnecessary utilization and cost, regardless of whether they are engaged with other PCPs. In our more than 20 years of service, AbsoluteCare has focused on fulfilling the needs of this population. And we have consistently achieved unprecedented outcomes by addressing medical and psychosocial issues, in addition to the hardships of life that can exacerbate chronic health conditions and complicate access to care.
Our Values:
  • Accountability - We have the integrity to do what we say we will do
  • Caring - The needs of our team and members matter
  • Trust - Our members can rely on us
  • Teamwork - We act together as one inclusive group
Description:
The Utilization Review Nurse ensures appropriate utilization of health services by performing initial, concurrent and retrospective clinical case reviews. This role collaborates and communicates with health plans and different providers/care teams to help ensure inpatient bed days and associated discharge/transitional care plans are appropriate. The Utilization Review Nurse provides clinical review for different healthcare services requiring authorization- including acute inpatient, skilled nursing facility, acute rehab, home nursing as well as others. Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity and appropriateness of treatment setting by utilizing the applicable policies and guidelines. Utilizes decision making and critical thinking skills in the review and determination of coverage for medically necessary health care services. Is part of a team that accountable for facilitating and providing care coordination services and associated quality outcomes for patients across the continuum of discharge planning and transitional care. Collaborates with different teams to develop and/or implement comprehensive discharge care plans based on assessment of member's clinical and social needs.
  • Reviews and interprets medical records and compares against industry guidelines and company policies to determine medical appropriateness and necessity of care.
  • Apply critical thinking and decision-making skills to determine if the medical record documentation supports the need for service while maintaining quality standards.
  • Continuously reviewing the patients' medical record to ensure that members will not receive unnecessary procedures, ineffective treatment, or unnecessarily extensive hospital stays.
  • As needed, perform onsite of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies.
  • Understands key aspects of discharge planning, transitional care management and drivers of readmissions when coordinating care for complex, vulnerable populations.
  • Ability to work with multidisciplinary teams and embrace teamwork.
  • Identifies members for referral opportunities to integrate with other products, services and/or programs Identifies opportunities to promote quality effectiveness
  • Demonstrates proficiency with case load and the ability to manage complex cases effectively
  • Works with less structured, more complex issues and ability to identify solutions to non-standard requests and problems.
  • Demonstrates a solid understanding of managed care, Medicare, and Medicaid regulations.
  • Schedule: Monday thru Friday daytime hours, along with rotating weekends and holidays.
Experience
  • Ability to interpret clinical data.
  • Active Registered Nurse license by the State of Louisiana and/or the state(s) in which the nurse is required to practice.
  • Bachelor's Degree in Nursing from an accredited school of nursing
  • Understanding of complex vulnerable populations and their associated care coordination needs.
  • Knowledge of medical appropriateness criteria such as InterQual®, Milliman Care Guidelines®
  • Experience and knowledge with Medicaid and Medicare managed care organizations, regulations and populations.
  • Must have excellent oral, written, and interpersonal communication skills, and must be a creative problem solver.
  • Proven ability to meet deadlines and work under pressure.
  • Must have good typing skills and proficiency using MS Office Word, Excel and Outlook
  • 3-5 years of acute care clinical experience required working in any of the following areas: ER, Critical Care, ICU, Ortho, Med Surg, Telemetry.
  • Health plan, ACO or IPA experience.
Our employeesare offered the following benefits
  • Free parking
  • Free Vision Plan
  • Medical and Dental plans
  • Life Insurance
  • Short Term Disability
  • 401 k Retirement plan

AbsoluteCare provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, age, disability, genetics, protected Veteran status, or any other characteristic protected by law or policy.

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