Utilization Review Nurse
$85K - $105K/yr
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 ...
Utilization Review Nurse
$85K - $105K/yr
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 ...
Utilization Review Nurse
New Lenox, IL · On-site
$34.73 - $45.15/hr
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 ...
Utilization Review Nurse
New Lenox, IL · On-site
$34.73 - $45.15/hr
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 ...
Utilization Review Nurse
Murray, UT · On-site +1
... quality and trust that are integral to our mission. EO/AA This position is responsible for ... Performs verbal/fax clinical review with payer as determined by nursing judgment and/or ...
Utilization Review Nurse
Murray, UT · On-site +1
... quality and trust that are integral to our mission. EO/AA This position is responsible for ... Performs verbal/fax clinical review with payer as determined by nursing judgment and/or ...
Be Seen First
UM Review Nurse
Tampa, FL · Remote
$36 - $40/hr
PURPOSE AND SCOPE: The UM Nurse Reviewer is responsible for the medical necessity review of ... Adheres to quality standards and confidentiality policies and procedures. * Ensures compliance with ...
New
Quick apply
Be Seen First
UM Review Nurse
Tampa, FL · Remote
$36 - $40/hr
PURPOSE AND SCOPE: The UM Nurse Reviewer is responsible for the medical necessity review of ... Adheres to quality standards and confidentiality policies and procedures. * Ensures compliance with ...
New
... quality and trust that are integral to our mission. EO/AA This position is responsible for ... Performs verbal/fax clinical review with payer as determined by nursing judgment and/or ...
... quality and trust that are integral to our mission. EO/AA This position is responsible for ... Performs verbal/fax clinical review with payer as determined by nursing judgment and/or ...
Qualifications Associates RN degree required, Bachelor's degree preferred Two years of experience in managed care quality assurance or utilization review RN must have two years of experience in an ...
Qualifications Associates RN degree required, Bachelor's degree preferred Two years of experience in managed care quality assurance or utilization review RN must have two years of experience in an ...
... quality and trust that are integral to our mission. EO/AA This position is responsible for ... Performs verbal/fax clinical review with payer as determined by nursing judgment and/or ...
... quality and trust that are integral to our mission. EO/AA This position is responsible for ... Performs verbal/fax clinical review with payer as determined by nursing judgment and/or ...
... quality assurance or utilization review • RN must have two years of experience in an acute care hospital.
... quality assurance or utilization review • RN must have two years of experience in an acute care hospital.
Utilization Review Nurse
Baltimore, MD · On-site
... overall quality of treatment.\r\n MINIMUM QUALIFICATIONS Education: Determined by the Maryland ... review files and the UR database\r\n Experience in Risk Management\r\n\r\n\r\n LICENSES ...
Utilization Review Nurse
Baltimore, MD · On-site
... overall quality of treatment.\r\n MINIMUM QUALIFICATIONS Education: Determined by the Maryland ... review files and the UR database\r\n Experience in Risk Management\r\n\r\n\r\n LICENSES ...
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 ... Our collaborative approach ensures members receive high-quality, personalized care while supporting ...
Quick apply
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 ... Our collaborative approach ensures members receive high-quality, personalized care while supporting ...
Utilization Review Nurse
Plano, TX · Remote
... quality of medical/surgical services, and serving as liaison between providers and medical and ... Registered Nurse (RN) with a valid, current, unrestricted license in the state of operations. * 3 ...
Utilization Review Nurse
Plano, TX · Remote
... quality of medical/surgical services, and serving as liaison between providers and medical and ... Registered Nurse (RN) with a valid, current, unrestricted license in the state of operations. * 3 ...
Utilization Review Nurse
Albany, NY · On-site
$77K - $119K/yr
... Quality Screening for assigned patients. • Applies MCG criteria to monitor appropriateness of ... Minimum Qualifications: • Registered nurse with a New York State current license. • Associate ...
Utilization Review Nurse
Albany, NY · On-site
$77K - $119K/yr
... Quality Screening for assigned patients. • Applies MCG criteria to monitor appropriateness of ... Minimum Qualifications: • Registered nurse with a New York State current license. • Associate ...
Utilization Review Nurse
Albany, NY · On-site
$77K - $119K/yr
... Quality Screening for assigned patients. • Applies MCG criteria to monitor appropriateness of ... Minimum Qualifications: • Registered nurse with a New York State current license. • Associate ...
New
Utilization Review Nurse
Albany, NY · On-site
$77K - $119K/yr
... Quality Screening for assigned patients. • Applies MCG criteria to monitor appropriateness of ... Minimum Qualifications: • Registered nurse with a New York State current license. • Associate ...
New
Utilization Review Nurse (RN)
Madera, CA · On-site
Utilization Review Nurse Located in the heart of Central California, Madera Community Hospital is a ... quality care and dedicated to making a difference in our community. Position Summary: The ...
Utilization Review Nurse (RN)
Madera, CA · On-site
Utilization Review Nurse Located in the heart of Central California, Madera Community Hospital is a ... quality care and dedicated to making a difference in our community. Position Summary: The ...
Utilization Review Nurse
Southfield, MI · On-site
$42 - $46/hr
Job Summary Our client is seeking a Utilization Review Nurse to manage the full lifecycle of ... Perform quality assurance on physician reports to ensure accuracy, clarity, completeness, and ...
Utilization Review Nurse
Southfield, MI · On-site
$42 - $46/hr
Job Summary Our client is seeking a Utilization Review Nurse to manage the full lifecycle of ... Perform quality assurance on physician reports to ensure accuracy, clarity, completeness, and ...
Clinical Review Nurse
Lake Mary, FL · On-site
As a Utilization Review Nurse, you will utilize your critical thinking skills, clinical expertise ... Improve quality results by studying, evaluating procedures and processes and recommending changes ...
Clinical Review Nurse
Lake Mary, FL · On-site
As a Utilization Review Nurse, you will utilize your critical thinking skills, clinical expertise ... Improve quality results by studying, evaluating procedures and processes and recommending changes ...
Utilization Review Nurse | Full Time
Las Vegas, NV · On-site
$41 - $60/hr
- Utilization Review Nurse Position Summary The Utilization Review Nurse is responsible for reviewing ... Monitor resource utilization while supporting quality patient care and organizational goals. * Stay ...
Quick apply
Utilization Review Nurse | Full Time
Las Vegas, NV · On-site
$41 - $60/hr
- Utilization Review Nurse Position Summary The Utilization Review Nurse is responsible for reviewing ... Monitor resource utilization while supporting quality patient care and organizational goals. * Stay ...
... quality and trust that are integral to our mission. EO/AA This position is responsible for ... Performs verbal/fax clinical review with payer as determined by nursing judgment and/or ...
... quality and trust that are integral to our mission. EO/AA This position is responsible for ... Performs verbal/fax clinical review with payer as determined by nursing judgment and/or ...
As a Utilization Review Nurse, you will utilize your critical thinking skills, clinical expertise ... Improve quality results by studying, evaluating procedures and processes and recommending changes ...
As a Utilization Review Nurse, you will utilize your critical thinking skills, clinical expertise ... Improve quality results by studying, evaluating procedures and processes and recommending changes ...
Review Nurse-PA/UM
Atlanta, GA · On-site
Participate in quality improvement and peer review activities * Maintain confidentiality of review ... Registered Nurse, with at least three years of recent clinical experience required * Current and ...
Review Nurse-PA/UM
Atlanta, GA · On-site
Participate in quality improvement and peer review activities * Maintain confidentiality of review ... Registered Nurse, with at least three years of recent clinical experience required * Current and ...
Quality Review Nurse information
See salary details
$29.5K - $42.3K
2% of jobs
$42.3K - $55K
0% of jobs
$66.3K is the 25th percentile. Wages below this are outliers.
$55K - $67.8K
26% of jobs
The median wage is $76.8K / yr.
$67.8K - $80.6K
31% of jobs
$80.6K - $93.4K
11% of jobs
$98K is the 75th percentile. Wages above this are outliers.
$93.4K - $106.1K
11% of jobs
$106.1K - $118.9K
5% of jobs
$118.9K - $131.7K
7% of jobs
$131.7K - $144.5K
2% of jobs
$144.5K - $157.2K
1% of jobs
$157.2K - $170K
2% of jobs
$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.
More about Quality Review Nurse jobs
What cities are hiring for Quality Review Nurse jobs?
Cities with the most Quality Review Nurse job openings:
What are the most commonly searched types of Quality Review Nurse jobs?
The most popular types of Quality Review Nurse jobs are:
What states have the most Quality Review Nurse jobs?
States with the most job openings for Quality Review Nurse jobs include:
What job categories do people searching Quality Review Nurse jobs look for?
The top searched job categories for Quality Review Nurse jobs are:
$85K - $105K/yr
Other
Medical, Dental, Vision, Life, Retirement, PTO
Re-posted 14 days ago
Job description
UTILIZATION REVIEW NURSE
REMOTE
Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR, 97470, as needed for business operations.
EMPLOYMENT TYPE: Full-Time, Exempt
About Umpqua Health
At Umpqua Health, we're more than a healthcare organization-we're a community-driven Coordinated Care Organization (CCO) dedicated to improving the health and well-being of individuals and families throughout Douglas County, Oregon. We provide integrated, whole-person care through primary care, specialty care, behavioral health services, and care coordination. Our collaborative approach ensures members receive high-quality, personalized care while supporting a stronger, healthier community.
POSITION PURPOSE
The Utilization Management Nurse evaluates clinical service requests to ensure medically necessary, cost-effective, and evidence-based care for members. This role conducts prior authorizations, facilitates care coordination, and supports safe transitions across care settings, ensuring compliance with Oregon Health Plan (OHP), Medicare, and applicable regulations. The UM Nurse collaborates with interdisciplinary teams and community providers to promote integrated, high-quality care.
ESSENTIAL JOB RESPONSIBILITIES
Monday through Friday - 8:00am - 5:00pm; standard business hours with flexibility to meet service timelines.
SALARY
Wage Band: $85,000- $105,340
BENEFITS
Why Umpqua Health?
We are committed to advancing health equity by collaborating across communities, addressing systemic barriers, and ensuring fair access to care and resources. At Umpqua Health, every team member plays a vital role in making a meaningful impact, empowering healthier lives and strengthening the communities we serve.
Inclusive Culture
We foster a respectful, inclusive environment where employees feel valued, supported, and empowered.
Growth & Development
We support ongoing learning through mentorship, clear career pathways, and professional development opportunities.
Work/Life Balance
We promote flexibility and well-being so employees can thrive both professionally and personally.
Equal Opportunity
Umpqua Health is an equal opportunity employer that embraces individuals from all backgrounds. We prohibit discrimination and harassment of any kind, ensuring that all employment decisions are based on qualifications, merit, and the needs of the business. Our dedication to fairness and equality extends to all aspects of employment, including hiring, training, promotion, and compensation, without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, veteran status, or any other protected category under federal, state, or local law.
REMOTE
Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR, 97470, as needed for business operations.
EMPLOYMENT TYPE: Full-Time, Exempt
About Umpqua Health
At Umpqua Health, we're more than a healthcare organization-we're a community-driven Coordinated Care Organization (CCO) dedicated to improving the health and well-being of individuals and families throughout Douglas County, Oregon. We provide integrated, whole-person care through primary care, specialty care, behavioral health services, and care coordination. Our collaborative approach ensures members receive high-quality, personalized care while supporting a stronger, healthier community.
POSITION PURPOSE
The Utilization Management Nurse evaluates clinical service requests to ensure medically necessary, cost-effective, and evidence-based care for members. This role conducts prior authorizations, facilitates care coordination, and supports safe transitions across care settings, ensuring compliance with Oregon Health Plan (OHP), Medicare, and applicable regulations. The UM Nurse collaborates with interdisciplinary teams and community providers to promote integrated, high-quality care.
ESSENTIAL JOB RESPONSIBILITIES
- Perform clinical assessments and prior authorizations to determine medical necessity
- Escalate complex cases to Medical Directors and request additional documentation as needed
- Collaborate with care coordinators, discharge planners, and interdisciplinary teams for care transitions
- Liaise with internal departments to resolve eligibility, benefits, or service issues
- Participate in discharge planning for members transitioning from acute, long-term, or residential care
- Conduct audits and support quality improvement initiatives
- Provide training and mentorship on UM protocols and workflows
- Maintain relationships with community providers and service organizations
- Ensure compliance with organizational policies, clinical standards, and federal/state regulations
- Perform other nursing-related duties as assigned
- Working with a variety of personalities, maintaining a consistent and fair communication style.
- Satisfying the needs of a fast-paced and challenging company.
- Active, unrestricted RN license (BSN or MSN) in Oregon or a compact state
- Graduation from an accredited nursing program
- Minimum 5 years of direct patient care experience
- Proficiency with Microsoft Office, EHR systems, and UM software
- Strong clinical knowledge, communication, and organizational skills
- No suspension, exclusion, or debarment from federal healthcare programs
- 2+ years of utilization review or case management experience in managed care
- Oregon residency and license
- Bilingual or translation skills a plus
- Experience with quality improvement audits and diverse team collaboration
- Ability to work independently in fast-paced environments
Monday through Friday - 8:00am - 5:00pm; standard business hours with flexibility to meet service timelines.
SALARY
Wage Band: $85,000- $105,340
BENEFITS
- Salary is dependent on skills, experience, and education
- Generous benefits package including vacation PTO, sick leave, federal holidays, and birthday leave
- Medical, dental, and vision insurance
- 401(k) with company match (fully vested immediately)
- Company-sponsored life insurance and additional benefits
- Fitness reimbursement program
- Tuition reimbursement and more
Why Umpqua Health?
We are committed to advancing health equity by collaborating across communities, addressing systemic barriers, and ensuring fair access to care and resources. At Umpqua Health, every team member plays a vital role in making a meaningful impact, empowering healthier lives and strengthening the communities we serve.
Inclusive Culture
We foster a respectful, inclusive environment where employees feel valued, supported, and empowered.
Growth & Development
We support ongoing learning through mentorship, clear career pathways, and professional development opportunities.
Work/Life Balance
We promote flexibility and well-being so employees can thrive both professionally and personally.
Equal Opportunity
Umpqua Health is an equal opportunity employer that embraces individuals from all backgrounds. We prohibit discrimination and harassment of any kind, ensuring that all employment decisions are based on qualifications, merit, and the needs of the business. Our dedication to fairness and equality extends to all aspects of employment, including hiring, training, promotion, and compensation, without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, veteran status, or any other protected category under federal, state, or local law.
About Umpqua Health
Sourced by ZipRecruiter
Industry
Health care and social assistance
Company size
51 - 200 Employees
Headquarters location
Roseburg, OR, US