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Retrospective Review Nurse Jobs (NOW HIRING)

Astrana Health, Inc.

UM Review Nurse

$34 - $47/hr

UM Review Nurse Department: HS - UM Employment Type: Full Time Location: 600 City Parkway West 10th ... Complete prior authorization/retrospective review of elective inpatient admissions, outpatient ...

Astrana Health, Inc.

UM Review Nurse

Monterey Park, CA · On-site +1

$34 - $47/hr

UM Review Nurse Department: HS - UM Employment Type: Full Time Location: 1600 Corporate Center Dr ... Complete prior authorization/retrospective review of elective inpatient admissions, outpatient ...

Astrana Health, Inc.

UM Review Nurse

$34 - $47/hr

UM Review Nurse Department: HS - UM Employment Type: Full Time Location: 1600 Corporate Center Dr ... Complete prior authorization/retrospective review of elective inpatient admissions, outpatient ...

Healthcare Support Staffing

Retrospective Review LPN

Newark, NJ · On-site

$27 - $36.50/hr

Managed care experience preferred Additional Information Are you an experienced Retrospective Review LPN in Newark, NJ area looking for a new opportunity with a prestigious healthcare company? Do you ...

Astrana Health

UM Review Nurse

$34 - $47/hr

UM Review Nurse Astrana Health is looking for a CA-licensed Utilization Review Nurse to assist our ... Complete prior authorization/retrospective review of elective inpatient admissions, outpatient ...

Ova Technologies

Utilization Review Nurse

Alpharetta, GA · On-site

Assist with denial prevention, appeals, and retrospective reviews when necessary.Maintain patient confidentiality and comply with HIPAA regulations. Required Qualifications Active Registered Nurse ...

New

Astrana Health

UM Review Nurse

Monterey Park, CA · Remote

$34 - $47/hr

We are seeking nurses with at least one year of outpatient Utilization Management experience in a ... Complete prior authorization/retrospective review of elective inpatient admissions, outpatient ...

Astrana Health, Inc.

UM Review Nurse

Monterey Park, CA · Remote

$34 - $47/hr

We are seeking nurses with at least one year of outpatient Utilization Management experience in a ... Complete prior authorization/retrospective review of elective inpatient admissions, outpatient ...

Schneck Medical Center

UTILIZATION REVIEW RN

Seymour, IN · On-site

... Retrospective Review 4. Payer Communication & Authorization 5. Denials Management and Appeals Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to ...

Shannon Health

Utilization Review Nurse

Big Spring, TX · On-site

Job Summary The Utilization Review (UR) Nurse has acute knowledge and skills in areas of ... This individual is responsible for performing a variety of concurrent and retrospective UM-related ...

Shannon Health

Utilization Review Nurse

Big Spring, TX · On-site

Job Summary The Utilization Review (UR) Nurse has acute knowledge and skills in areas of ... This individual is responsible for performing a variety of concurrent and retrospective UM-related ...

CorVel

CA Utilization Review Nurse I

$30.64 - $45.80/hr

Utilization Review Nurse The Utilization Review Nurse gathers demographic and clinical information on prospective, concurrent and retrospective in-patient admissions and out-patient treatment ...

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Retrospective Review Nurse information

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$21

$42

$68

How much do retrospective review nurse jobs pay per hour?

As of Aug 8, 2026, the average hourly pay for retrospective review nurse in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

What is the difference between Retrospective Review Nurse vs Utilization Review Nurse?

AspectRetrospective Review NurseUtilization Review Nurse
CertificationsRN license, possibly case management certificationRN license, often case management or utilization review certification
Work EnvironmentReviewing medical records after care has been providedAssessing medical necessity during patient care or pre-authorization
Industry UsageHealthcare, insurance, managed careHealthcare, insurance, managed care
Primary FocusEvaluating past medical records for appropriateness and complianceDetermining medical necessity for current or upcoming services

While both roles involve reviewing medical information, the Retrospective Review Nurse focuses on analyzing past records after treatment, whereas the Utilization Review Nurse assesses the necessity of ongoing or upcoming care. Both positions require similar certifications and are common in healthcare and insurance industries, but their primary focus and timing of review differ.

What is a retrospective review nurse?

A Retrospective Review Nurse is a registered nurse who evaluates medical records after patient care has been provided, typically for the purpose of quality assurance, compliance, or insurance claims review. They analyze documentation to ensure that treatments and services were medically necessary and align with established guidelines. Their work helps healthcare organizations improve care quality, reduce costs, and meet regulatory requirements. Retrospective Review Nurses often collaborate with other medical professionals and use specialized software to review cases efficiently.

How does a retrospective review nurse typically collaborate with other healthcare professionals in the review process?

A Retrospective Review Nurse frequently works alongside physicians, case managers, and claims adjusters to assess the medical necessity and appropriateness of past healthcare services. Collaboration often involves discussing complex cases, clarifying documentation, and providing recommendations for coverage decisions or appeals. Effective communication and teamwork are essential, as the nurse must accurately interpret medical records and convey findings to both clinical and non-clinical team members. This collaborative environment helps ensure that patient care aligns with established guidelines and payer policies.

How to get into utilization review as a retrospective review nurse?

To become a retrospective review nurse, you typically need a registered nurse (RN) license and experience in clinical or case management roles. Gaining knowledge of medical record review, coding, and utilization review processes, along with certifications like the Certified Professional in Healthcare Quality (CPHQ), can improve your qualifications. Employers often seek familiarity with electronic health records (EHR) systems and strong analytical skills for this role.

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

To thrive as a Retrospective Review Nurse, you need a current RN license, a solid understanding of clinical documentation, and experience with medical claims review or utilization management. Familiarity with electronic medical record (EMR) systems, InterQual or Milliman guidelines, and health insurance policies is typically required. Strong analytical skills, attention to detail, and effective communication are essential soft skills for evaluating records and collaborating with providers. These abilities ensure accurate claims review, regulatory compliance, and optimal healthcare outcomes.
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Retrospective Review Nurse jobs near you
Infographic showing various Retrospective Review Nurse job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Retrospective Review LPN

Healthcare Support Staffing

Newark, NJ

$27 - $36.50/hr

Full-time

Medical, Dental, Vision

Re-posted 11 days ago

Job description

Company Description

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Job Description

Job Title: Retrospective Review LPN

Are you an experienced LPN with Utilization Review experience looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered "yes" to any of these questions - this is the position for you!


Position Summary:

As the Retrospective Review LPN, you would be responsible for reviewing medical records against specified guidelines and applying clinical knowledge in the assessment, evaluation and interpretation of clinical notes submitted by providers. 


More Insight of Daily Responsibilities: 

  • Evaluates the medical record so that patient age, time of day, severity of injury, availability of medical resources, etc. are considered 
  • Documents the clinical aspects of the case and the reasoning for the determination 
  • Serves in all phases of the reconsideration process 
  • Verifies eligibility, timeliness and record completeness of ER PLP cases and follows up with the provider as necessary
  • Electronically enters claim detail information in organization applications 
  • Assists in resolving provider issues and keeps communication with internal departments such as Claims and Appeals
  • Participates in process development and testing of new process implementation
  • Evaluates data input and output for accuracy and ensures compliance with data integrity and corporate compliance directives
  • Participates in ad-hoc projects that require clinical evaluation of medical records as directed by the Manager and/or Director


Hours for this Position: Monday-Friday 8:00am-5:00pm 


Advantages of this Opportunity:

  • Competitive salary, negotiable based on experience
  • Benefits offered, Medical, Dental, and Vision
  • Fun and positive work environment
  • Weekly deposit options



Qualifications

What We Look For:

  • Must have clear and active LPN license in the state of NJ
  • 1-2 years of Utilization Review/Utilization Management experience
  • Managed care experience


Additional Information

Want More Information?

If you are interested, please email your resume to ahammer@ healthcaresupport.com or click apply.

The greatest compliment to our business is a referral.

If you know of someone looking for a new opportunity, please pass along my contact information! We offer referral bonuses of up to $100.00 for each placement.

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About Healthcare Support

Sourced by ZipRecruiter

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Maitland, FL, US

Year founded

2003

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