ZipRecruiter

Log In

1

Retrospective Review Nurse Jobs (NOW HIRING)

Sentara Healthcare

UTILIZATION REVIEW NURSE

Norfolk, VA · On-site +1

The Utilization Review Nurse is responsible for utilization management services within the scope of ... Conducts primary functions of prior authorization, retrospective review, medical director referrals ...

Sentara Health Plans

$65 - $85/hr

Conducts primary functions of prior authorization, retrospective review, medical director referrals ... Registered Nurse (required) Experience * 3 years of acute care clinical experience (required)

Sentara Health Plans

UTILIZATION REVIEW NURSE

Norfolk, VA · On-site

$65 - $85/hr

Conducts primary functions of prior authorization, retrospective review, medical director referrals ... Registered Nurse (required) Experience * 3 years of acute care clinical experience (required)

Houston Healthcare

$80 - $100/hr

Work Shift The Utilization Reviewer performs concurrent, extended stay and retrospective reviews of ... Graduate of an accredited School of Nursing. * Experience: Three (3) years in an acute care setting.

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 ...

next page

Showing results 1-20

All JobsHealthcare JobsNursing JobsUtilization Review Nurse JobsRetrospective Review Nurse Jobs

Retrospective Review Nurse information

See salary details

$21

$42

$68

How much do retrospective review nurse jobs pay per hour?

As of Sep 7, 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 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.

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.

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.

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.

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.
More about Retrospective Review Nurse jobs

What cities are hiring for Retrospective Review Nurse jobs?

Cities with the most Retrospective Review Nurse job openings:

What states have the most Retrospective Review Nurse jobs?

States with the most job openings for Retrospective Review Nurse jobs include:

What job categories do people searching Retrospective Review Nurse jobs look for?

The top searched job categories for Retrospective Review Nurse jobs are:

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, 81% Full Time, 14% Part Time, 1% Temporary, and 3% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

UTILIZATION REVIEW NURSE

Sentara Healthcare

Norfolk, VA • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 13 days ago

Sentara Health rating

6.8

Company rating: 6.8 out of 10

Based on 417 frontline employees who took The Breakroom Quiz

495th of 898 rated healthcare providers

Job description

City/State
Norfolk, VA
Work Shift
First (Days)
Overview:
Sentara Health Plans Community Care is looking to hire a Utilization Review Nurse.
The Utilization Review Nurse is responsible for utilization management services within the scope of licensure. Conducts primary functions of prior authorization, retrospective review, medical director referrals and execution of member/provider approval and/or denial letter. Reviews provider requests for services requiring authorization. Conducts pre-certification, care coordination for appropriateness of treatment, set reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
Responsible for written and/or verbal notification to members and providers. Ensures medical director written decision is consistent with criteria (CMS, state, medical policy, clinical criteria). Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.
Education:
• BSN (preferred)
Certification:
• Registered Nurse (required)
Experience:
• 3 years of acute care clinical experience (required)
• Previous Utilization Review experience (preferred)
• Milliman experience (preferred)
• Knowledge of NCQA (preferred)
• Microsoft suite (Word, Excel, Outlook) (preferred)
• Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills
Keywords: Talroo- Health, Utilization Review Nurse, RN, Care Coordination, or Discharge Planning, Case Management, Milliman, NCQA
Benefits: Caring For Your Family and Your Career
• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to 10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance - 5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down - 10,000
• Pet Insurance
• Legal Resources Plan
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.
Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
In support of our mission "to improve health every day," this is a tobacco-free environment.
For positions that are available as remote work, Sentara Health employs associates in the following states:
Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

What Sentara Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply