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Retrospective Review Nurse Jobs (NOW HIRING)

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 ...

AbsoluteCare

Utilization Review Nurse

New Orleans, LA · On-site

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 ...

AbsoluteCARE

Utilization Review Nurse

New Orleans, LA · On-site

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 ...

HandsOn Global Management

Be Seen First

UM Review Nurse

Tampa, FL · Remote

$36 - $40/hr

Performs prospective, concurrent, and retrospective inpatient and/or outpatient utilization reviews ... Licensed RN or LPN required. * Minimum of two to three years varied clinical experience required.

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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.
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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, 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

Shannon Health

Big Spring, TX • On-site

Full-time

Re-posted 14 days ago

Job description

Job Summary

The Utilization Review (UR) Nurse has acute knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the UM program by developing and/or maintaining effective and efficient processes for determining the appropriate admission status based on the regulatory and reimbursement requirements of various commercial and government payers. This individual is responsible for performing a variety of concurrent and retrospective UM-related reviews and functions and for ensuring that appropriate data is tracked, evaluated, and reported. There will be interaction with providers, patient, and the care team for continued UM process. Further job duties will include Denial prevention, denial management, Implementation of process improvements to mitigate payer denials & improve front-end processes, Collaboration with internal Physician Advisor and external physician advisors regarding physician practices (particularly documentation deficiencies/admission practices). This individual identifies, develops, and provides orientation, and training, for appropriate staff and colleagues on an ongoing basis. He/she actively participates in process improvement initiatives, working with a variety of departments and multi-disciplinary staff. This individual maintains current and accurate knowledge regarding commercial and government payers and CIHQ regulations/guidelines/criteria related to UM. The UR Nurse effectively and efficiently manages a diverse workload in a dynamic regulatory environment. The UR Nurse is a member of, and provides support to, the hospital’s UR Committee. He/she collaborates with multiple leaders at various levels throughout Shannon Health, for the purpose of supporting and improving the UM program.

Qualifications

Education

  • Required
    • High School Diploma, GED, or equivalent
    • Associate’s degree in Nursing
  • Preferred
    • Bachelor’s degree in Nursing

Experience:

  • Required
    • Five years of experience in Clinical Nursing
  • Preferred
    • Three years of experience in Inpatient Utilization Review

Certification/Licensure:

  • Required
    • Registered Nurse (RN), with authorization to practice in the State of Texas
  • Preferred
    • Accredited Case Manager (ACM) through ACMA
    • Certified Case Manager (CCM) through CCMC

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