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Retrospective Review Nurse Jobs (NOW HIRING)

AbsoluteCare

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 initial, concurrent and retrospective clinical case reviews. This role collaborates and communicates with ...

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 initial, concurrent and retrospective clinical case reviews. This role collaborates and communicates with ...

Corvel

CA Utilization Review Nurse I

Rancho Cucamonga, CA · Remote

$30.64 - $45.80/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

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

Corvel

CA Utilization Review Nurse I

Rancho Cucamonga, CA · On-site

$30.64 - $45.80/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

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

CorVel

CA Utilization Review Nurse I

Rancho Cucamonga, CA · On-site

$30.64 - $45.80/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

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

Healthcare Support Staffing

Appeals Review Nurse

Tampa, FL

$24.50 - $31.75/hr

  • Medical

  • Dental

  • Vision

Reviews clinical information provided by the facility and providers to evaluate the medical ... concurrent and retrospective decisions in the appeals process * Produces approval and denial ...

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Retrospective Review Nurse information

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How much do retrospective review nurse jobs pay per hour?

As of Aug 18, 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, 82% Full Time, 13% Part Time, 3% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Nurse

AbsoluteCare

New Orleans, LA • On-site

Full-time

Medical, Dental, Vision, Life, Retirement

Re-posted 9 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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