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Review Nurse Jobs (NOW HIRING)

ALOIS Healthcare

RN - Utilization Review

Pocatello, ID · On-site

Utilization Review Nurse A utilization review nurse is a registered nurse (RN) who is responsible for ensuring patients receive necessary care without performing unnecessary or duplicate services.

Astrana Health, Inc.

UM Review Nurse

$34 - $47/hr

UM Review Nurse Department: HS - UM Employment Type: Full Time Location: 1600 Corporate Center Dr., Monterey Park, CA 91754 Reporting To: Phillip Vasquez Compensation: $34.00 - $47.00 / hour ...

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., Monterey Park, CA 91754 Reporting To: Phillip Vasquez Compensation: $34.00 - $47.00 / hour ...

Cobalt Benefits Group

Utilization Review Nurse

Utilization Review Nurse (Ur Nurse) Join our team at Cobalt Benefits Group and start an exciting new career in employee benefits solutions. As a Utilization Review Nurse (UR Nurse), you'll play an ...

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 ...

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 Health Services Department. In this position, you will utilize your clinical judgement to approve or ...

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You will perform frequent case reviews, check medical records and speak with care providers regarding ...

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How much do review nurse jobs pay per hour?

As of Jul 11, 2026, the average hourly pay for review nurse in the United States is $38.62, according to ZipRecruiter salary data. Most workers in this role earn between $29.57 and $43.27 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Review Nurse, and why are they important?

To thrive as a Review Nurse, you need a solid background in clinical nursing, strong analytical abilities, and typically an active RN license. Familiarity with medical coding systems (such as ICD-10 and CPT), utilization management software, and electronic medical records is commonly required. Excellent attention to detail, critical thinking, and effective communication skills set top performers apart in this role. These competencies are crucial for ensuring accurate case reviews, compliance with healthcare regulations, and clear collaboration with healthcare teams and insurers.

How to make an extra $2000 a month as a nurse?

Review nurses can increase their income by taking on additional shifts, working overtime, or joining per diem or travel nursing assignments that pay higher rates. Developing specialized skills or certifications, such as in critical care or anesthesia, can also qualify them for higher-paying roles or side opportunities like telehealth consulting.

What does a review nurse do?

A review nurse evaluates medical records and patient information to determine insurance coverage, compliance, or quality of care. They analyze documentation, ensure accuracy, and may collaborate with healthcare providers or insurance companies to facilitate claims or audits.

How does a Review Nurse typically collaborate with physicians and other healthcare professionals to ensure accurate patient care decisions?

As a Review Nurse, you will regularly communicate with physicians, case managers, and other healthcare professionals to review medical records, discuss patient care plans, and ensure that treatments align with established guidelines. Collaboration often involves clarifying clinical details, providing evidence-based recommendations, and sometimes participating in interdisciplinary team meetings. This collaborative approach helps ensure that patient care decisions are well-informed, compliant with regulations, and medically necessary, while also supporting efficient healthcare delivery.

How to become a nurse reviewer?

To become a nurse reviewer, you typically need a valid nursing license and several years of clinical experience. Strong analytical skills, attention to detail, and familiarity with medical documentation are important, and some roles may require knowledge of medical coding or review software.

What are review nurses and what do they do?

Review nurses are registered nurses who evaluate medical records and treatment plans to ensure that healthcare services provided to patients are medically necessary and meet regulatory standards. They often work for insurance companies, hospitals, or government agencies, reviewing claims and authorizations for procedures or medications. Their goal is to ensure quality care while controlling costs, and they may communicate with healthcare providers to clarify or obtain additional information. Review nurses play a key role in utilization management and healthcare compliance.

What is the difference between Review Nurse vs Case Manager Nurse?

AspectReview NurseCase Manager Nurse
CertificationsRN license, possibly specialized certificationsRN license, case management certification often preferred
Work EnvironmentInsurance companies, healthcare review organizationsHospitals, clinics, insurance companies, community health
Primary ResponsibilitiesReview medical records for insurance claims, compliance, and coverageCoordinate patient care, develop treatment plans, advocate for patients
Industry UsageInsurance, healthcare reviewHealthcare, insurance, social services

Review Nurses primarily focus on evaluating medical records for insurance claims and compliance, while Case Manager Nurses coordinate patient care and develop treatment plans. Both roles require RN licensure, but their work environments and responsibilities differ significantly.

How to make 300,000 as a nurse?

To earn $300,000 as a review nurse or in nursing generally, professionals often work in high-paying specialties such as nurse anesthetist or nurse practitioner, which require advanced certifications and education. Working in specialized, high-demand environments, taking on overtime, or pursuing leadership roles can also increase income significantly.
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Review Nurse jobs near you
Utilization Review Nurse

Utilization Review Nurse

Health Business Solutions LLC

Cooper City, FL

Full-time

Posted 3 days ago

New

Job description

Job Summary: We are seeking a highly motivated and experienced Utilization Review Nurse to join our team. The Utilization Review Nurse will play a crucial role in supporting our clients in the healthcare industry by providing expert clinical guidance, facilitating effective utilization management, and ensuring revenue cycle efficiency. This position offers a unique opportunity to combine clinical expertise with revenue cycle management knowledge.

Key Responsibilities:

· Clinical Assessment: Conduct comprehensive clinical assessments of medical records to ensure patients are receiving appropriate care at the correct level of service.

  • Care Coordination: Collaborate with interdisciplinary healthcare teams to coordinate patient care and treatment plans, ensuring the most cost-effective and clinically appropriate care is provided.
  • Revenue Cycle Management: Utilize clinical expertise to support revenue cycle processes, including accurate coding, documentation improvement, and compliance with healthcare regulations.
  • Utilization Review:

a) Apply medical necessity screening criteria and clinical knowledge to ensure appropriateness of admissions and length of stays

b) Conduct initial admission, continuing stay, and 23-hour observations reviews for all patients

c) Support Utilization Review Coordinator team members on cases escalated for level of care determinations

d) Screen cases for Physician Advisor review

e) Collaborate with insurance companies on concurrently denied and high risk for denial cases

  • Documentation Improvement: Identify opportunities for improving clinical documentation to support accurate coding and billing processes, ultimately improving reimbursement.


  • Data Analysis: Analyze clinical and financial data to identify trends, opportunities for improvement, and areas of potential cost savings for clients.


  • Compliance: Stay up-to-date with healthcare regulations, guidelines, and policies to ensure all patient care and revenue cycle processes are in compliance with industry standards and regulatory requirements to ensure appropriate reimbursement.

Qualifications:

· Registered Nurse (RN) licensure required; must hold a USRN multi-state/compact nursing license.

· Bachelor of Science in Nursing (BSN) preferred.

· Case Management Certification (e.g., CCM) is a plus.

· Minimum of 3 years of clinical nursing experience, preferably in a hospital or acute care setting.

· Minimum 2 years of work experience in Utilization Review

· Strong understanding of revenue cycle management and healthcare reimbursement.

· Proficiency in medical coding and clinical documentation improvement.

· Excellent communication, interpersonal, and teamwork skills.

· Ability to work independently and make sound clinical and financial decisions.

· Strong analytical and problem-solving skills.

· Proficient in using healthcare information systems and technology.

· Commitment to maintaining patient confidentiality and ethical standards.

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