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Review Nurse Jobs (NOW HIRING)

Fusion HCR

Utilization Review Nurse

Las Vegas, NV · On-site

Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in Acute Care. Overview Seeking an experienced Utilization Review Nurse (RN) to review patient admissions ...

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 Floor, Orange, CA 92868 Reporting To: Brenda Fresnares 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 ...

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 ...

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 ...

UNC Health

Utilization Review Nurse

Kinston, NC · On-site

Utilization Review Nurse Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve. Summary: This ...

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 ...

CommonSpirit Health

Utilization Review Nurse

Job Summary and Responsibilities As our Utilization Review Nurse, you will ensure the medical necessity and appropriateness of care for all hospitalized patients, promoting fiscal responsibility and ...

Leon Health, Inc.

Concurrent Review Nurse

Miami, FL · On-site

Under the general supervision of the Director of Health Services, the Concurrent Review Nurse is responsible for ensuring the delivery of medically necessary, high-quality, and cost-effective care.

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How much do review nurse jobs pay per hour?

As of Aug 8, 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.

What does a review nurse do?

A review nurse evaluates patient records, medical documentation, and treatment plans to ensure compliance with healthcare standards and regulations. They often work in insurance, legal, or healthcare settings, analyzing cases for accuracy and appropriateness, and may require knowledge of medical coding and documentation practices.

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.

What is a review nurse?

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 become a review nurse?

To become a review nurse, you typically need to hold a registered nurse (RN) license, which requires completing an accredited nursing program and passing the NCLEX-RN exam. Experience in clinical nursing and knowledge of medical records and documentation are important, and some positions may require certification in case management or utilization review.
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Review Nurse jobs near you
Infographic showing various 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 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $80,321 per year, or $38.6 per hour.

Utilization Review Nurse

Fusion HCR

Las Vegas, NV • On-site

Other

Re-posted yesterday

Job description

Fusion HCR is hiring!Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in Acute Care.
Overview
Seeking an experienced Utilization Review Nurse (RN) to review patient admissions for medical necessity, appropriate level of care, and compliance with payer guidelines. This role works closely with clinical teams to ensure efficient resource utilization and quality patient outcomes.
Responsibilities
  • Review admissions using InterQual and/or Milliman criteria
  • Evaluate medical necessity, level of care, and documentation accuracy
  • Ensure compliance with Medicare, Medicaid, and regulatory guidelines
  • Collaborate with physicians, case management, and care teams
  • Support discharge planning and care coordination
  • Document findings and communicate recommendations

Requirements
  • Active RN license (Nevada)
  • 5+ years acute care nursing experience
  • 3+ years Utilization Review experience
  • 3+ years discharge planning experience (acute care)
  • Experience with InterQual (must be able to pass exam)
  • Experience with Milliman guidelines

Preferred
  • Background in Case Management or CDI
  • Strong knowledge of Joint Commission and CMS guidelines

Why Apply
  • Competitive pay
  • Stable, high-demand role
  • Collaborative healthcare environment

Apply Now
If you have strong Utilization Review, InterQual, and acute care experience, we want to hear from you!

Apply