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Review Nurse Jobs (NOW HIRING)

Global Force

Utilization Review Nurse

Las Vegas, NV · On-site

About the job Utilization Review Nurse Sign on bonus may apply up to $15,000 Position Summary: Reviews patient admissions for appropriateness, efficiency of resource utilization and compliance with ...

Oscar Health

Utilization Review Nurse

Dallas, TX · 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 ...

Oscar Health

Utilization Review Nurse

Miami, FL · 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 ...

Oscar Health

Utilization Review Nurse

Atlanta, GA · 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 ...

Shannon Health

Utilization Review Nurse

Big Spring, TX · On-site

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 ...

US Tech Solutions

Utilization Review Nurse

Chicago, IL · On-site

Do you have experience with Utilization Review? * Do you have an Active Registered Nurse License? About US Tech Solutions: US Tech Solutions is a global staff augmentation firm providing a wide range ...

IntePros

Utilization Review Nurse

Philadelphia, PA · On-site

PA RN License Required We are seeking an experienced Care Management Coordinator to join our Infusion Therapy team. This role is responsible for performing utilization management reviews to determine ...

Medix

Utilization Review Nurse

Orange, CA · On-site

$38 - $53/hr

Job Summary Our client is seeking a Utilization Review Nurse responsible for managing the complete Utilization Management (UM) process, from admission through discharge planning. The primary goal is ...

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 ...

Florida Blue

Concurrent Review Nurse

Jacksonville, FL · On-site

$71K - $115K/yr

Registered Nurse - State Licensure And/Or Compact State Licensure Florida * Experience in one or more of the following: home health care, rehab, SNF, utilization review, discharge planning or case ...

Shannon Health

Utilization Review Nurse

Big Spring, TX · On-site

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 ...

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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

Global Force

Las Vegas, NV • On-site

Other

Posted 5 days ago

Job description

About the job Utilization Review Nurse
Sign on bonus may apply up to $15,000
Position Summary: Reviews patient admissions for appropriateness, efficiency of resource utilization and compliance with third party payer requirements. Duties include analyzing medical charts, determining whether care provided is within established parameters.
Job Requirement
Education/Experience:
Graduation from an accredited school of nursing and five (5) years of acute hospital clinical nursing experience, one (1) year of which was in Utilization Management, Case Management, or Clinical Documentation Improvement.
Licensing/Certification Requirements:
Valid license by the State of Nevada to practice as a Registered Nurse.
Additional Position Requirements

  • Minimum three (3) years of Utilization Management experience.
  • Minimum of three (3) year's experience with discharge planning in an acute care facility.
  • Recent documented experience with InterQual, and ability to pass the InterQual exam.
  • Recent documented experience with Milliman experience.

Knowledge, Skills, Abilities, and Physical Requirements
Knowledge of:
Interquel or Milliman utilization review criteria, Medicare/Medicaid guidelines, hospital policies and procedures; Joint Commission Accredited Health care Organizations standards, state statutes governing hospital services and health care, and other relevant regulations and standards; clinical medical and nursing procedures; disease processes; department and hospital safety practices and principles; patient rights; age specific patient care practices; infection control policies and practices; department and hospital emergency response policies and procedures.
Skill in:
Interpreting patient charts to determine whether care given is within best practice, appropriate for the diagnosis and properly documented; excellent ability to collaborate, co-ordinate and communicate findings; interpreting regulations and standards for others; writing reports, meeting minutes and other technical documents; analyzing statistical and other quantitative data; applying investigative and interviewing techniques; using a computer and a variety of software applications; communicating with a wide variety and establishing interpersonal relationships to interact effectively with co-workers, supervisor, staff in other work units and exchange or convey information.
Physical Requirements and Working Conditions:
Mobility to work in a typical office setting and use standard equipment, stamina to remain seated for extended periods of time, vision to read printed materials and a computer screen, and hearing and speech to communicate effectively in person and over the telephone. Strength and agility to exert up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects. May work shifts and weekends. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this classification.

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