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Review Nurse Jobs (NOW HIRING)

Penn Medicine

Utilization Review Nurse

West Chester, PA · On-site

The Utilization Review Nurse will provide utilization review for authorization, concurrent review and discharge review services using InterQual criteria guidelines to validate medical necessity and ...

Netsmart

Utilization Review Nurse

Review, analyze, and identify utilization patterns and trends, problems, or inappropriate utilization of resources Qualifications Required * Current and unrestricted RN license * At least 3 years ...

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 ...

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 ...

silvercross

Utilization Review Nurse

$34.73 - $45.15/hr

Nurse, Registered (RN) licensure * BSN preferred. 2-5 years previous Utilization Review experience preferred. * Current CPR * Relevant hospital nursing; hospital case management; insurance case ...

McBee Associates

Utilization Review Nurse

Review, analyze, and identify utilization patterns and trends, problems, or inappropriate utilization of resources Qualifications Required * Current and unrestricted RN license * At least 3 years ...

MNCP Staffing

Utilization Review Nurse

Las Vegas, NV · On-site

Reviews patient admissions for appropriateness, efficiency of resource utilization and compliance ... Graduation from an accredited school of nursing and five (5) years of acute hospital clinical ...

iPlace USA

Concurrent Review Nurse

Bedford, NH · On-site

Perform onsite review of emergent/urgent and continued stay requests Qualifications * 2+ years of clinical nursing experience in an acute care. * Current state's RN license. Additional Information ...

Medix

Utilization Review Nurse

Southfield, MI · On-site

$42 - $46/hr

Job Summary Our client is seeking a Utilization Review Nurse. This role involves managing the full lifecycle of Independent Review Organization (IRO) cases, ensuring compliance with regulatory ...

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How much do review nurse jobs pay per hour?

As of Aug 22, 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 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.

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 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 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 100% Full Time. Highlights an 100% Remote job distribution, with an average salary of $80,321 per year, or $38.6 per hour.

Utilization Review Nurse

Pennsylvania Medicine

West Chester, PA • On-site

Per diem

Posted 12 days ago

Job description

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.
Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?
Summary:
  • The Utilization Review Nurse will provide utilization review for authorization, concurrent review and discharge review services using InterQual criteria guidelines to validate medical necessity and appropriateness of the treatment plan. Uses critical thinking/leadership skills to ensure patients are at appropriate level of care, safely transitioned across the healthcare continuum, and third-party payor standards are met. Reports same to the Utilization Review Committee responsible for ensuring appropriate utilization review practices to decrease LOS/readmissions, prevent financial loss and lower financial risk. The Utilization Nurse will seek out and resolve discrepancies/delays in the care delivery process. Assures appropriate services are generated in a timely and cost-effective manner.

Responsibilities:
  • Works collaboratively and maintains active communication with physicians, nursing and other members of the multi-disciplinary care team to effect timely, appropriate patient management.
    Assesses patient progress through the expected in-house course, mobilizing resources of the patient care team to ensure patient outcomes are achieved as planned.
    Is the liaison between third party payors and actively participates in denial management activities.
    Works with physicians in documenting medical care to accurately and completely reflect intensity of service and severity of illness.
    Evaluates the appropriateness of continued stay by performing concurrent review and reviewing planned interventions with the physician. Makes appropriate recommendations for continued stay and/or modification of the care plan and course of treatment.
    Consults and advises members of the interdisciplinary team and ancillary staff to facilitate patients toward targeted outcomes.
    Collaborates appropriately with physician advisor to avoid denials.
    Serves as preceptor to new hires.
    Identifies trends in inappropriate utilization of resources, including, but not limited to, delays in diagnostic testing, medical surgical procedures and physician management.
    Promotes individual professional growth and development by meeting requirements for mandatory/continuing education, skills competence, supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor, and resource to less experienced staff.
    Communicates relevant clinical information including admission review, concurrent review and discharge planning needs, to third party payors to secure optimal reimbursement.
    Applies InterQual criteria to monitor appropriateness of admissions and continued stays and documents findings in the electronic health record.
    Follows 100% of assigned inpatient admissions
    Determines medical appropriateness of the patient's admission (severity of service)
    Monitors the plan of care and proactively identifies barriers to the plan (intensity of service)
    Intervenes to avoid delays in plan of care.
    Coordinates the flow of clinical information with third party payors to ensure appropriate reimbursement, proactively identifies potential denials in order to avoid non-appealable denials.
Credentials:
  • Registered Nurse - PA (Required)
  • Certified Case Manager
Education or Equivalent Experience:
  • Associate of Arts or Science (Required)
  • Major/Area of Study: Nursing/ASN 3+ years nursing experience
  • Bachelor of Arts or Science
  • Major/Area of Study: Nursing/BSN 3+ years nursing experience 1+ years utilization review
We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.
Live Your Life's Work
We are an Equal Opportunity employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.

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