Utilization Review Experience, the nurse can come from a Hospital, Home Health, or Managed Care company/ health plan Additional Information Hello! My name is Krishna Gapuz and I am a R ecruiting ...
Utilization Review Experience, the nurse can come from a Hospital, Home Health, or Managed Care company/ health plan Additional Information Hello! My name is Krishna Gapuz and I am a R ecruiting ...
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 ...
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 ...
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 ...
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 ...
UM Review Nurse
Monterey Park, CA · Remote
$34 - $47/hr
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 deny outpatient ...
UM Review Nurse
Monterey Park, CA · Remote
$34 - $47/hr
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 deny outpatient ...
These reviews are conducted independently of treatment teams to provide objective feedback to ... Determined by the Maryland State Board of Nursing under the licensing requirements for Registered ...
These reviews are conducted independently of treatment teams to provide objective feedback to ... Determined by the Maryland State Board of Nursing under the licensing requirements for Registered ...
HEDIS Review Nurse - Remote - Contract
Dallas, TX · Remote
$42/hr
The review nurse is responsible for medical record abstractions and overreads during the annual Healthcare Effectiveness Data and Information Set (HEDIS) survey. The review nurse is responsible for ...
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HEDIS Review Nurse - Remote - Contract
Dallas, TX · Remote
$42/hr
The review nurse is responsible for medical record abstractions and overreads during the annual Healthcare Effectiveness Data and Information Set (HEDIS) survey. The review nurse is responsible for ...
New
Utilization Review Nurse
Miami, FL · On-site
Utilization Review Nurse Job Summary The Utilization Nurse is responsible for conducting prospective, concurrent, and retrospective clinical reviews to determine medical necessity, level of care, and ...
Utilization Review Nurse
Miami, FL · On-site
Utilization Review Nurse Job Summary The Utilization Nurse is responsible for conducting prospective, concurrent, and retrospective clinical reviews to determine medical necessity, level of care, and ...
Benefits | CoxHealth The Utilization Review Nurse RN collaborates with the physician and members of the multidisciplinary team to facilitate progression-of-care; monitors the patient's progress ...
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Benefits | CoxHealth The Utilization Review Nurse RN collaborates with the physician and members of the multidisciplinary team to facilitate progression-of-care; monitors the patient's progress ...
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Performs verbal/fax clinical review with payer as determined by nursing judgment and/or collaboration with the payer per university contractual obligation. * Participant in UR Committee as needed.
Performs verbal/fax clinical review with payer as determined by nursing judgment and/or collaboration with the payer per university contractual obligation. * Participant in UR Committee as needed.
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 ...
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 ...
Utilization Review Nurse
New Lenox, IL · On-site +1
$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 ...
Utilization Review Nurse
New Lenox, IL · On-site +1
$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 ...
Utilization Review Nurse
$85K - $105K/yr
UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR, 97457, as needed for business operations. EMPLOYMENT TYPE: Full-Time, Exempt About Umpqua Health At ...
Utilization Review Nurse
$85K - $105K/yr
UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR, 97457, as needed for business operations. EMPLOYMENT TYPE: Full-Time, Exempt About Umpqua Health At ...
Care Review Nurse
Columbus, OH · On-site
Review cases for in patients/in hospital: skilled care, acute rehab and long term acute care Nurses working at the facilities Members are being care for, will be sending over clinical information to ...
Care Review Nurse
Columbus, OH · On-site
Review cases for in patients/in hospital: skilled care, acute rehab and long term acute care Nurses working at the facilities Members are being care for, will be sending over clinical information to ...
Utilization Review Nurse
Providence, RI · On-site
... review. · MUST HAVE 1 YEAR OF UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. · MUST HAVE 6 months of Prior Authorization. Education: · Active and unrestricted RN licensure in state ...
Utilization Review Nurse
Providence, RI · On-site
... review. · MUST HAVE 1 YEAR OF UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. · MUST HAVE 6 months of Prior Authorization. Education: · Active and unrestricted RN licensure in state ...
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 ...
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 ...
Utilization Review Nurse
Miami, FL · On-site
Utilization Review Nurse Job Summary The Utilization Nurse is responsible for conducting prospective, concurrent, and retrospective clinical reviews to determine medical necessity, level of care, and ...
Utilization Review Nurse
Miami, FL · On-site
Utilization Review Nurse Job Summary The Utilization Nurse is responsible for conducting prospective, concurrent, and retrospective clinical reviews to determine medical necessity, level of care, and ...
UM Review Nurse
Monterey Park, CA · Remote
$34 - $47/hr
Description 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 ...
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UM Review Nurse
Monterey Park, CA · Remote
$34 - $47/hr
Description 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 ...
Utilization Review Nurse
Roseburg, OR · On-site +1
$85K - $105K/yr
UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR, 97457, as needed for business operations. EMPLOYMENT TYPE: Full-Time, Exempt About Umpqua Health At ...
Utilization Review Nurse
Roseburg, OR · On-site +1
$85K - $105K/yr
UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR, 97457, as needed for business operations. EMPLOYMENT TYPE: Full-Time, Exempt About Umpqua Health At ...
Utilization Review Nurse
New Lenox, IL · On-site
$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 ...
Utilization Review Nurse
New Lenox, IL · On-site
$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 ...
Clinica Review Nurse
Uniondale, NY · On-site
$2.5K/wk
Details Client Name Center Light - Uniondale - Long Island Job Type Travel Offering Nursing Profession RN Specialty Utilization Review Job ID 27808114 Job Title Clinica Review Nurse Weekly Pay $2500 ...
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Clinica Review Nurse
Uniondale, NY · On-site
$2.5K/wk
Details Client Name Center Light - Uniondale - Long Island Job Type Travel Offering Nursing Profession RN Specialty Utilization Review Job ID 27808114 Job Title Clinica Review Nurse Weekly Pay $2500 ...
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Review Nurse information
See salary details
$17.31 - $21.68
3% of jobs
$21.68 - $26.05
7% of jobs
$29.33 is the 25th percentile. Wages below this are outliers.
$26.05 - $30.42
20% of jobs
The median wage is $34.13 / hr.
$30.42 - $34.79
24% of jobs
$34.79 - $39.16
14% of jobs
$41.84 is the 75th percentile. Wages above this are outliers.
$39.16 - $43.53
11% of jobs
$43.53 - $47.90
7% of jobs
$47.90 - $52.27
5% of jobs
$52.27 - $56.64
3% of jobs
$56.64 - $61.01
3% of jobs
$61.01 - $65.38
2% of jobs
$17
$38
$65
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?
| Aspect | Review Nurse | Case Manager Nurse |
|---|---|---|
| Certifications | RN license, possibly specialized certifications | RN license, case management certification often preferred |
| Work Environment | Insurance companies, healthcare review organizations | Hospitals, clinics, insurance companies, community health |
| Primary Responsibilities | Review medical records for insurance claims, compliance, and coverage | Coordinate patient care, develop treatment plans, advocate for patients |
| Industry Usage | Insurance, healthcare review | Healthcare, 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.
More about Review Nurse jobs
What cities are hiring for Review Nurse jobs? Cities with the most Review Nurse job openings:
What are the most commonly searched types of Review Nurse jobs? The most popular types of Review Nurse jobs are:
What states have the most Review Nurse jobs? States with the most job openings for Review Nurse jobs include:
What job categories do people searching Review Nurse jobs look for? The top searched job categories for Review Nurse jobs are:
Job description
Company Description
HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!
Interested in being considered?
IF IS JOB OPPORTUNITY IS FOR YOU, GIVE ME A CALL AT 321-574-6926
Job Description
Day to Day Responsibilities:
Conducts utilization management activities in accordance with Utilization Management policies and procedures. Responds to calls, conducts certification reviews, facilitates the discharge planning and referral process and coordinates denials with physician advisors for all assigned programs.
Receives prospective & concurrent requests for service. Coordinates certification reviews for pre-admission, continued stay and retroactive reviews. Interprets and applies clinical information to make delivery decisions and determine appropriate level of care for utilization review activities. (50%)
Follows departmental policies & procedures for review, determination & notification. Ensures day to day UM processes are conducted in accordance with NCQA, URAC and other regulatory standards. (15%)
Maintains effective interactions/communication w/ outside providers to assure appropriate delivery of service to members. (10%)
Reviews requests for medical necessity (referring cases to medical director that require additional expertise). Coordinate denials with physician advisors (10%)
Documents all activities per APS policies and procedures. (15%)
Work Environment / Physical Demands:
Work is performed in a professional office setting, business casual dress environment.
Working extended hours may be required as needed.
IF IS JOB OPPORTUNITY IS FOR YOU, GIVE ME A CALL AT 321-574-6926 ASAP!
Qualifications
RN License in NY with 2 years of experience
Computer literate. This includes simultaneous use of multiple programs and applications; navigating varied file formats; performing copy/paste, save, and update information in multiple formats.
Utilization Review Experience, the nurse can come from a Hospital, Home Health, or Managed Care company/ health plan
Additional Information
Hello!
My name is Krishna Gapuz and I am a Recruiting Consultant with Healthcare Support. I specialize in the placement of medical professionals nationwide (both clinical and non-clinical). We just had an amazing opportunity become available for a Utilization Review RN right in Syracuse, NY (Zip Code 13202). They are looking to start a qualified candidate as quickly as possible (pending hire requirements). This is an amazing opportunity for a Monday - Friday 8:00a.m.-6:00p.m. job with a stable, prestigious company (This Company is one of the leading providers of Healthcare in your area!)
If you would like to be considered for this opportunity please respond to this Email as soon (today) as possible! (or you're more than welcome to call me at my office 321-574-6926.
If you opt to respond to this Email, please include:
- Why did you leave your last position and how long ago (or why are you looking to leave your current position)?
- How much were you last making (hourly)?
- If offered, how soon could you start?
About Healthcare Support
Sourced by ZipRecruiter
HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.
Industry
Recruiting and staffing services
Company size
201 - 500 Employees
Headquarters location
Maitland, FL, US
Year founded
2003