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Review Nurse Jobs (NOW HIRING)

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 ...

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 ...

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 ...

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 ...

Integrated Resources INC

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 ...

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 ...

iPlace USA

Concurrent Review Nurse

Bedford, NH

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 ...

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How much do review nurse jobs pay per hour?

As of Aug 26, 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 1% As Needed, 81% Full Time, 14% Part Time, 3% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $80,321 per year, or $38.6 per hour.

Utilization Review Nurse

Granville Health System

Oxford, NC • On-site

Other

Re-posted 5 days ago

Granville Health System rating

8.6

Company rating: 8.6 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

Job description

Position Summary:

Conducts patient reviews as specified in review plan using screening criteria; identifies and documents actual and potential delays in services or treatment and works with departments and other providers to resolve problems; communicates to attending physician need for documentation for admission or continuation of hospitalization; refers cases that do not meet criteria to Director when needed. Screens all cases against high risk screens for discharge planning; conduct concurrent and retrospective reviews.

Qualifications:

North Carolina License as a Registered Nurse. Three years clinical nursing experience. One year utilization and review experience. Experience with MCG authorization criteria preferred. Knowledge of current nursing principles, techniques, procedures; knowledge of current utilization management criteria and standards. Excellent communication skills. Ability to work with physicians and hospital staff. Maintains professional knowledge and skills related to areas of responsibility. Self direction with the ability to work with minimal supervision and manage multiple tasks. Demonstrates understanding of variations in care of the following age groups - newborn, infant, child, adolescent, adult and geriatric.

What Granville Health System employees say

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Hours and flexibility

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