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Rn Utilization Review Nurse Jobs (NOW HIRING)

talent4health

RN - Utilization Review

Cleveland, OH · On-site

$2.2K/wk

Details Client Name Southwest General Hospital Center Southwest General Health Center Job Type Travel Offering Nursing Profession RN Specialty Utilization Review Job ID 18807560 Job Title RN - ...

Talent4Health

RN - Utilization Review

Fort Myers, FL · On-site

$2.0K/wk

  • Medical

  • Dental

  • Vision

Details Client Name Lee Health-Corporate Center Job Type Travel Offering Nursing Profession RN Specialty Utilization Review Job ID 37756438 Job Title RN - Utilization Review Weekly Pay $2033.0 Shift ...

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Medlivo

Travel Nurse RN - Utilization Review

Atlanta, GA · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Medlivo is seeking a travel nurse RN Utilization Review for a travel nursing job in Atlanta, Georgia. & Requirements * Specialty: Utilization Review * Discipline: RN * Duration: 13 weeks * 40 hours ...

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How much do rn utilization review nurse jobs pay per hour?

As of Aug 14, 2026, the average hourly pay for rn utilization review nurse in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as an RN Utilization Review Nurse?

To thrive as an RN Utilization Review Nurse, a current RN license, strong clinical knowledge, and experience with healthcare regulations and insurance guidelines are essential. Familiarity with medical review software, EHR systems, and utilization management platforms—as well as certification such as CCM (Certified Case Manager)—is often required. Strong analytical thinking, attention to detail, and effective communication with interdisciplinary teams set outstanding candidates apart. These skills ensure accurate care assessments, compliance with insurance requirements, and effective coordination between providers, patients, and payers.

What is an RN Utilization Review Nurse?

An RN Utilization Review Nurse evaluates patient care to ensure medical services are necessary, efficient, and compliant with healthcare regulations. They review medical records, collaborate with healthcare providers, and assess treatment plans to optimize patient outcomes while managing costs. These nurses often work for hospitals, insurance companies, or healthcare organizations, ensuring appropriate resource utilization. Their role helps prevent unnecessary procedures and supports quality patient care.

How to get into utilization review as a registered nurse?

To become a utilization review nurse, registered nurses typically need clinical experience, knowledge of healthcare policies, and familiarity with medical records and insurance processes. Earning certifications such as the Certified Professional in Healthcare Quality (CPHQ) or Utilization Review Certification (URAC) can enhance qualifications. Strong analytical skills and understanding of medical necessity criteria are also important for success in this role.

What does an RN Utilization Review Nurse do?

A typical day for an RN Utilization Review Nurse involves reviewing patient medical records to determine the medical necessity of hospital admissions or ongoing care, communicating with physicians, case managers, and insurance representatives, and documenting decisions in electronic health record systems. You will often spend a significant amount of time on critical assessments, phone or email correspondence, and ensuring compliance with regulatory and insurance guidelines. The work is generally office-based or remote, and you may collaborate closely with both clinical and administrative staff. This structured environment allows you to leverage your clinical background while supporting cost-effective, high-quality patient care.

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Rn Utilization Review Nurse jobs near you
Infographic showing various Rn Utilization 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 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

RN Utilization Review (UR)

Integrated Resources

Atlanta, GA • On-site

Other

Posted 8 days ago

Job description

Job Title: RN Utilization Review
Location: Atlanta, GA
Duration: 5 months contract (possibility of extension)
Shift Time: Day Shift | 08:30 AM to 05:00 PM | Every other weekend & holidays required
Responsibilities Include:
  • Perform utilization reviews for inpatient and outpatient cases.
  • Evaluate medical necessity, level of care, and appropriateness of admissions and continued stays.
  • Review clinical documentation to ensure compliance with organizational, payer, and regulatory requirements.
  • Collaborate with physicians, case managers, and multidisciplinary teams to optimize patient care and resource utilization.
  • Identify opportunities for improved clinical documentation and efficient care delivery.
  • Maintain accurate and timely documentation in the electronic medical record (EMR).
  • Ensure compliance with CMS, Medicare, Medicaid, and commercial payer guidelines.
  • Participate in interdisciplinary meetings and discharge planning when required.
Required Certificate :
  • Minimum 1 years of recent RN Utilization Review, Case Management, or Acute Care Nursing experience.
  • Active Registered Nurse (RN) License (Georgia or Compact License).
  • BLS (AHA)

*** REFERRAL BONUS $750 ON EACH SUCCESFUL REFERRAL***
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About Integrated Resources

Sourced by ZipRecruiter

Integrated Resources Inc (IRI), based in Edison, NJ, US, is an esteemed player in the staffing solutions industry with a credible presence on their official website irionline.com. Notably, IRI provides a range of professional staffing services including contract, contract-to-hire, and direct hire solutions to a wide spectrum of industries such as healthcare, life sciences, manufacturing, financial, insurance, and others. Since its inception, IRI has been committed to delivering top-talent and optimum solutions to meet its clients' diverse needs.

Industry

Recruiting and staffing services

Company size

51 - 200 Employees

Headquarters location

Edison, NJ, US

Year founded

1996

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