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Rn Utilization Review Nurse Jobs (NOW HIRING)

Phenom People

RN Utilization Review PRN

Paris, KY · On-site

PRN, RN - Utilization Review Making Communities Healthier with Comprehensive Care... You can get to know who we are and what truly makes us different by our mission, 'Making Communities Healthier'

US Tech Solutions

Utilization Review Nurse

Canton, MA · On-site

$55 - $60/hr

Active, unrestricted Registered Nurse (RN) license. * Associate Degree in Nursing (ADN) required ... Utilization Management (UM) * Medical Necessity Review * Prior Authorization * Precertification

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 ... Valid license by the State of Nevada to practice as a Registered Nurse. Additional Position ...

AbsoluteCare

Utilization Review Nurse

New Orleans, LA · On-site

The Utilization Review Nurse ensures appropriate utilization of health services by performing ... Active Registered Nurse license by the State of Louisiana and/or the state(s) in which the nurse is ...

Jacobi Medical Center

RN - Utilization Review

Bronx, NY · On-site

$2.8K/wk

Details Client Name Jacobi Medical Center - NYCHH Job Type Travel Offering Nursing Profession RN Specialty Utilization Review Job ID 18960406 Weekly Pay $2816.09 Shift Details Shift 5x8 Days ...

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

As of Aug 19, 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 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.

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.

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.

How to get into utilization review as a registered nurse?

To become a utilization review nurse, registered nurses typically need clinical experience and knowledge of healthcare policies. Earning certifications such as the Certified Professional in Healthcare Quality (CPHQ) or Utilization Review Certification (URC) can improve job prospects. Familiarity with medical records, insurance processes, and strong communication skills are also important for success in this role.
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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, 82% Full Time, 13% Part Time, 3% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

RN / Utilization Review

TPF Nursing Agency

Middleburg Heights, OH • On-site

Other

Medical, Dental, Vision, Retirement

Re-posted 12 days ago

Job description

TPF Nursing welcomes you to our job board. Please review the job opportunity below:
Client: Southwest General Hospital Health Center
Location: Middleburg Heights OH
Shift: 5 x 8 Days
Start / End: Mon 7/20/26 - 10/17/26
Duration: 13 Weeks
Highlights

  • Shift: 8am-4:30pm
  • Minimum of five (5) years recent RN experience
  • Previous Case Management or Utilization Management Experience required
  • Previous experience with screening criteria Cerner, InterQual, and MCG Criteria, Standardized Templates required
  • Full-Time 40 hours per week, 5 (8) hour shifts 8a-4:30p, as well as every 3rd weekend
  • Minimum of five (5) years recent experience in clinical nursing or related nursing field. (e.g. Utilization Review or Case Management)
  • Previous Care Management, Case Management or Utilization Management Experience
  • Experience with doing 30+ reviews a day
  • Previous experience with screening criteria including Cerner, InterQual, and MCG is required
  • Excellent critical thinking and communication skills
  • Strong computer skills
  • Current licensure by Ohio State Board of Nursing
  • ACM/CCM Certification helpful
  • Is candidate local to facility? Highly desired
If you have any questions, please feel free to call us directly at 212-219-2677 and ask for a recruiter. We encourage applicants and staff to ask questions, discuss potential / existing assignments, keep us informed about their needs and how we might help. Most clinical contracts are 13 weeks with a didactic and clinical orientation. These clinical opportunities are updated on a regular basis, so please come back if you don't see an opportunity that suits you.
Benefits available through agency:
  • Health Insurance
  • Dental Insurance
  • Vision Insurance
  • Safe Harbor and Retirement Savings Plan -401k
  • Weekly Pay
  • 24/7 On Call
  • Holiday OT
  • Sick Pay
  • FMLA
  • Joint Commission Certified

LT # 22836

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