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Sco Um Review Rn Jobs (NOW HIRING)

Next Move Healthcare

RN, Utilization Review

Hanover, MD · On-site

RN, Utilization Review Care Career is looking for Utilization Review RN's to fulfill an assignment in Hanover, Maryland. Benefits: * Medical, dental, vision, and 401K within the first month * Maximum ...

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How much do sco um review rn jobs pay per hour?

As of Jun 22, 2026, the average hourly pay for sco um review rn in the United States is $44.48, according to ZipRecruiter salary data. Most workers in this role earn between $33.65 and $51.92 per hour, depending on experience, location, and employer.

What are some common challenges faced by a SCO UM Review RN and how can they be managed effectively?

A SCO UM Review RN often faces challenges such as balancing a high volume of case reviews with the need for thorough, accurate assessments and staying updated with frequently changing regulatory requirements. Time management and strong organizational skills are crucial for managing daily responsibilities, which typically include reviewing medical records, collaborating with interdisciplinary teams, and communicating with providers and members. Building strong relationships with both clinical and non-clinical staff can help streamline workflows, while ongoing professional development ensures you remain current with best practices and compliance standards.

What are the key skills and qualifications needed to thrive as a SCO UM Review RN, and why are they important?

To thrive as a SCO UM Review RN (Senior Care Options Utilization Management Review Registered Nurse), you need a valid RN license, strong clinical assessment skills, and a solid understanding of medical necessity criteria for managed care populations. Familiarity with utilization management software, InterQual or Milliman guidelines, and electronic health records is typically required. Exceptional attention to detail, critical thinking, and effective communication are vital soft skills for collaborating with care teams and advocating for patient needs. These skills ensure accurate review processes, regulatory compliance, and optimized patient outcomes in managed care environments.

What are SCO UM Review RNs?

SCO UM Review RNs are registered nurses who specialize in Utilization Management (UM) review for Senior Care Options (SCO) programs. They evaluate medical records, treatment plans, and healthcare services to ensure that care provided to elderly patients is medically necessary and meets health plan guidelines. These nurses play a key role in coordinating care, preventing unnecessary services, and advocating for appropriate patient care within managed care organizations.

What is the difference between Sco Um Review Rn vs Licensed Practical Nurse?

AspectSco Um Review RnLicensed Practical Nurse
CredentialsRegistered Nurse (RN) license, possibly specialized certificationsLicensed Practical Nurse (LPN) license
Work EnvironmentHospitals, clinics, outpatient facilities, often in more complex care settingsLong-term care, nursing homes, clinics, with more routine patient care
Job ResponsibilitiesAssessments, care planning, complex patient care, medication administrationBasic patient care, vital signs, assisting RNs and physicians

Both Sco Um Review Rn and Licensed Practical Nurse roles involve patient care, but Sco Um Review Rn typically requires a higher level of education and certification, allowing for more complex responsibilities. LPNs focus on routine patient care and support roles. The choice depends on your career goals and desired scope of practice.

More about Sco Um Review Rn jobs
What states have the most Sco Um Review Rn jobs? States with the most job openings for Sco Um Review Rn jobs include:
What job categories do people searching Sco Um Review Rn jobs look for? The top searched job categories for Sco Um Review Rn jobs are:
Sco Um Review Rn jobs near you
Infographic showing various Sco Um Review Rn job openings in the United States as of June 2026, with employment types broken down into 100% As Needed. Highlights an 95% Physical, 3% Hybrid, and 2% Remote job distribution, with an average salary of $92,525 per year, or $44.5 per hour.

Utilization Review Registered Nurse (RN) - 26-07363

NavitasPartners

San Bernardino, CA

$35/hr

Other

Posted 5 days ago

Job description

Utilization Review Registered Nurse (RN)

Specialty: Utilization Review / Case Management
Location: Apple Valley, California (CA)
Duration: 13 Weeks

Position Overview

We are seeking an experienced Utilization Review Registered Nurse (RN) to support utilization management activities within an acute care hospital setting. The ideal candidate will have recent hospital-based utilization review experience and a strong understanding of medical necessity criteria, regulatory requirements, and care coordination processes.

Schedule
  • Day Shift
  • Weekend Requirement: Minimum of 4 weekend day shifts within a 6-week period (additional weekends may be required)
Required Licensure
  • Active California RN License required
  • Pending California license accepted, but license must be active by the start date
Experience Requirements
  • Minimum 3 years of acute care Utilization Review or Care Management experience in a hospital setting
  • Experience must be hospital-based; health plan and medical group experience alone will not qualify
  • Seasoned traveler required
  • First-time travelers will not be considered
Patient Ratio
  • Approximately 1:40
Required Skills
  • Utilization Review
  • Medical Necessity Review
  • Concurrent Review
  • InterQual and/or Milliman Guidelines
  • Care Coordination
  • Discharge Planning Collaboration
  • Denial Prevention and Management
  • Regulatory Compliance
  • Clinical Documentation Review
  • Electronic Medical Record Documentation
Responsibilities
  • Perform utilization review activities to ensure appropriate level of care and resource utilization
  • Evaluate admissions, continued stays, and services for medical necessity
  • Collaborate with physicians, case managers, and interdisciplinary teams
  • Identify and address barriers to care progression and discharge
  • Ensure compliance with regulatory, payer, and facility requirements
  • Maintain accurate and timely documentation of utilization review activities
  • Assist in denial prevention and appeals processes as needed

For more details reach at sthakur@navitashealth.com or Call / Text at 732 791 4807 - EXT 4807.

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