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Senior Rn Utilization Review Nurse Jobs (NOW HIRING)

Fusion HCR

Utilization Review Nurse

Las Vegas, NV · On-site

Overview Seeking an experienced Utilization Review Nurse (RN) to review patient admissions for medical necessity, appropriate level of care, and compliance with payer guidelines. This role works ...

CommonSpirit Health

Job Summary and Responsibilities As our Utilization Review Nurse at the Utilization Management Hub ... Registered Nurse with current California License required. * Minimum two (2) years of acute ...

Sedgwick

RN Utilization Review

Annapolis, MD

$73K - $75K/yr

Maintains a score of 90% or higher on monthly internal utilization review audits. * Meets productivity goals as outlined by supervisor. Education & Licensing Active unrestricted RN license in a state ...

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

As of Jun 7, 2026, the average hourly pay for senior 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 the difference between Senior Rn Utilization Review Nurse vs Rn Case Manager?

AspectSenior Rn Utilization Review NurseRn Case Manager
CertificationsRN license, possibly UR or case management certificationRN license, often case management certification
Work EnvironmentHospitals, insurance companies, healthcare organizationsHospitals, community health, insurance providers
Primary FocusReviewing medical necessity and utilization of servicesCoordinating patient care and discharge planning
Common UsageUsed in insurance and healthcare review settingsUsed in patient care coordination and discharge planning

The Senior Rn Utilization Review Nurse primarily focuses on evaluating the necessity and appropriateness of healthcare services, often working within insurance companies or healthcare organizations. In contrast, Rn Case Managers concentrate on coordinating patient care, discharge planning, and ensuring smooth healthcare delivery. Both roles require RN licensure and relevant certifications, but their daily responsibilities and work environments differ slightly.

What does a Senior RN Utilization Review Nurse do?

A Senior RN Utilization Review Nurse is a registered nurse who evaluates the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, apply clinical guidelines, and collaborate with healthcare providers to ensure that treatments are cost-effective and meet established standards of care. Additionally, they often mentor junior staff, participate in policy development, and help optimize resource utilization within healthcare organizations. Their work supports quality patient care while managing healthcare costs.

What are some typical challenges faced by Senior RN Utilization Review Nurses when coordinating with multidisciplinary teams?

Senior RN Utilization Review Nurses often collaborate with physicians, case managers, and insurance representatives to ensure patients receive appropriate, cost-effective care. A common challenge is balancing clinical guidelines with payer requirements, which can sometimes lead to differing opinions on the necessity of certain treatments or services. Effective communication, strong negotiation skills, and up-to-date knowledge of regulatory standards are essential to navigate these situations successfully. Being proactive and maintaining strong professional relationships helps facilitate smoother approvals and promotes patient-centered care.

What are the key skills and qualifications needed to thrive as a Senior RN Utilization Review Nurse, and why are they important?

To thrive as a Senior RN Utilization Review Nurse, you need a strong clinical nursing background, active RN licensure, and in-depth knowledge of medical necessity criteria and healthcare regulations. Familiarity with utilization review software, electronic health records (EHRs), and certifications like CCM (Certified Case Manager) or URAC are highly beneficial. Exceptional critical thinking, attention to detail, and effective communication skills distinguish top performers in this role. These skills ensure accurate case evaluations, compliance with regulations, and optimized patient care while controlling healthcare costs.
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Senior Rn Utilization Review Nurse jobs near you
Infographic showing various Senior Rn Utilization Review Nurse job openings in the United States as of May 2026, with employment types broken down into 2% As Needed, 66% Full Time, 3% Part Time, and 29% Contract. Highlights an 98% Physical, and 2% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Travel Nurse RN - Utilization Review

Integrated Healthcare Services

Bakersfield, CA

Contractor

Posted 27 days ago

Job description

Integrated Healthcare Services is seeking a travel nurse RN Utilization Review for a travel nursing job in Bakersfield, California.

Job Description & Requirements
  • Specialty: Utilization Review
  • Discipline: RN
  • Duration: 13 weeks
  • 40 hours per week
  • Shift: 8 hours, days
  • Employment Type: Travel

Job Title: RN - Case Management (Utilization Review)

Location: California

Employment Type: Full-Time

Contract Length: Permanent

Job Summary: The Utilization Review Nurse II is responsible for evaluating medical records, discharge planning, and ensuring compliance with payor documentation requirements to maximize hospital reimbursement.

Job Responsibilities:

  • Evaluate medical records for inpatient admissions to ensure required documentation is present.
  • Initiate Physician Advisories for unwarranted admissions.
  • Conduct ongoing reviews and discuss care changes with attending physicians.
  • Formulate and document discharge plans.
  • Coordinate with hospital services to ensure efficient resource use.
  • Identify pay source issues and provide appropriate referrals.
  • Collaborate with admitting office to prevent inappropriate admissions.
  • Schedule specialized tests and authorize payments under Medically Indigent Adult programs.
  • Review and approve surgery schedules for elective procedures.
  • Coordinate with correctional facilities regarding elective procedures and medical goods.
  • Answer provider questions about reimbursement and documentation requirements.
  • Teach providers payor documentation requirements to maximize reimbursement.
  • Assist in training Utilization Review Nurse I staff.
  • Perform other job-related duties as assigned.

Required Qualifications:

  • Two (2) years of experience as an RN in an acute care hospital, including one (1) year on a medical/surgical ward or unit.
  • One (1) year of utilization review/discharge planning experience in an acute care hospital or two (2) years as a Case Manager in a clinic or physician’s office.
  • Knowledge of payor source documentation requirements and governmental regulations.
  • Understanding of acute care nursing principles, patient disease processes, medical terminology, and hospital routines.
  • Ability to evaluate medical records, assess clinical performance, and communicate documentation needs effectively.
  • Proficiency in gathering and analyzing data for reports and recommendations.

Required Certifications & Licensure:

  • Valid Registered Nurse license in the State of California.
  • Current American Heart Association Healthcare Provider Basic Life Support (BLS) card.

Preferred Qualifications:

  • None specified.

Additional Information: This role requires strong interpersonal skills to collaborate with physicians, health providers, payor sources, and the general public.


QUALIFICATION/LICENSURE
Work Authorization : US Citizen
Preferred years of experience : 2 years
Travel required : No travel required
Shift timings : Days

RightSourcing IHS Job ID #37276836. Pay package is based on 8 hour shifts and 40 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: RN - Utilization Review

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