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Senior Rn Utilization Review Nurse Jobs (NOW HIRING)

Pacer Group

RN - UTILIZATION REVIEW

Everett, WA · On-site

$65/hr

Fully Remote Position Job Title : RN - UTILIZATION REVIEW Location: Everett, WA 98201 Start Date: 05/04/2026 Duration: 13 weeks Schedule Shift: Day 5x8-Hour (08:00 - 16:30) Shift Notes: Days (5×8 ...

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'

UNC Health

Utilization Review Nurse

Kinston, NC · On-site

Utilization Review Nurse Become part of an inclusive organization with over 40,000 teammates, whose ... Five (5) years of health care experience as a Registered Nurse. Licensure/Registration ...

Oscar Health

Utilization Review Nurse

Miami, FL · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate ...

Stcharles

RN Utilization Review

Bend, OR

$48.30 - $72.45/hr

CHARLES HEALTH SYSTEM TITLE: RN Utilization Management REPORTS TO POSITION: Manager- Utilization Management DEPARTMENT: Utilization Management DATE LAST REVIEWED: November 2024 OUR VISION: Creating ...

Oscar Health

Utilization Review Nurse

Atlanta, GA · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate ...

Sedgwick

RN Utilization Review

Knoxville, TN · On-site

$63K - $65K/yr

... RN Utilization Review As a nurse at Sedgwick, you can build a meaningful and rewarding career while advocating for patients in a nontraditional clinical setting. * Apply your RN clinical knowledge ...

Zack Group

Travel Utilization Review RN

Tuba City, AZ · On-site

Utilization Review * Discipline: RN * Start Date: 09/07/2026 * Duration: 13 weeks * 40 hours per week * Shift: 8 hours, days * Employment Type: Travel Zack Group is currently seeking Utilization ...

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Senior Rn Utilization Review Nurse information

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

As of Aug 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 a Senior RN Utilization Review Nurse 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 August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Registered Nurse - Utilization Review (Remote)

Talencia

Torrance, CA • On-site

$57/hr

Contractor

Re-posted 16 days ago

Job description

Job Title: RN - Utilization Review (Remote) 
Location: Remote – Must work in Pacific Standard Time (PST)
Duration: 13 Weeks
Unit: Remote Utilization Management
Pay Rate: $54/hr (W2) or $57/hr (1099)
 
Shift & Schedule
  • Schedule: Monday to Friday, 5x8-Hour Days
  • Hours: 08:00 AM – 04:30 PM (PST)
  • Weekend Requirement: Every third weekend
Position Summary
We are seeking a Registered Nurse (RN) with a strong background in Utilization Review to work remotely.
This role involves reviewing medical necessity, documentation, and level of care decisions across multiple hospitals and service lines.
Key Responsibilities
  • Perform utilization review for inpatient, observation, and extended outpatient cases
  • Apply InterQual criteria (required – Hardstop)
  • Use Epic for documentation and review workflows (recent use within 6–12 months required)
  • Interpret and apply Medicare rules and documentation (e.g., CC44s, ABNs, HINNs, MCSNs)
  • Rotate across three hospital systems under centralized UM
  • Adhere to California labor laws (breaks, meals, and time reporting)
Required Qualifications
  • Active CA RN License
  • Minimum 3 years of acute care CM/UM experience in a hospital setting (not health plan or medical group)
  • InterQual experience (Hardstop)
  • Recent Epic use (within the last 6–12 months)
  • Strong understanding of Medicare, HMO, and IPA processes
  • High attention to detail, organizational, and communication skills
  • Comfortable working independently in a fully remote environment