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Senior Rn Utilization Review Nurse Jobs (NOW HIRING)

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 ...

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 ...

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

Austin area - Travis/Williamson Counties or Richardson area - Dallas/Collin Counties*** RN working ... This position is responsible for performing initial, concurrent review activities; discharge care ...

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

As of Jun 9, 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.

Registered Nurse - Utilization Review - RNUR26-06087

NavitasPartners

Oakland, CA • Remote

$40/hr

Other

This job post has expired 1 day ago. Applications are no longer accepted.

Job description

Job Title: Registered Nurse - Utilization Review

Location: Santa Rosa, CA 

Shift Details: Day Shift | 5x8 Hours | 08:00 AM - 04:30 PM
Contract Duration: 13 Weeks
Orientation: 40 Hours (Non-Billable)

Required Qualifications
  • Active Registered Nurse (RN) License required
  • Minimum 1-2 years acute care nursing experience preferred
  • Experience in Utilization Review, Case Management, or similar role preferred
  • Strong understanding of medical necessity, payer guidelines, and clinical documentation
  • Knowledge of insurance authorization processes preferred
  • Strong analytical, communication, and decision-making skills
  • Ability to work independently in a remote environment
  • Proficiency with EMR systems preferred (Epic experience a plus)
Job Responsibilities
  • Perform utilization review of inpatient and outpatient cases
  • Evaluate medical necessity based on clinical guidelines and payer policies
  • Review patient records and documentation for appropriate level of care
  • Collaborate with physicians, case managers, and insurance providers
  • Process prior authorizations and continued stay reviews
  • Document all review decisions accurately in EMR systems
  • Identify cases requiring further clinical escalation
  • Ensure compliance with regulatory, hospital, and insurance standards
  • Support discharge planning and care coordination as needed
  • Maintain productivity and quality standards in a remote setting

For more details contact at sthakur@navitashealth.com 

About Navitas Healthcare, LLC certified WBENC and one of the fastest-growing healthcare staffing firms in the US providing Medical, Clinical and Non-Clinical services to numerous hospitals. We offer the most competitive pay for every position we cater. We understand this is a partnership. You will not be blindsided and your salary will be discussed upfront.

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