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Um Review Nurse Jobs (NOW HIRING)

HandsOn Global Management

UM Review Nurse

Tampa, FL · Remote

$36 - $40/hr

The UM Nurse Reviewer is responsible for the medical necessity review of outpatient services that require prior authorization, and /or management of concurrent inpatient admissions. The medical ...

US Tech Solutions

Utilization Review Nurse

Canton, MA · On-site

$55 - $60/hr

... Nurse to support outpatient utilization review and prior authorization activities for a leading ... Perform outpatient utilization management (UM) and medical necessity reviews for prior ...

Gonzaba Medical Group

UM Nurse

San Antonio, TX · On-site

UM Nurse focuses on the Gonzaba Medical Group UM Review Process. Supervisory Responsibilities: This position has no supervisory responsibilities. General Requirements: All duties performed will be ...

Gonzaba Medical Group

UM Nurse

San Antonio, TX · On-site

UM Nurse focuses on the Gonzaba Medical Group UM Review Process. Supervisory Responsibilities: This position has no supervisory responsibilities. General Requirements: All duties performed will be ...

Gonzaba Medical Group

UM Nurse

San Antonio, TX · On-site

UM Nurse focuses on the Gonzaba Medical Group UM Review Process. Supervisory Responsibilities: This position has no supervisory responsibilities. General Requirements: All duties performed will be ...

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Um Review Nurse information

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$39K

$89.5K

$163K

How much do um review nurse jobs pay per year?

As of Sep 9, 2026, the average yearly pay for um review nurse in the United States is $89,483.00, according to ZipRecruiter salary data. Most workers in this role earn between $64,500.00 and $104,500.00 per year, depending on experience, location, and employer.

What is a UM Review Nurse?

A UM (Utilization Management) Review Nurse is a registered nurse who evaluates medical records and treatment plans to ensure healthcare services are medically necessary and comply with insurance policies. They review patient cases, coordinate with healthcare providers, and help determine coverage for medical procedures or hospital stays. Their work helps manage healthcare costs while maintaining quality patient care. UM Review Nurses often work for insurance companies, hospitals, or managed care organizations.

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

To thrive as a UM Review Nurse, you need a valid RN license, strong clinical assessment skills, and knowledge of utilization management processes and healthcare regulations. Familiarity with utilization review software, electronic medical records (EMRs), and tools like InterQual or Milliman Care Guidelines is typically required. Excellent critical thinking, attention to detail, and communication skills help UM Review Nurses effectively collaborate with healthcare providers and insurance representatives. These competencies ensure accurate determinations of medical necessity, efficient resource use, and compliance with regulatory standards.

What are some common challenges faced by UM Review Nurses, and how can they be effectively managed?

UM Review Nurses often encounter challenges such as managing high caseloads, staying updated with changing healthcare regulations, and navigating complex insurance policies. Effective time management and strong organizational skills are essential for handling multiple concurrent reviews. Additionally, clear communication with physicians, patients, and insurance representatives helps ensure that clinical decisions are well-supported and that care authorization processes run smoothly. Many organizations provide ongoing training and peer support to help nurses stay current and address these challenges.
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Um Review Nurse jobs near you
Infographic showing various Um Review Nurse job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 3% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $89,483 per year, or $43 per hour.

UM Review Nurse

Tampa, FL • Remote

HandsOn Global Management
See more jobs at HandsOn Global Managementexternal

$36 - $40/hr

Full-time

Medical, PTO

Posted 23 days ago

Job description

PURPOSE AND SCOPE:

The UM Nurse Reviewer is responsible for the medical necessity review of outpatient services that

require prior authorization, and /or management of concurrent inpatient admissions. The medical

necessity review process includes assessment and interpretation of plan specific benefits, medical

criteria, and clinical documentation.

PRINCIPAL RESPONSIBILITIES AND DUTIES

• Performs prospective, concurrent, and retrospective inpatient and/or outpatient utilization reviews

(UR) using evidence-based guidelines, policies and nationally recognized clinical criteria, and internal

policies and procedures.

• Evaluates severity of illness and intensity of service of member’s needs at time of inpatient

admission utilizing approved criteria.

• Triage and prioritize cases and other assigned duties to meet CMS turnaround time standards.

• Prepare and escalate cases to MDs for review when appropriate.

• Demonstrates effective communication methods and skills, using lines of authority appropriately.

• Establishes a relationship with providers to determine/provide needed services to member.

• Maintains accurate record of UR activities.

• Regular attendance is required as employee works as part of a team & requires interaction with

medical staff and clients.

• Adheres to quality standards and confidentiality policies and procedures.

• Ensures compliance with all state and federal regulations and guidelines in day-to-day activities.

• Adapts to changes in policies, procedures, new techniques, and additional responsibilities.


CUSTOMER SERVICE:

• Responsible for driving the HealthOps culture through values and customer service standards.

• Accountable for outstanding customer service to all external and internal contacts.

• Develops and maintains positive relationships through effective and timely communication.

• Takes initiative and action to respond, resolve and follow up regarding customer service issues with all

customers in a timely manner.


EDUCATION, EXPERIENCE AND REQUIRED SKILLS:

• Licensed RN or LPN required.

• Minimum of two to three years varied clinical experience required.

• Managed care experience preferred.

• An equivalent combination of education, training, and experience.

• Ability to read and interpret documents and calculate figures and amounts.

• Excellent oral and written communication skills including good grammar, voice and diction.

• Proficient in MS Office with basic computer and keyboarding skills.

• Excellent customer service skills (friendly, courteous and helpful).

• InterQual experience helpful.

Company Description

HandsOn Global Management (“HGM”) is a hybrid family office / PE fund / technology incubator focused on building innovative companies and driving synergies within our portfolio. We specialize in technology platforms, analytics and business process services.

Headquartered in Santa Monica, CA, HandsOn Global Management (“HGM”) manages a number of funds and investments in partnership with some of the world’s largest investment banks, private equity groups and global financial institutions. Over the last decade, HGM has completed several acquisitions, integrated them and taken some public. Companies acquired and controlled by HGM employ over 17,000 people in the Americas, EMEA, and Asia, and have over 50% of the Fortune 100® as customers.

HGM’s main focus is on acquiring synergetic assets in U.S. and emerging markets, which yield above-market returns. To achieve this goal, HGM invests in companies with strong fundamentals and significant performance improvement potential, where the HGM team can apply their hands-on approach to managing portfolio companies, as well as their investment discipline and technology to increase the overall value proposition of each portfolio company.