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Utilization Management Nurse Reviewer Jobs (NOW HIRING)

Intus, Inc

Utilization Management Nurse

$80K - $95K/yr

Role Overview The Utilization Management Nurse plays a critical role in ensuring high-quality, cost ... Concurrent review of all hospital admissions (observation and inpatient) with the Interdisciplinary ...

SIHO Insurance Services, Inc.

Be Seen First

Utilization Management Nurse

Columbus, IN · On-site

Job Title: Utilization Management Nurse Reports To: Manager of Utilization Management Brief ... By performing review of services prospectively, retrospectively, and throughout the episode of care ...

Curana Health, Inc.

Utilization Management Nurse

$75K - $85K/yr

Summary The primary role of the Utilization Management Nurse is to review and monitor members' utilization of health care services with the goal of maintaining high quality cost-effective care. The ...

Curana Health, Inc.

Summary The primary role of the Utilization Management Nurse is to review and monitor members' utilization of health care services with the goal of maintaining high quality cost-effective care. The ...

UCLA Health

Utilization Management Nurse

Los Angeles, CA · On-site

$74.16 - $107.75/hr

The UM Nurse functions in two utilization management roles for coverage purposes utilization review/payor authorization and patient placement-ensuring continuity of operations, timely access to care ...

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Utilization Management Nurse Reviewer information

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How much do utilization management nurse reviewer jobs pay per hour?

As of Jun 17, 2026, the average hourly pay for utilization management nurse reviewer 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.

How much do utilization review nurses make in the US?

Utilization management nurse reviewers in the US typically earn between $70,000 and $90,000 annually, depending on experience, location, and certifications. Salaries can vary based on healthcare setting and level of responsibility, with some experienced professionals earning over $100,000.

What are the key skills and qualifications needed to thrive as a Utilization Management Nurse Reviewer, and why are they important?

To thrive as a Utilization Management Nurse Reviewer, you need a strong clinical background, active RN licensure, and in-depth knowledge of medical necessity criteria and healthcare regulations. Familiarity with utilization management software, electronic health records (EHRs), and decision-support tools like InterQual or Milliman is typically required. Critical thinking, attention to detail, and effective communication are essential soft skills for accurately reviewing cases and collaborating with providers. These skills ensure that patient care is both medically appropriate and cost-effective, supporting quality outcomes and regulatory compliance.

How to make an extra $2000 a month as a nurse?

A Utilization Management Nurse Reviewer can increase income by taking on additional part-time or freelance review assignments, leveraging certification in case management or related areas, and working flexible hours. Developing specialized skills and obtaining relevant certifications can also qualify for higher-paying opportunities or overtime pay, helping to reach the extra $2000 monthly goal.

How can I become a utilization review nurse?

To become a utilization review nurse, you typically need to hold a registered nurse (RN) license and have experience in clinical nursing or case management. Many employers also require knowledge of healthcare policies, utilization review processes, and sometimes certification such as the Certified Professional in Healthcare Quality (CPHQ) or a similar credential. Strong communication skills and familiarity with electronic health records (EHR) systems are also beneficial.

What are Utilization Management Nurse Reviewers?

Utilization Management Nurse Reviewers are registered nurses who evaluate medical records and treatment plans to determine the medical necessity, appropriateness, and efficiency of healthcare services. They work for insurance companies, hospitals, or managed care organizations to ensure that patients receive appropriate care while controlling costs. Their responsibilities include reviewing clinical documentation, applying evidence-based guidelines, and communicating with healthcare providers about coverage decisions. This role helps balance quality patient care with resource management in the healthcare system.

What are some common challenges faced by Utilization Management Nurse Reviewers and how can they be addressed?

Utilization Management Nurse Reviewers often navigate complex cases where clinical guidelines and insurance policies must be balanced with patient needs, which can be challenging. They may encounter high caseloads, tight deadlines, and frequent communication with providers and payers, requiring strong organizational and negotiation skills. Staying current with evolving regulations and payer criteria is essential. Building effective communication and time-management strategies, as well as leveraging ongoing training, can help address these challenges and ensure quality, timely reviews.

What is the difference between Utilization Management Nurse Reviewer vs Utilization Review Nurse?

AspectUtilization Management Nurse ReviewerUtilization Review Nurse
CertificationsRN license, possibly certifications in case management or utilization reviewRN license, certifications in case management or utilization review
Work EnvironmentInsurance companies, health plans, or managed care organizationsHospitals, clinics, or insurance companies
Employer & Industry UsagePrimarily in managed care and insurance sectorsIn healthcare facilities and insurance sectors

Both roles involve reviewing patient cases to determine medical necessity, but the Utilization Management Nurse Reviewer typically works within insurance or managed care organizations focusing on authorization and coverage decisions. The Utilization Review Nurse may work directly in healthcare settings or insurance, with a broader scope including ongoing patient care assessments. While overlapping in credentials and industry, their primary work environments and specific responsibilities differ slightly.

What does a nurse utilization reviewer do?

A nurse utilization reviewer evaluates medical records and treatment plans to determine the appropriateness and necessity of healthcare services. They ensure that care complies with insurance policies and clinical guidelines, often working with electronic health records and requiring knowledge of coding and documentation standards. This role involves reviewing cases, making recommendations, and supporting cost-effective patient care decisions.
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Utilization Management Nurse Reviewer jobs near you

Utilization Management Nurse

Integrated Community Living and Par

Allentown, PA

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 21 hours ago

Job description

Benefits:
  • Employee discounts
  • Paid time off
  • 401(k) matching
  • Competitive salary
  • Dental insurance
  • Health insurance
  • Training & development
  • Vision insurance
  • Wellness resources

Benefits/Perks
  • Competitive Compensation
  • Great Work Environment
  • Career Advancement Opportunities
Job Summary
We are seeking a Utilization Management Nurse to join our team! As a Utilization Management Nurse on the team, you will be responsible for reviewing patient files and treatment methods with an eye for efficiency and effectiveness. Your role will be to ensure we are running at optimal efficiency, and that all patients under our care are receiving the necessary treatments and procedures. The ideal candidate has deep experience in a similar medical setting, has a bachelor's or higher in Nursing, and has a certification in either Case Management or Utilization Management.
Responsibilities
  • Review patient files and treatment information for efficiency
  • Monitor the activity of staff to ensure effective patient treatment
  • Advocate for quality patient care to prevent complications
  • Review discharge information for outgoing patients
  • Work closely with clinical staff to provide excellent patient care
  • Prepare reports on patient management and cost assessments
Qualifications
  • Nurse, with state LPN licensure, required
  • Certificate in Case Management or Utilization Management desired
  • Strong communication and interpersonal skills
  • Strong analytical skills