ZipRecruiter

Log In

1

Utilization Management Nurse Reviewer Jobs (NOW HIRING)

next page

Showing results 1-20

All JobsUtilization Management Nurse Reviewer Jobs

Utilization Management Nurse Reviewer information

See salary details

$21

$42

$68

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.
More about Utilization Management Nurse Reviewer jobs
What cities are hiring for Utilization Management Nurse Reviewer jobs? Cities with the most Utilization Management Nurse Reviewer job openings:
What states have the most Utilization Management Nurse Reviewer jobs? States with the most job openings for Utilization Management Nurse Reviewer jobs include:
What job categories do people searching Utilization Management Nurse Reviewer jobs look for? The top searched job categories for Utilization Management Nurse Reviewer jobs are:
Utilization Management Nurse Reviewer jobs near you
Utilization Management Nurse Consultant

Utilization Management Nurse Consultant

CVS Health

New York, NY • Remote

$29.10 - $62.32/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 24 days ago

CVS Health rating

5.8

Company rating: 5.8 out of 10

Based on 4,246 frontline employees who took The Breakroom Quiz

78th of 99 rated pharmacies

Job description

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselvesaccountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

Utilization Management is a 24/7 operation and work schedule may include weekends, holidays, and evening hours.

UM Nurse Consultant

Fully Remote- WFH

Schedule - Tuesday- Saturday- 9:30am-6:00pm

Position Summary:

UM Nurse Consultant

Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.

Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care. Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services and/or programs Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

Required Qualifications

-Must have 3+ years of Med Surg experience as an RN in the hospital setting

- Active and unrestricted RN licensure in state of residence

- Able to work in multiple IT platforms/systems

- 1+ years of experience with Microsoft Office Applications (Outlook, Teams, Excel)

Preferred Qualifications

- Knowledge of Medicare/Medicaid

- Managed care experience

- Utilization Management experience

Education

Associates Degree in Nursing required

BSN preferred

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$29.10 - $62.32

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This fulltime position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial wellbeing of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.


Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 06/19/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

What CVS Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply