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Utilization Management Pre Service Review Nurse Jobs

Sentara Health Plans

$10K/mo

The Utilization Review Nurse is responsible for utilization management services within the scope of ... Conducts pre-certification, care coordination for appropriateness of treatment, set reviews to ...

US Tech Solutions

Utilization Review Nurse

Canton, MA · On-site

$55 - $60/hr

... services using established clinical guidelines, collaborating with physicians and healthcare ... Perform outpatient utilization management (UM) and medical necessity reviews for prior ...

HHC

UTILIZATION REVIEW NURSE RN

Indianapolis, IN · On-site

Physicians provide a comprehensive range of primary and specialty care services at the 327-bed ... Responsible for managing each patient's plan of care, monitoring for appropriate resource ...

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How much do utilization management pre service review nurse jobs pay per hour?

As of Sep 14, 2026, the average hourly pay for utilization management pre service 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.

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Infographic showing various Utilization Management Pre Service Review Nurse job openings in the United States as of June 2026, with employment types broken down into 3% As Needed, 82% Full Time, 12% Part Time, and 3% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Nurse III

Seattle, WA • On-site

Kaiser Permanente
Health Care and Social Assistance • 10K+ employees
Learn more about Kaiser Permanenteexternal

Other

Posted 9 days ago

Kaiser Permanente rating

8.2

Company rating: 8.2 out of 10

Based on 930 frontline employees who took The Breakroom Quiz

Job description

**  UTILIZATION REVIEW NURSE III  - WASHINGTON STATE - PRE-SERVICE CLINICAL UR/UM ** **  PRIOR UTILIZATION REVIEW/UTILIZATION MANAGEMENT RN WORK EXPERIENCE HIGHLY PREFERRED!  ** **  MUST LIVE IN WASHINGTON OR IDAHO, COMMUTABLE DISTANCE TO KAISER PERMANENTE WASHINGTON MEDICAL CENTER  **  Job Summary:

In addition to the responsibilities listed below, this position is also responsible for applying advanced clinical and regulatory knowledge of evidence-based guidelines, insurance policies, and clinical criteria to consult on the medical necessity, level of care, and duration of treatment required for moderately complex reviews, and collaborating with the health care team, members, and caregivers to assist in discharge planning, cost of care options, and/or coordinating and/or adjudicating referrals to appropriate services based on medical necessity.

Essential Responsibilities:
  • Pursues effective relationships with others by proactively providing resources, information, advice, and expertise with coworkers and members. Listens to, seeks, and addresses performance feedback; provides mentoring to team members. Pursues self-development; creates plans and takes action to capitalize on strengths and develop weaknesses; influences others through technical explanations and examples. Adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; helps others adapt to new tasks and processes. Supports and responds to the needs of others to support a business outcome.
  • Completes work assignments autonomously by applying up-to-date expertise in subject area to generate creative solutions; ensures all procedures and policies are followed; leverages an understanding of data and resources to support projects or initiatives. Collaborates cross-functionally to solve business problems; escalates issues or risks as appropriate; communicates progress and information. Supports, identifies, and monitors priorities, deadlines, and expectations. Identifies, speaks up, and implements ways to address improvement opportunities for team.
  • Provides high-quality consultation by: facilitating and communicating with physicians, managers, staff, members, and/or caregivers regarding requirements related to medical necessity and benefit denials across the continuum of care; and leveraging comprehensive knowledge to ensure the correct and consistent application, interpretation, and utilization of member health care benefits, cost of care options, and coverage by members and physicians.
  • Supports education and compliance initiatives by: remaining up-to-date and sharing information with the team on the relevant state and federal regulations, guidelines, criteria, and documentation requirements that affect utilization management; and supporting the development and delivery of education and training programs for staff and physicians at the local level to promote best practices in utilization management.
  • Assists in quality improvement efforts by: conducting standard data analyses and developing reports to identify utilization patterns, trends, and opportunities for improvement; providing input and participating in the implementation of corrective action plans to address deficiencies in utilization review workflows/processes; actively adhering to utilization policies, procedures, and guidelines to ensure compliant and cost-effective care; and developing and refining desk-level procedures (e.g., workflows).
  • Performs utilization reviews by: following standard policies and procedures when conducting reviews of medical records and treatment plans to evaluate the medical necessity, appropriateness, and efficiency of requested health care services; and assessing the ongoing need for services, proactively identifying, anticipating, and escalating potential issues/delays to internal team members, and recommending appropriate actions for moderately complex member cases.

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