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Utilization Management Review Nurse Jobs (NOW HIRING)

Integrated Resources

Care Review Nurse

Columbus, OH · On-site

Care Review Nurse Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing ...

Global Force

Utilization Review Nurse

Las Vegas, NV · On-site

About the job Utilization Review Nurse Sign on bonus may apply up to $15,000 Position Summary ... Minimum three (3) years of Utilization Management experience. * Minimum of three (3) year ...

Moffitt

$77K - $117K/yr

The Utilization Review Nurse serves as a clinical resource in utilization management and denial mitigation within the acute care oncology setting. Job Title: Utilization Review Nurse Minimum ...

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

As of Aug 24, 2026, the average hourly pay for utilization management 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 a utilization management review nurse?

A Utilization Management Review Nurse is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services, procedures, and facilities. They review patient medical records, insurance information, and treatment plans to ensure that provided care meets established guidelines and is medically necessary. These nurses often work for insurance companies, hospitals, or managed care organizations and play a key role in controlling healthcare costs while ensuring patients receive appropriate care.

What are the key skills and qualifications needed to thrive as a utilization management review nurse?

To excel as a Utilization Management Review Nurse, you need a solid background in clinical nursing, active RN licensure, and expertise in utilization review processes. Familiarity with medical necessity criteria (such as InterQual or MCG), electronic medical records, and health insurance systems is commonly required. Strong analytical thinking, attention to detail, and effective communication skills help you collaborate with providers and advocate for appropriate patient care. These skills are crucial for ensuring patients receive necessary and cost-effective treatments while supporting compliance and organizational goals.

How does a utilization management review nurse collaborate with physicians and other healthcare professionals during the review process?

A Utilization Management Review Nurse frequently interacts with physicians, case managers, and other healthcare professionals to ensure that patient care meets established guidelines and is medically necessary. This collaboration often involves reviewing clinical documentation, discussing care plans, and providing feedback to providers about authorization decisions or alternative treatment options. Effective communication and negotiation skills are important, as nurses must sometimes clarify or advocate for appropriate patient care while adhering to payer policies and regulatory standards. Working as part of a multidisciplinary team helps promote optimal patient outcomes and efficient resource use.

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

AspectUtilization Management Review NurseUtilization Review Nurse
CertificationsRN license, possibly certifications like CCM or CUCRN license, often similar certifications
Work EnvironmentManaged care organizations, insurance companies, hospitalsInsurance companies, healthcare providers, managed care
Job FocusReviewing medical necessity for utilization managementAssessing medical necessity and appropriateness of care

Both roles involve reviewing patient cases to ensure appropriate care, often requiring RN licensure and similar certifications. The main difference lies in terminology and specific employer usage, with 'Utilization Management Review Nurse' emphasizing the management aspect, while 'Utilization Review Nurse' is a broader term used across various healthcare settings. Both positions aim to optimize patient care and control costs within healthcare organizations.

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Utilization Management Review Nurse jobs near you
Infographic showing various Utilization Management Review Nurse job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 84% Full Time, 13% Part Time, and 2% Contract. Highlights an 83% Physical, 2% Hybrid, and 15% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Management Review Nurse

Harris Health System

Bellaire, TX • On-site

Other

Posted 4 days ago

Harris Health System rating

7.9

Company rating: 7.9 out of 10

Based on 104 frontline employees who took The Breakroom Quiz

108th of 893 rated healthcare providers

Job description

Utilization Management Review Nurse (UMRN)

The Utilization Management Review Nurse (UMRN) performs technical and administrative work required to evaluate the necessity, appropriateness, and efficiency of the utilization of medical services procedures and facilities. This role supports the health system by utilizing clinical knowledge, expertise and industry standard clinical guidelines carrying the responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity. The UMRN promotes quality care and cost-effective outcomes to enhance the physical, psychosocial and vocational health of individuals, partnering with Care Management, Physician Advisors, Finance, and 3rd party payers to deliver the best holistic outcomes for all patients. This position will work with payers to reconcile denials and reconsiderations, assist with appeals as needed and arrange peer to peer level review while collecting, analyzing and addressing variances from the plan of care/care path with physician and/or other members of the healthcare team. The UMRN participates in quality improvement activities, exemplifies professionalism, and promotes a customer-friendly environment by utilizing ServiceFIRST behaviors in interactions with Harris Health team members, payer vendors, and physicians.

Minimum Qualifications:

  • Degrees: Graduated from an accredited school of Nursing with a Bachelors in Nursing.
  • Licenses & Certifications: Registered Nurse: Licensed to practice nursing in the State of Texas. Case Management Certification (ACM or CCM) within two years of hire. Basic Life Support: American Heart Association (AHA) or Red Cross approved program.
  • Work Experience: 5 Years of Experience: Strong clinical background in a variety of acute healthcare settings including 2 years in Case Management, Quality Management, Utilization Management, or Coding.
  • Communication Skills: Above Average Verbal Communication (Heavy Public Contact) Exceptional Verbal (Public Speaking) Writing/ Correspondence Writing/ Reports
  • Language: Bilingual Skills (Preferred)
  • Proficiencies: MS Word PC MS Excel MS PowerPoint
  • Knowledge/Skills/Abilities: Analytical Mathematics Medical Terms Other: Utilization review tools: MCG and or Change healthcare (Interqual)

Work Schedule: Flexible: 8 hour shifts as per system need; variable to 10-12 as needed. Weekends: Depends on needs of system. Telecommute Holidays: Depends on needs of system. Other Special Requirements Equipment Operated: Standard office equipment, computer software, etc.

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About Harris Health System

Sourced by ZipRecruiter

Harris Health System is a fully integrated healthcare system that cares for all residents of Harris County, Texas. We are the first accredited healthcare institution in Harris County to be designated by the National Committee for Quality Assurance as a Patient-Centered Medical Home, and are one of the largest systems in the country to achieve the quality standard. Our system includes community health centers, same-day clinics, three multi-specialty clinic locations, a dental center, mobile health units and two full-service hospitals.

Industry

Hospitals

Company size

5,001 - 10,000 Employees

Headquarters location

Houston, TX, US

Year founded

1966

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