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Utilization Review Nurse

Tampa, FL · On-site

$73K - $110K/yr

The Utilization Review Nurse performs care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote ...

Medix

Utilization Review Nurse

Orange, CA · On-site

$38 - $53/hr

Job Summary Our client is seeking a Utilization Review Nurse responsible for managing the complete ... Manage the beginning-to-end Utilization Management (UM) process through Discharge Planning.

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

As of Aug 3, 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 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.

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

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.

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.
More about Utilization Management Review Nurse jobs
What cities are hiring for Utilization Management Review Nurse jobs? Cities with the most Utilization Management Review Nurse job openings:
What job categories do people searching Utilization Management Review Nurse jobs look for? The top searched job categories for Utilization Management Review Nurse jobs are:
Utilization Management Review Nurse jobs near you
Infographic showing various Utilization Management Review Nurse job openings in the United States as of July 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, 1% Temporary, and 2% Contract. Highlights an 93% Physical, 2% Hybrid, and 5% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Nurse

Access Healthcare Staffing & Recruitment

Las Vegas, NV • On-site

Full-time

Re-posted 26 days ago

Job description

Salary: $40-$63

Utilization Review Nurse (RN)

Las Vegas, NV | Full-Time

Salary: $40 $63/hour


Position Summary

Reviews patient admissions for medical necessity, appropriate resource utilization, and compliance with payer guidelines. Analyzes medical records to ensure care meets established clinical and regulatory standards.


Requirements:

Education/Experience:

  • Graduate of an accredited nursing program
  • 5+ years of acute care nursing experience
  • At least 1 year in Utilization Management, Case Management, or CDI
  • Minimum 3 years of Utilization Management experience
  • 3+ years of discharge planning experience in acute care


Licensure:

  • Active Nevada RN license


Additional Requirements:

  • Experience with InterQual (must be able to pass exam)
  • Experience with Milliman criteria


Key Skills & Knowledge

  • Utilization review criteria (InterQual/Milliman), Medicare/Medicaid guidelines
  • Chart review and clinical documentation analysis
  • Regulatory compliance and hospital standards
  • Strong communication, collaboration, and analytical skills


Work Environment

  • Office-based with extended sitting and computer use
  • May require shifts and weekends