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

As of Jul 28, 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.
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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 | $15K Sign on | Urgent Hiring

Utilization Review Nurse | $15K Sign on | Urgent Hiring

Lancesoft INC

Las Vegas, NV • On-site

$43 - $63/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 11 days ago

Job description

The Utilization Review Nurse plays a critical role in assessing patient admissions to ensure appropriate care, resource efficiency, and adherence to third-party payer requirements. This position involves detailed analysis of medical charts and collaboration with case management teams to support compliance and quality standards within acute care settings.

Responsibilities

  • Review patient admissions for medical necessity and compliance with payer guidelines
  • Analyze clinical documentation to verify appropriate resource utilization
  • Collaborate closely with case management and discharge planning teams
  • Apply InterQual and Milliman criteria in utilization review processes
  • Document findings and communicate review outcomes effectively
  • Maintain up-to-date knowledge of regulatory compliance standards
  • Support clinical documentation improvement initiatives

Required Qualifications

  • Graduation from an accredited school of nursing and five (5) years of acute hospital clinical nursing experience, one (1) year of which was in Utilization Management, Case Management, or Clinical Documentation Improvement.
  • Valid license by the State of Nevada to practice as a Registered Nurse.
  • Minimum three (3) years of Utilization Management experience.
  • Minimum of three (3) year's experience with discharge planning in an acute care facility.
  • Recent documented experience with InterQual, and ability to pass the InterQual exam.
  • Recent documented experience with Milliman experience.

$15K Sign On bonus eligible

~DW

Company Description

LanceSoft is rated as one of the largest staffing firms in the US by SIA. Our mission is to establish global cross-culture human connections that further the careers of our employees and strengthen the businesses of our clients. We are driven to use the power of our global network to connect businesses with the right people, and people with the right businesses without bias. We provide Global Workforce Solutions with a human touch.
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About LanceSoft

Sourced by ZipRecruiter

Established in 2000, LanceSoft is a Certified MBE and Woman-Owned organization. Lancesoft Inc. is one of the highest rated companies in the industry. We have been recognized as one of the Largest Staffing firms and ranked in the top 50 fastest Growing Healthcare Staffing firms in 2022. Lancesoft offers short- and long-term contracts, permanent placements, and travel opportunities to credentialed and experienced professionals throughout the United States. We pride ourselves on having industry leading benefits. We understand the importance of partnering with an expert who values your needs, which is why we're 100% committed to finding you an assignment that best matches your career and lifestyle goals. Our team of experienced career specialists takes the time to understand your needs and match you with the right job Lancesoft has been chosen by Staffing Industry Analysts as one of the Best Staffing Firms to Work for.LanceSoft specializes in providing Registered Nurses, Nurse Practitioners, LPNs/LVNs, Social Workers, Medical Assistants, and Certified Nursing Assistants to work in Acute Care Centers, Skilled Nursing Facilities, Long-Term Care centers, Rehab Facilities, Behavioral Health Centers, Drug & Alcohol Facilities, Home Health & Community Health, Urgent Care Clinics, and many other provider-based facilities.

Industry

Recruiting and staffing services

Company size

1,001 - 5,000 Employees

Headquarters location

Herndon, VA, US

Year founded

2000

Social media

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