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Utilization Review Nurse Compact License Jobs in Puerto Rico

San Juan Capestrano

Utilization Coordinator

San Juan, PR · On-site

Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...

Encompass Health

Case Manager

Manati, PR

$17 - $21.75/hr

Participate in utilization review process: data collection, trend review, and resolution actions ... For Nursing, must possess minimum of an Associate Degree in Nursing, RN licensure with BSN ...

UHS

PR

Provide backup to Utilization Review Department out of business hours including document in the ... Valid and current active license for Social Work, Psychiatric Nursing, Psychological Counseling ...

UHS

PR · On-site

Provide backup to Utilization Review Department out of business hours including document in the ... Valid and current active license for Social Work, Psychiatric Nursing, Psychological Counseling ...

Centers Home

OASIS Reviewer

San Juan, PR

Active and unrestricted Registered Nurse (RN) license. * Minimum 1 year of clinical nursing experience required * OASIS review experience preferred * Homecare experience preferred * Proficiency with ...

Harboroaks

$60 - $70/hr

Demonstrate knowledge and utilization of universal precautions in providing direct patient care ... Qualifications EDUCATION/LICENSURE/EXPERIENCE/SKILL REQUIREMENTS * Must have graduated from an ...

San Juan Capestrano

Enfermero(a) Graduado

San Juan, PR · On-site

Demonstrate knowledge and utilization of universal precautions in providing direct patient care ... Must possess a current Registered Nurse (RN) license as required by the state of employment or be ...

Northbridge University

LPN Program Manager

San Juan, PR · On-site

$90 - $115/hr

... reviews, and classroom observations. * Support faculty in meeting FBON-required qualifications and ... Active and unrestricted RN license in the State of Florida. * Minimum of three years of recent ...

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Utilization Review Nurse Compact License information

What is a utilization review nurse with a compact license?

A Utilization Review Nurse with a Compact License is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services provided to patients, ensuring they meet established criteria and guidelines. Holding a Compact License means the nurse is authorized to practice in multiple states that are part of the Nurse Licensure Compact (NLC), making them eligible for remote or multi-state utilization review positions. This role involves reviewing medical records, collaborating with healthcare providers, and helping ensure patients receive appropriate care while controlling healthcare costs.

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

To thrive as a Utilization Review Nurse with a Compact License, you need a current RN license (valid under the Nurse Licensure Compact), strong clinical judgment, and in-depth knowledge of medical necessity criteria and healthcare regulations. Familiarity with utilization management software, electronic health records (EHRs), and standardized review tools like InterQual or Milliman is typically required. Excellent communication, critical thinking, and attention to detail are essential soft skills for collaborating with healthcare providers and ensuring accurate documentation. These skills and qualifications are vital to ensure cost-effective, quality patient care while maintaining compliance with regulatory standards across multiple states.

What are the typical challenges utilization review nurses with a compact license face when managing cases across multiple states?

Utilization Review Nurses with a Compact License often manage cases for patients located in various states, which can present challenges such as staying updated on differing state-specific regulations, payer policies, and healthcare guidelines. Navigating multiple systems and ensuring compliance with each state’s requirements can be complex and requires strong organizational skills. Collaboration with multidisciplinary teams and timely communication with providers in different locations are essential for effectively coordinating care and maintaining efficiency. Many employers offer robust onboarding and ongoing training to help UR nurses stay current and confident in managing cross-state cases.

What is the difference between Utilization Review Nurse Compact License vs Utilization Review Nurse State License?

AspectUtilization Review Nurse Compact LicenseUtilization Review Nurse State License
CredentialsMulti-state license valid in participating statesLicense specific to one state
Work EnvironmentAllows practice across multiple states without multiple licensesLimited to practicing within the issuing state
Employer & Industry UsagePreferred for telehealth and multi-state employersRequired for in-state employment or non-participating states
Search & Comparison IntentCommonly compared for flexibility in multi-state rolesStandard license for local practice

The Utilization Review Nurse Compact License enables nurses to work across multiple states with a single license, increasing flexibility for telehealth and multi-state employers. In contrast, a Utilization Review Nurse State License restricts practice to one state, suitable for local or in-state roles. Choosing between them depends on your work location and employer needs.

What are popular job titles related to Utilization Review Nurse Compact License jobs in Puerto Rico?

For Utilization Review Nurse Compact License jobs in Puerto Rico, the most frequently searched job titles are:

What job categories do people searching Utilization Review Nurse Compact License jobs in Puerto Rico look for?

The top searched job categories for Utilization Review Nurse Compact License jobs in Puerto Rico are:

Utilization Review Nurse Compact License jobs near you
Infographic showing various Utilization Review Nurse Compact License job openings in Puerto Rico as of August 2026, with employment types broken down into 2% As Needed, 71% Full Time, 20% Part Time, 2% Temporary, and 5% Contract. Highlights an 91% Physical, 1% Hybrid, and 8% Remote job distribution.

Utilization Coordinator

San Juan Capestrano

San Juan, PR

Full-time

Re-posted 22 days ago

Job description

Overview

PURPOSE STATEMENT: 

Proactively monitor utilization of services for patients to optimize reimbursement for the facility.  

Responsibilities

ESSENTIAL FUNCTIONS: 

  • Act as liaison between managed care organizations and the facility professional clinical staff. 
  • Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements. 
  • Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.  
  • Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office. 
  • Conduct quality reviews for medical necessity and services provided.   
  • Facilitate peer review calls between facility and external organizations.  
  • Initiate and complete the formal appeal process for denied admissions or continued stay.  
  • Assist the admissions department with pre-certifications of care.  
  • Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates. 

OTHER FUNCTIONS:  

  • Perform other functions and tasks as assigned. 
Qualifications

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS: 

  • Required Education: High school diploma or equivalent. 
  • Preferred Education: Associate's, Bachelor's, or Master's degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field. 
  • Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred 

LICENSES/DESIGNATIONS/CERTIFICATIONS:  

  • Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services. 
  • CPR and de-escalation and restraint certification required (training available upon hire and offered by facility.   
  • First aid may be required based on state or facility requirements. 

 

ADDITIONAL REGULATORY REQUIREMENTS: 

While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances  (e.g. emergencies, changes in workload, rush jobs or technological developments) dictate. 

We are committed to providing equal  employment opportunities to all applicants for employment regardless of an individual's characteristics protected by applicable state, federal and local laws.

Employment Type: FULL_TIME

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