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Utilization Review Nurse Consultant Jobs (NOW HIRING)

Sentara Health Plans

$65 - $85/hr

The Utilization Review Nurse is responsible for utilization management services within the scope of licensure. Conducts primary functions of prior authorization, retrospective review, medical ...

New

Sentara Health Plans

UTILIZATION REVIEW NURSE

Norfolk, VA · On-site

$65 - $85/hr

The Utilization Review Nurse is responsible for utilization management services within the scope of licensure. Conducts primary functions of prior authorization, retrospective review, medical ...

New

Acrisure, LLC

Utilization Review Nurse

Bradenton, FL · On-site

$55 - $90/hr

Utilization Review Nurse, LPN** to evaluate treatment requests and help ensure injured workers receive appropriate, timely care in accordance with applicable clinical guidelines and regulatory ...

Acrisure

Utilization Review Nurse

Bradenton, FL · On-site

Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure injured workers receive appropriate, timely care in accordance with applicable clinical guidelines ...

Acrisure, LLC

$55 - $90/hr

Utilization Review Nurse, LPN** to evaluate treatment requests and help ensure injured workers receive appropriate, timely care in accordance with applicable clinical guidelines and regulatory ...

New

Acrisure

Utilization Review Nurse

Bradenton, FL

Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure injured workers receive appropriate, timely care in accordance with applicable clinical guidelines ...

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Utilization Review Nurse Consultant information

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

As of Sep 2, 2026, the average hourly pay for utilization review nurse consultant 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 are the main challenges a utilization review nurse consultant faces when collaborating with physicians and insurance providers?

Utilization Review Nurse Consultants often encounter challenges when balancing the needs of patients, the expectations of healthcare providers, and the policies of insurance companies. Effective communication is essential, as they must present clinical findings clearly and advocate for appropriate patient care while adhering to insurance guidelines. Navigating disagreements or denials requires strong negotiation skills and a thorough understanding of medical necessity criteria. Building professional relationships and staying current with evolving regulations can help overcome these challenges and improve collaboration.

What are the key skills and qualifications needed to thrive as a utilization review nurse consultant, and why are they important?

To thrive as a Utilization Review Nurse Consultant, you need a current RN license, strong clinical assessment skills, and knowledge of healthcare regulations and insurance processes. Familiarity with utilization management software, electronic health records (EHRs), and case management systems is typically required, along with certifications like Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ). Exceptional critical thinking, attention to detail, and effective communication are vital soft skills for collaborating with providers and payers. These competencies ensure accurate, ethical, and efficient review of medical services, supporting both patient care quality and cost containment.

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

AspectUtilization Review Nurse ConsultantUtilization Review Nurse
CredentialsRN license, certification in case management or utilization reviewRN license, often with certification in utilization review or case management
Work EnvironmentConsults with healthcare providers, reviews cases for insurance companies or healthcare organizationsPerforms case reviews, often within insurance or hospital settings
Employer & IndustryInsurance companies, healthcare consulting firms, managed care organizationsHospitals, insurance companies, healthcare providers

The Utilization Review Nurse Consultant typically provides expert advice and case management consulting, often working across multiple organizations. In contrast, the Utilization Review Nurse primarily conducts case reviews within specific healthcare or insurance settings. Both roles require RN licensure and certification, but the consultant role emphasizes advisory and strategic functions, while the nurse role focuses on case assessment and approval processes.

More about Utilization Review Nurse Consultant jobs

What job categories do people searching Utilization Review Nurse Consultant jobs look for?

The top searched job categories for Utilization Review Nurse Consultant jobs are:

Utilization Review Nurse Consultant jobs near you
Infographic showing various Utilization Review Nurse Consultant job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 1% Temporary, and 3% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

UTILIZATION REVIEW NURSE

Sentara Healthcare

Norfolk, VA • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 9 days ago

Sentara Health rating

6.8

Company rating: 6.8 out of 10

Based on 416 frontline employees who took The Breakroom Quiz

498th of 898 rated healthcare providers

Job description

City/State
Norfolk, VA
Work Shift
First (Days)
Overview:
Sentara Health Plans Community Care is looking to hire a Utilization Review Nurse.
The Utilization Review Nurse is responsible for utilization management services within the scope of licensure. Conducts primary functions of prior authorization, retrospective review, medical director referrals and execution of member/provider approval and/or denial letter. Reviews provider requests for services requiring authorization. Conducts pre-certification, care coordination for appropriateness of treatment, set reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
Responsible for written and/or verbal notification to members and providers. Ensures medical director written decision is consistent with criteria (CMS, state, medical policy, clinical criteria). Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.
Education:
• BSN (preferred)
Certification:
• Registered Nurse (required)
Experience:
• 3 years of acute care clinical experience (required)
• Previous Utilization Review experience (preferred)
• Milliman experience (preferred)
• Knowledge of NCQA (preferred)
• Microsoft suite (Word, Excel, Outlook) (preferred)
• Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills
Keywords: Talroo- Health, Utilization Review Nurse, RN, Care Coordination, or Discharge Planning, Case Management, Milliman, NCQA
Benefits: Caring For Your Family and Your Career
• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to 10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance - 5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down - 10,000
• Pet Insurance
• Legal Resources Plan
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.
Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
In support of our mission "to improve health every day," this is a tobacco-free environment.
For positions that are available as remote work, Sentara Health employs associates in the following states:
Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

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