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Utilization Review Nurse Consultant Jobs (NOW HIRING)

Fusion HCR

Utilization Review Nurse

Las Vegas, NV · On-site

Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in Acute Care. Overview Seeking an experienced Utilization Review Nurse (RN) to review patient admissions ...

Acrisure LLC

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

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

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 ...

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: Reviews patient admissions for appropriateness, efficiency of resource utilization and compliance with ...

Oscar Health

Utilization Review Nurse

Dallas, TX · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You will perform frequent case reviews, check medical records and speak with care providers regarding ...

Oscar Health

Utilization Review Nurse

Miami, FL · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You will perform frequent case reviews, check medical records and speak with care providers regarding ...

Oscar Health

Utilization Review Nurse

Atlanta, GA · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You will perform frequent case reviews, check medical records and speak with care providers regarding ...

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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 Aug 19, 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, 82% Full Time, 13% Part Time, 3% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Nurse

Fusion HCR

Las Vegas, NV • On-site

Other

Re-posted 12 days ago

Job description

Fusion HCR is hiring!Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in Acute Care.
Overview
Seeking an experienced Utilization Review Nurse (RN) to review patient admissions for medical necessity, appropriate level of care, and compliance with payer guidelines. This role works closely with clinical teams to ensure efficient resource utilization and quality patient outcomes.
Responsibilities
  • Review admissions using InterQual and/or Milliman criteria
  • Evaluate medical necessity, level of care, and documentation accuracy
  • Ensure compliance with Medicare, Medicaid, and regulatory guidelines
  • Collaborate with physicians, case management, and care teams
  • Support discharge planning and care coordination
  • Document findings and communicate recommendations

Requirements
  • Active RN license (Nevada)
  • 5+ years acute care nursing experience
  • 3+ years Utilization Review experience
  • 3+ years discharge planning experience (acute care)
  • Experience with InterQual (must be able to pass exam)
  • Experience with Milliman guidelines

Preferred
  • Background in Case Management or CDI
  • Strong knowledge of Joint Commission and CMS guidelines

Why Apply
  • Competitive pay
  • Stable, high-demand role
  • Collaborative healthcare environment

Apply Now
If you have strong Utilization Review, InterQual, and acute care experience, we want to hear from you!

Apply