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Utilization Review Nurse Jobs (NOW HIRING)

Umpqua Health

Utilization Review Nurse

Roseburg, OR · Remote

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR, 97457, as needed for business operations. EMPLOYMENT TYPE: Full-Time, Exempt About Umpqua Health At ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · Remote

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE, ability to travel to 3031 NE STEPHENS ST. ROSEBURG, OR 97470, as needed for business operations. EMPLOYMENT TYPE: Full-Time, Exempt About Umpqua Health At Umpqua ...

TEKsystems

Utilization Review Nurse

Los Angeles, CA · On-site

$35 - $50/hr

... review activities • Participate in special projects related to claim denials and appeals Required Qualifications: • Active LVN or RN license (California) • 2+ years of experience in Utilization ...

VIVA USA INC

Utilization Review Nurse

Nashville, TN · On-site +1

$37.22 - $42.22/hr

Registered Nurse responsible for collaborating with healthcare providers, members, and business ... all Utilization Management activities to include review of inpatient and outpatient medical ...

TEKsystems

Utilization Review Nurse

Canoga Park, CA

$35 - $50/hr

... review activities • Participate in special projects related to claim denials and appeals Required Qualifications: • Active LVN or RN license (California) • 2+ years of experience in Utilization ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · On-site +1

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3031 NE STEPHENS ST., ROSEBURG OR, 97457, as needed for business operations. EMPLOYMENT TYPE: Full-Time, Exempt About Umpqua Health At ...

UNC Health Careers

Utilization Review Nurse

Kinston, NC · On-site

$32.48 - $38.98/hr

To accomplish these goals, the UR, Nurse applies established criteria to evaluate the ... review and proactively resolving care, service, or transition of care delays/issues as necessary ...

UK St Claire

Utilization Review Nurse

Morehead, KY · On-site +1

Supports utilization review processes by planning, analyzing data, and setting goals to ensure ... Education Requirement Bachelor's degree in nursing, or a related field Experience Requirement 2+ ...

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Utilization Review Nurse information

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How much do utilization review nurse jobs pay per hour?

As of Jun 10, 2026, the average hourly pay for utilization 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 are the key skills and qualifications needed to thrive as a Utilization Review Nurse, and why are they important?

To thrive as a Utilization Review Nurse, you need a strong background in clinical nursing, critical thinking, and knowledge of healthcare regulations, usually supported by an RN license and nursing degree. Familiarity with utilization management software, medical coding systems (like ICD-10 and CPT), and case management certifications (such as CCM or URAC) is typically required. Excellent communication, negotiation, and organizational skills help you collaborate with providers and advocate for patient care while managing complex cases. These skills ensure appropriate resource use, regulatory compliance, and high-quality patient outcomes in healthcare settings.

What does a Utilization Review Nurse do?

A Utilization Review Nurse is responsible for evaluating the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, coordinate with healthcare providers, and ensure that care meets established guidelines and insurance requirements. Their primary goal is to ensure patients receive appropriate care while helping to manage healthcare costs and prevent unnecessary procedures.

What are some typical challenges Utilization Review Nurses face when communicating with healthcare providers and insurance companies?

Utilization Review Nurses often need to balance clinical judgment with insurance guidelines, which can lead to challenging conversations with providers who may disagree with coverage decisions. They must clearly explain the rationale behind approvals or denials and ensure all documentation is thorough and compliant. Navigating differing priorities while maintaining positive, professional relationships is key, and strong communication skills help facilitate collaboration and resolve conflicts efficiently.

What Does a Utilization Review Nurse Do?

A utilization review nurse determines the best course of treatment for a patient using preapproved policy criteria. Utilization review nurses collect and review patient records, clinical documentation, and billing information to recommend the best use of patient care resources. Their assessments help determine the length of hospital stays, the effectiveness of the care plan, and the necessity of the services administered. Utilization review nurses inform and educate patients about their options based on their insurance benefits and limitations. Utilization review nurses also assess patient care services in clinical appeals for approval or denial.

What is the difference between Utilization Review Nurse vs Case Manager?

AspectUtilization Review NurseCase Manager
CredentialsRN license, certification in utilization review (e.g., URAC)RN license, case management certification (e.g., CCM)
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, insurance companies, community health settings
Employer & Industry UsagePrimarily in insurance and healthcare organizations for reviewing medical necessityIn healthcare and insurance for coordinating patient care and discharge planning

Utilization Review Nurses focus on evaluating the necessity and appropriateness of medical services, often working in insurance or healthcare settings. Case Managers coordinate patient care, discharge planning, and resource management. While both roles require RN licensure and related certifications, their primary responsibilities differ: UR Nurses review medical necessity, whereas Case Managers facilitate patient care and services.

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Utilization Review Nurse jobs near you
Infographic showing various Utilization Review Nurse job openings in the United States as of June 2026, with employment types broken down into 100% Full Time. Highlights an 50% In-person, and 50% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
Utilization Review Nurse

Utilization Review Nurse

Global Force USA

Las Vegas, NV

Full-time

Posted 2 days ago

Job description

Position Summary: Reviews patient admissions for appropriateness, efficiency of resource utilization and compliance with third party payer requirements. Duties include analyzing medical charts, determining whether care provided is within established parameters.

Job Requirement

Education/Experience:
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.

Licensing/Certification Requirements:
Valid license by the State of Nevada to practice as a Registered Nurse.

Additional Position Requirements
  • 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.
Knowledge, Skills, Abilities, and Physical Requirements

Knowledge of:
Interquel or Milliman utilization review criteria, Medicare/Medicaid guidelines, hospital policies and procedures; Joint Commission Accredited Health care Organizations standards, state statutes governing hospital services and health care, and other relevant regulations and standards; clinical medical and nursing procedures; disease processes; department and hospital safety practices and principles; patient rights; age specific patient care practices; infection control policies and practices; department and hospital emergency response policies and procedures.
Skill in:
Interpreting patient charts to determine whether care given is within best practice, appropriate for the diagnosis and properly documented; excellent ability to collaborate, co-ordinate and communicate findings; interpreting regulations and standards for others; writing reports, meeting minutes and other technical documents; analyzing statistical and other quantitative data; applying investigative and interviewing techniques; using a computer and a variety of software applications; communicating with a wide variety and establishing interpersonal relationships to interact effectively with co-workers, supervisor, staff in other work units and exchange or convey information.
Physical Requirements and Working Conditions:
Mobility to work in a typical office setting and use standard equipment, stamina to remain seated for extended periods of time, vision to read printed materials and a computer screen, and hearing and speech to communicate effectively in person and over the telephone. Strength and agility to exert up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects. May work shifts and weekends. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this classification.