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Utilization Review Rn Jobs (NOW HIRING)

OU Health (Parent)

Utilization Review RN

Whittier, CA · On-site

$2.8K/wk

Details Client Name PIH HEALTH Job Type Travel Offering Nursing Profession Registered Nurse Specialty Utilization Review Job ID 18027156 Job Title Utilization Review RN Weekly Pay $2800.0 Shift ...

Lancesoft INC

Utilization Review RN

Atlanta, GA · On-site

$3.0K - $3.1K/wk

Utilization Review RN - Target Review * Health Plan Insurance (no acute care) * BLS (AHA) * RN state license Company Description LanceSoft is rated as one of the largest staffing firms in the US by ...

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How much do utilization review rn jobs pay per hour?

As of Aug 21, 2026, the average hourly pay for utilization review rn 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 a utilization review RN?

A Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, collaborate with healthcare teams, and ensure that patient care meets established guidelines and payer requirements. Their role helps control costs, optimize care, and support compliance with healthcare regulations. Utilization Review RNs often work in hospitals, insurance companies, or managed care organizations.

How does a utilization review RN collaborate with physicians and other healthcare professionals during the patient care review process?

A Utilization Review RN works closely with physicians, case managers, and other healthcare team members to ensure that patients receive appropriate care while adhering to regulatory and insurance guidelines. This collaboration often involves discussing clinical findings, clarifying documentation, and negotiating care plans to meet both patient needs and payer requirements. Effective communication and teamwork are essential, as Utilization Review RNs frequently serve as liaisons between clinical staff and insurance representatives to facilitate timely authorizations and prevent unnecessary delays in patient care.

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

To thrive as a Utilization Review RN, you need a current RN license, strong clinical assessment skills, and knowledge of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or ACM is often required. Excellent critical thinking, communication, and negotiation skills help you advocate for appropriate patient care while collaborating with providers and payers. These skills ensure cost-effective, quality care and compliance with regulatory standards in healthcare delivery.

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

AspectUtilization Review RnCase Manager
CredentialsRN license, certifications in utilization reviewRN license, certifications in case management
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community agencies, insurance companies
Primary FocusReviewing medical necessity and appropriateness of careCoordinating patient care and discharge planning

Utilization Review Rns primarily focus on evaluating the necessity of medical treatments, while Case Managers coordinate patient care and discharge planning. Both roles require RN licensure and certifications, but their daily responsibilities and work environments differ slightly, with Utilization Review Rns concentrating on review processes and Case Managers on patient advocacy and care coordination.

How to get into utilization review as a registered nurse?

To become a utilization review RN, you typically need a valid registered nurse license and experience in clinical settings. Additional certifications such as the Certified Professional in Healthcare Quality (CPHQ) or case management certification can enhance job prospects, and familiarity with electronic health records (EHR) systems is often required.
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Utilization Review RN jobs near you
Infographic showing various Utilization Review Rn 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 Registered Nurse

Ironside HR

Kearney, NE • On-site

Other

Re-posted 12 days ago

Job description


A facility located near Lexington, Nebraska is seeking a Utilization Review Registered Nurse to join their team!
Utilization Review Registered Nurse Opportunity:
  • Full-time, permanent position
  • Schedule: Monday-Friday, 9: 00AM-5: 00PM
  • Collaborates with providers, departments, and community resources to ensure patient-centered care and effective communication of care plans
  • Supports utilization review, quality data collection, compliance, and accurate medical documentation while maintaining patient safety and infection control standards
Utilization Review Registered Nurse Requirements:
  • NE Registered Nurse License
  • Associate s or Bachelor s degree in Nursing required (Bachelor s preferred)
  • At least two years of nursing experience
  • BLS certification required within six months of hire
  • Strong communication, documentation, and confidentiality skills with the ability to collaborate with patients, staff, insurance representatives, and regulatory agencies while following infection control protocols
The Location:
  • Located in South Central Nebraska
  • Maintains more than 100 acres of green space, public parks, trails, a skate park, aquatic center, indoor sports field house and racquets center
  • Not far from Johnson Lake which offers boating, fishing, and trails
  • Known for a welcoming small-town feel with affordable living and a strong sense of community
Interested? Contact Aidan G. | Ironsidehr.Com | 469-921-0777 | aidan@ironsidehr.Com
Ironside Human Resources logo

About Ironside Human Resources

Sourced by ZipRecruiter

Ironside Human Resources, based in Dallas, TX, US, is a national healthcare recruitment company that offers staffing solutions to hospitals and healthcare providers across the United States. With an official website located at ironsidehr.com, the firm specializes in direct-hire recruitment for diverse sectors, including nursing, allied health, ancillary, administrative and executive-level roles in the healthcare industry. The company was founded in 2011 and has since committed to solving the healthcare staffing shortage through their unique, cost-effective recruitment strategies. Their core commitment is defined by their professional integrity, exceptional customer service, and dedication to delivering value and effective solutions.

Industry

Recruiting and staffing services

Company size

1 - 10 Employees

Headquarters location

Dallas, TX, US

Year founded

2011

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