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Utilization Review Rn Jobs (NOW HIRING)

Providence Service

Utilization Review RN

Portland, OR · On-site

Description Utilization Review RN at Providence Health Plaza. Utilization Management covers 7 days/week, including holidays. This posting is not for a specific job vacancy. It serves to establish a ...

St Luke's Health

Utilization Review RN

Houston, TX · On-site

$41.14 - $61.20/hr

Job Summary and Responsibilities As our Utilization Management Professional, you will be a critical ... review outcomes. * Collaborates with facility RN Care Coordinators to ensure progression of care.

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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.

RN - Utilization Review

Springfield Memorial Hospital - AYA

Tuba City, AZ • On-site

$2.4K/wk

Other

This job post has expired 1 day ago. Applications are no longer accepted.

Job description

Details
Client Name
Tuba City Regl Healthcare Corp
Job Type
Travel
Offering
Nursing
Profession
RN
Specialty
Utilization Review
Job ID
37695961
Job Title
RN - Utilization Review
Weekly Pay
$2452.28
Shift Details
Shift
8H Days
Scheduled Hours
40
Job Order Details
Start Date
09/07/2026
End Date
12/07/2026
Duration
13 Week(s)
Job Description
GetMed Staffing is searching for a strong Utilization Review RN to assist our traveler-friendly client. A minimum of 1-2 years of experience is required.
Traveling with GetMed Staffing offers the unique opportunity to gain diverse experiences, both personally and professionally. Gain experience that matters.
Client Details
Address
PO Box 600
City
Tuba City
State
AZ
Zip Code
86045
Job Board Disclaimer
Weekly Pay is estimated and does not include taxes, insurance, or other deductions that may occur.

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