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Utilization Review Rn Jobs (NOW HIRING)

Bellevue Hospital

RN - Utilization Review

Manhattan, NY · On-site

$2.7K/wk

Details Client Name Bellevue Hospital Job Type Travel Offering Nursing Profession RN Specialty Utilization Review Job ID 37956884 Job Title RN - Utilization Review Weekly Pay $2742.5 Shift Details ...

KPC Global MSO

Utilization Review RN

Santa Ana, CA · On-site

SUMMARY The Utilization Review RN reviews client health records to ensure proper utilization of treatment resources. RESPONSIBILITIES AND DUTIES: * Coordinates and reviews all medical records, as ...

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 ...

HealthCare Support

Utilization Management

Houston, TX · On-site

$38 - $40.86/hr

Behavioral Health Utilization Review RN HealthCare Support is actively seeking a Remote BH Utilization Review RN to fill an opening with a Managed Care Company . Daily Responsibilities for Remote BH ...

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 ...

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 ...

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Utilization Review RN information

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How much do utilization review rn jobs pay per hour?

As of Sep 11, 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, 81% Full Time, 14% Part Time, 3% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

RN - Utilization Review

Manhattan, NY • On-site

Bellevue Hospital
Health Care and Social Assistance • 201 - 500 employees
Learn more about Bellevue Hospitalexternal

$2.7K/wk

Other

Posted 6 days ago

Job description

Details
Client Name
Bellevue Hospital
Job Type
Travel
Offering
Nursing
Profession
RN
Specialty
Utilization Review
Job ID
37956884
Job Title
RN - Utilization Review
Weekly Pay
$2742.5
Shift Details
Shift
8a-4p
Scheduled Hours
40
Job Order Details
Start Date
09/21/2026
End Date
11/14/2026
Duration
8 Week(s)
Job Description
About the Position
Specialty: RN - Utilization Review
Experience: 2+ years of experience in utilization review, case management, or acute care nursing
License: Active State or Compact RN License
Certifications: BLS - AHA; Certified Case Manager (CCM) preferred
Must-Have: Strong understanding of insurance guidelines, medical necessity criteria (e.g., InterQual or MCG), and discharge planning
Description: The Utilization Review RN is responsible for reviewing medical records to determine the appropriateness and medical necessity of hospital admissions and continued stays. The nurse collaborates with providers, insurance companies, and case managers to ensure compliance with coverage guidelines and supports optimal patient outcomes while managing healthcare costs.
Requirements
Required for Onboarding:
  • Active RN License
  • BLS

Client Details
Address
462 1st Avenue
City
New York City
State
NY
Zip Code
10016

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