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Utilization Review Rn Jobs (NOW HIRING)

MedSource Travelers

RN - Utilization Review

York, ME · On-site

Utilization Review Rn Travel Position Shift: 8 HR Days Start Date: 07/06/2026 End Date: 10/05/2026 Duration: 13 Week(s) Location: York, ME Equal Opportunity Employer: MedSource LLC is an equal ...

CareConnect

Utilization Review RN

Greenvale, NY

Reviews and coordinates prospective, concurrent and retrospective activities related to utilization ... Bachelor's Degree in Nursing, preferred. Must be enrolled in an accredited program within 24 months ...

CareConnect

Utilization Review RN

Greenvale, NY · On-site

Reviews and coordinates prospective, concurrent and retrospective activities related to utilization ... Bachelor's Degree in Nursing, preferred. Must be enrolled in an accredited program within 24 months ...

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Utilization Review RN information

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How much do utilization review rn jobs pay per hour?

As of Jul 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.

How to get into utilization review as a nurse?

To become a utilization review RN, candidates typically need a valid nursing license and experience in clinical settings. Additional certifications such as Certified Professional in Healthcare Quality (CPHQ) or case management credentials can enhance prospects, and familiarity with electronic health records and insurance policies is beneficial.

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.

How to make $300,000 as a nurse?

A Utilization Review RN can earn $300,000 by gaining extensive experience, obtaining certifications such as Certified Review Officer (CRO), working in high-paying settings like insurance companies or managed care organizations, and taking on leadership or specialized roles that offer higher compensation. Advanced skills in clinical assessment, documentation, and understanding of healthcare policies can also contribute to higher earnings.

What does an RN utilization review do?

An RN utilization review evaluates medical records and treatment plans to determine the necessity, appropriateness, and efficiency of healthcare services. They ensure compliance with insurance policies and clinical guidelines, often using electronic health records and requiring knowledge of coding and documentation standards. This role supports cost-effective patient care and involves collaboration with healthcare providers and insurance companies.

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 make $150,000 as a nurse?

A Utilization Review RN can earn $150,000 by gaining extensive experience, obtaining certifications such as Certified Review Officer (CRO), working in high-demand settings, and possibly taking on leadership or specialized roles. Increasing your workload, working overtime, or pursuing advanced education can also contribute to higher earnings within this field.

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.
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Utilization Review RN jobs near you
Infographic showing various Utilization Review Rn job openings in the United States as of July 2026, with employment types broken down into 1% As Needed, 80% Full Time, 15% Part Time, 1% Temporary, and 3% Contract. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
RN Utilization Review-Case Management-FT-1st shift

RN Utilization Review-Case Management-FT-1st shift

Huntsville Hospital Health System

Huntsville, AL • On-site

Other

Re-posted 10 days ago

Huntsville Hospital Health System rating

6.1

Company rating: 6.1 out of 10

Based on 205 frontline employees who took The Breakroom Quiz

721st of 881 rated healthcare providers

Job description

Overview

The Surgical Utilization Review Registered Nurse (UR RN) is responsible for conducting concurrent medical necessity reviews to ensure appropriate level-of-care determinations, regulatory compliance, and reimbursement integrity. This position serves as a liaison between physicians, advanced practice providers, nursing, case management, revenue cycle, and payer organizations to facilitate accurate patient status assignment, timely authorization management, and denial prevention. The primary focus of this role is surgical utilization review, including pre-operative, post-operative, and procedural patient populations. Responsibilities include validating compliance with Medicare, commercial payer, and organizational requirements, including Inpatient Only (IPO) procedures, Two-Midnight Rule criteria, observation services, and medical necessity requirements.This role requires strong collaboration with surgeons, physician assistants, nurse practitioners, hospitalists', and clinical staff to obtain clarifying documentation, facilitate timely order placement, and support appropriate status determinations. The Surgical UR RN is expected to serve as a resource for utilization management best practices and support broader utilization review functions as operational needs dictate.

Qualifications

Required Education: Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) or Licensed Registered Nurse

Preferred Education: Bachelors Science Nursing or higher

Required Experience: 2 years previous nursing experience

Preferred Experience: Utilization Review or Case Management experience

Required License/Registration/Certification: Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) or Licensed Registered Nurse

Preferred License/Registration/Certification: ACM or CCM Certification

Computer Skills Required: Data entry skills; Demonstrable skills with Google Docs, Google Sheets, Microsoft Suite and email applications.

Employment Type: OTHER

What Huntsville Hospital Health System employees say

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Hours and flexibility

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