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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 ...

HAN Staff

RN - Utilization Review

Fort Myers, FL · On-site

$2.1K/wk

Health Advocates Network is urgently hiring Utilization Review Registered Nurses (RNs) in the Fort Myers, FL area. Must have 2 years Utilization Review experience. * Pay Rate: $2,110 weekly

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 29, 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.

Utilization Review RN

Providence Health and Services

Eureka, CA • On-site

$1.9K/wk

Other

Posted 18 days ago

Providence Health & Services rating

7.7

Company rating: 7.7 out of 10

Based on 848 frontline employees who took The Breakroom Quiz

163rd of 895 rated healthcare providers

Job description

Details
Client Name
Providence Health and Services
Job Type
Travel
Offering
Nursing
Profession
Registered Nurse
Specialty
Utilization Review
Job ID
17979666
Job Title
Utilization Review RN
Weekly Pay
$1949.74
Shift Details
Shift
8 Hour Days
Scheduled Hours
40
Job Order Details
Start Date
04/06/2026
End Date
07/06/2026
Duration
13 Week(s)
Job Description
Remote Utilization Review RN responsible for concurrent reviews, medical necessity determinations, prior authorizations, continued stay reviews, and utilization management using InterQual criteria while ensuring compliance with CMS, Medicare regulations, and hospital guidelines in an acute care setting.
Client Details
City
Eureka
State
CA
Zip Code
95501

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