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Utilization Review Rn Jobs (NOW HIRING)

OU Health (Parent)

Utilization Review RN

Whittier, CA · On-site

$2K/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 ...

CommonSpirit Health

Utilization Review RN

Omaha, NE · On-site

Ensures compliance with principles of utilization review, hospital policies and external regulatory ... review outcomes. Collaborates with facility RN Care Coordinators to ensure progression of care.

CHI Health

Utilization Review RN

Omaha, NE

$33.51 - $48.58/hr

Ensures compliance with principles of utilization review, hospital policies and external regulatory ... 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 Jun 5, 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 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.

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 May 2026, with employment types broken down into 2% As Needed, 57% Full Time, 4% Part Time, 1% Temporary, and 36% Contract. Highlights an 98% Physical, and 2% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Registered Nurse - Utilization Review

Bestica Healthcare

Whittier, CA • On-site

Other

This job post has expired today. Applications are no longer accepted.

Job description

Utilization Review Rn

1st time ok/ 2 yr exp required for utilization review rn every other weekend required or more depending on unit needs no call or floating required must have experience with milliman care guidelines and acute hospital experience!! The emergency prospective review (epr) nurse – rn has the responsibility to conduct a review of all patients requiring hospital admission from the emergency room at all pih and non-pih facilities (for php members) after stabilizing care has been initiated for medical necessity and appropriateness. Also, the epr-rn is responsible for reviewing all interfacility transfer request from non-pih facility in accordance to transfer policies, health and safety codes, and applicable laws (cobra/emtala). The epr-rn performs, and supervises the eprnlvn, in utilization review with a prominent level of expertise by using approved criteria that demonstrates medical necessity to achieve appropriate authorization and reimbursement for services for the appropriate level of care and status (inpatient, observation, or outpatient).

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