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Utilization Review Rn Jobs in Missouri (NOW HIRING)

Sedgwick

RN Utilization Review

Jefferson City, MO

$73K - $75K/yr

Maintains a score of 90% or higher on monthly internal utilization review audits. * Meets productivity goals as outlined by supervisor. Education & Licensing Active unrestricted RN license in a state ...

New

UHS

Director of Utilization Review

Blue Springs, MO · On-site

Oversee precertification, concurrent, and discharge utilization reviews. * Facility regulatory ... A valid clinical license in the State of Missouri (LPC, LCSW,or RN) required. EEO Statement All UHS ...

Summit BHC

Utilization Review Manager

Eolia, MO · On-site

Utilization Review Manager | The Aviary Recovery Center | Eolia, Missouri About the Job: PURPOSE ... Current licensure as an LPN or RN or current clinical professional license or certification, as ...

UHS

Director of Utilization Review

Blue Springs, MO

Oversee precertification, concurrent, and discharge utilization reviews. * Facility regulatory ... A valid clinical license in the State of Missouri (LPC, LCSW,or RN) required. EEO Statement All UHS ...

UHS

Director of Utilization Review

Blue Springs, MO · On-site

Oversee precertification, concurrent, and discharge utilization reviews. * Facility regulatory ... A valid clinical license in the State of Missouri (LPC, LCSW,or RN) required. EEO Statement All UHS ...

UnitiMed

RN Case Manager

Kansas City, MO

Referral bonus up to $700 Registered Nurse (RN),Case Management/Utilization Review, About the Company: Uniti Med is an award-winning healthcare staffing company with a mission to provide staffing ...

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Utilization Review Rn information

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$39

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How much do utilization review rn jobs pay per hour?

As of Jun 8, 2026, the average hourly pay for utilization review rn in Missouri is $39.66, according to ZipRecruiter salary data. Most workers in this role earn between $31.35 and $45.53 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 Missouri as of May 2026, with employment types broken down into 60% Full Time, 20% Part Time, and 20% Contract. Highlights an 100% In-person job distribution, with an average salary of $82,494 per year, or $39.7 per hour.
Utilization Review Registered Nurse

Utilization Review Registered Nurse

BJC HealthCare

Saint Louis, MO • On-site

$33.60 - $51.39/hr

Full-time, Per diem

Medical, Dental, Vision, Life, Retirement, PTO

Posted yesterday

BJC Healthcare rating

7.6

Company rating: 7.6 out of 10

Based on 217 frontline employees who took The Breakroom Quiz

185th of 869 rated healthcare providers

Job description

Additional Information About the Role
Join a stable work-from-home team! This is a great opportunity for a local remote position. There is no communication with patients. This position supports all units/staff (commercial, behavioral health, inpatient, etc.)
  • PRN (at minimum, two 8hr shifts every pay period)
  • Monday - Friday; days; 8am-4:30pm
  • Assigned Sunday shifts (every 4-6 weeks)
  • No major holidays

Orientation schedule: PRN hires must be available for full-time orientation for 2 full weeks, Monday - Friday from 8am-4:30pm.
Requirements:
  • 2 years of RN experience performing care for hospitalized patients
  • 2 years of Utilization Review (UR) experience reviewing hospital admissions for medical necessity
  • Must live within one hour of the BJC Commons (4249 Clayton Ave, St. Louis, MO 63110)
  • Must have high speed internet
  • Must have at least one active MO or IL RN license
    • If candidate only has one RN license (MO or IL), the application process for the 2nd license must be started after receiving the job offer.

Additional Preferred Requirements
  • EPIC experience

Overview
BJC HealthCare is one of the largest nonprofit health care organizations in the United States, delivering services to residents primarily in the greater St. Louis, southern Illinois and southeast Missouri regions. With net revenues of $6.3 billion and more than 30,000 employees, BJC serves patients and their families in urban, suburban and rural communities through its 14 hospitals and multiple community health locations. Services include inpatient and outpatient care, primary care, community health and wellness, workplace health, home health, community mental health, rehabilitation, long-term care and hospice.
BJC is the largest provider of charity care, unreimbursed care and community benefits in the state of Missouri. BJC and its hospitals and health service organizations provide $785.9 million annually in community benefit. That includes $410.6 million in charity care and other financial assistance to patients to ensure medical care regardless of their ability to pay. In addition, BJC provides additional community benefits through commitments to research, emergency preparedness, regional health care safety net services, health literacy, community outreach and community health programs and regional economic development.
BJC's patients have access to the latest advances in medical science and technology through a formal affiliation between Barnes-Jewish Hospital and St. Louis Children's Hospital with the renowned Washington University School of Medicine, which consistently ranks among the top medical schools in the country.
Preferred Qualifications
Role Purpose
Ensure that the administration of hospital resources are appropriate, efficient and fall within the parameters of the patient's payment structure while providing safe and quality care. Evaluate the cost and quality of medical services provided by the medical team. Ensure appropriate utilization, which includes the evaluation of potential under and over-utilization according to patient's presentation and documentation. Education of medical providers and other health care professionals on the appropriate and cost-effective use of health care resources.
Responsibilities
  • Uses clinical and analytical skills to review and interpret diagnostic test results to determine appropriateness of patient's level of care.
  • Uses Interqual Criteria to determine level of care for all elective inpatient hospitalizations to assure services are provided in the appropriate setting.

    • Minimum Requirements
    Education
  • Nursing Diploma/Associate's
    • - Nursing
    Experience
  • 2-5 years

    • Supervisor Experience
  • No Experience

    • Licenses & Certifications
  • RN

    • Preferred Requirements
    Education
  • Bachelor's Degree
    • - Nursing
    Benefits and Legal Statement
    BJC Total Rewards
    At BJC we're committed to providing you and your family with benefits and resources to help you manage your physical, emotional, social and financial well-being.
    • Comprehensive medical, dental, vison, life insurance, and legal services available first day of the month after hire date
    • Disability insurance* paid for by BJC
    • Annual 4% BJC Automatic Retirement Contribution
    • 401(k) plan with BJC match
    • Tuition Assistance available on first day
    • BJC Institute for Learning and Development
    • Health Care and Dependent Care Flexible Spending Accounts
    • Paid Time Off benefit combines vacation, sick days, holidays and personal time
    • Adoption assistance

    To learn more, go to our Benefits Summary
    *Not all benefits apply to all jobs
    The above information on this description has been designed to indicate the general nature and level of work performed by employees in this position. It is not designed to contain or be interpreted as an exhaustive list of all responsibilities, duties and qualifications required of employees assigned to this job. Equal Opportunity Employer

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    About BJC Healthcare

    Sourced by ZipRecruiter

    BJC Healthcare, situated in Saint Louis, MO, US, is one of the largest healthcare organizations in the United States. Launched in 1993, BJC encompasses 15 hospitals and multiple health service organizations covering the metropolitan St. Louis area, mid-Missouri and Southern Illinois. This healthcare titan's services cover a vast field, from community health and wellness, to pediatric care, to advanced specialty care. BJC is well-known for its two nationally recognized hospitals, Barnes-Jewish Hospital and St. Louis Children's Hospital, both affiliated with Washington University School of Medicine. Its mission revolves around improving the health and well-being of the communities it serves through leadership, education, innovation, and excellence in medicine.

    Industry

    Health care and social assistance

    Company size

    10,000+ Employees

    Headquarters location

    Saint Louis, MO, US

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