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Utilization Review Rn Jobs in Missouri (NOW HIRING)

Bothwell Regional Health Center

CRNA

Sedalia, MO · On-site

$50.81 - $82.95/hr

... utilization review and peer review programs. 3. Performs work and functions and provides service in ... Registered Nurse Anesthetist in the care of patients. REQUIRED STAFF COMPETENCIES: 1. Demonstrates ...

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Utilization Review Rn information

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$39

$64

How much do utilization review rn jobs pay per hour?

As of Jul 20, 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 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.
What are the most commonly searched types of Utilization Review Rn jobs in Missouri? The most popular types of Utilization Review Rn jobs in Missouri are:
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What cities in Missouri are hiring for Utilization Review Rn jobs? Cities in Missouri with the most Utilization Review Rn job openings:
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Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Missouri as of July 2026, with employment types broken down into 86% Full Time, 9% Part Time, and 5% Contract. Highlights an 96% In-person, 2% Hybrid, and 2% Remote job distribution, with an average salary of $82,494 per year, or $39.7 per hour.
RN, Utilization Review - PRN

RN, Utilization Review - PRN

Saint Luke's Hospital of Kansas City

Kansas City, MO • Remote

Part-time

Posted 2 days ago

New

Saint Luke's Health System (Kansas City) rating

7.1

Company rating: 7.1 out of 10

Based on 109 frontline employees who took The Breakroom Quiz

374th of 886 rated healthcare providers

Job description

Job DescriptionSaint Luke's is looking to add to the UR team!

Schedule: Day Shift

Status: PRN - 1 shift required every 2 weeks

  • MO/KS RN license required

  • Case Management experience preferred

  • Min of 2 years bedside experience preferred

  • Remote position; will cover all campuses

The Opportunity:

The Utilization Review RN is responsible for assuring the receipt of high quality, cost efficient medical outcomes through utilization review and management. This position includes monitoring patient charts and utilization of health care services. Collaborates and communicates with physicians, Care Coordinators, Social Workers and other members of the multidisciplinary and revenue cycle teams.

  • Completes initial and concurrent reviews; identifies appropriate level of service and length of stay, using clinical guidelines (InterQual).

  • Complies with CMS regulation regarding utilization review/management.

  • Obtains and manages insurance authorizations and proactively works denials to help mitigate financial impact.

  • Submits referrals for secondary level review as appropriate and follows through on process.

  • Documents communication and work in electronic medical record.

  • Works with physicians and members of the multidisciplinary and revenue cycle teams to ensure appropriate level of service, level of care and billing.

Why Saint Luke's?

  • We believe in work/life balance.

  • We are dedicated to innovation and always looking for ways to improve.

  • We believe in creating a collaborative environment where all voices are heard.

  • We are here for you and will support you in achieving your goals.

Job Requirements

Applicable Experience:

Less than 1 yearRegistered Nurse - VariousAssociate DegreeJob DetailsPRNDay (United States of America)

The best place to get care. The best place to give care. Saint Luke's 12,000 employees strive toward that vision every day. Our employees are proud to work for the only faith-based, nonprofit, locally owned health system in Kansas City. Joining Saint Luke's means joining a team of exceptional professionals who strive for excellence in patient care. Do the best work of your career within a highly diverse and inclusive workspace where all voices matter.

Join the Kansas City region's premiere provider of health services. Equal Opportunity Employer.

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