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Utilization Review Rn Jobs in Missouri (NOW HIRING)

Athene Nursing and Rehabilitation

Clinical Liaison (RN/LPN)

MO · On-site

$64K - $86K/yr

Clinical Liaison (RN/LPN) We are seeking a compassionate and driven Clinical Liaison to join our ... Work with utilization review and internal admissions teams to ensure efficient transfers * Provide ...

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Utilization Review Rn information

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$20

$39

$64

How much do utilization review rn jobs pay per hour?

As of Jun 29, 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.

How do I become a utilization review RN?

To become a utilization review RN, you typically need to hold a valid registered nurse (RN) license and have experience in clinical nursing. Additional certifications such as the Certified Professional in Healthcare Quality (CPHQ) or Utilization Review Certification (URAC) can enhance job prospects, and strong knowledge of medical coding, insurance policies, and healthcare regulations is important.

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 does an RN utilization review do?

An RN utilization review evaluates medical records and treatment plans to determine the appropriateness, necessity, 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.

How to make $300,000 a year as a nurse?

To earn $300,000 annually as a Utilization Review RN, professionals typically need extensive experience, advanced certifications such as CCM or ANCC, and may work in high-paying settings like insurance companies or healthcare consulting firms. Increasing specialization, taking on leadership roles, or working overtime can also boost income, but reaching this level often requires a combination of skills, experience, and strategic career moves.

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 CCM or ANCC, and working in high-paying settings like insurance companies or managed care organizations. Advanced skills in case management, strong clinical knowledge, and sometimes working overtime or in leadership roles can also contribute to higher earnings.

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:
What are popular job titles related to Utilization Review Rn jobs in Missouri? For Utilization Review Rn jobs in Missouri, the most frequently searched job titles are:
What job categories do people searching Utilization Review Rn jobs in Missouri look for? The top searched job categories for Utilization Review Rn jobs in Missouri are:
What cities in Missouri are hiring for Utilization Review Rn jobs? Cities in Missouri with the most Utilization Review Rn job openings:
What are popular job titles related to Utilization Review Rn jobs in MO? For Utilization Review Rn jobs in MO, the most frequently searched job titles are:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Missouri as of June 2026, with employment types broken down into 72% Full Time, 14% Part Time, and 14% Contract. Highlights an 100% In-person job distribution, with an average salary of $82,494 per year, or $39.7 per hour.
Clinical Performance Registered Nurse

Clinical Performance Registered Nurse

Sound Physicians

Bridgeton, MO • On-site

$95K - $100K/yr

Full-time

Posted 9 days ago

Job description

Bring Better to the Bedside as a Clinical Performance Registered Nurse in Bridgeton, MO at SSM DePaul Health Center
We believe in bringing "better" to our local community in Bridgeton - better care, better collaboration, and a deep commitment to the people we serve.
We are looking for a registered nurse known for being an innovative self-starter and who enjoys process and quality improvement. As a clinical performance nurse (CPN), you are a collaborative influencer who can gain credibility with your clinical provider team and implement strategic plans to improve patient care.
If you're looking for a role that supports your professional growth and your connection to a vibrant community, we'd love to talk.
Qualifications:
As a CPN, you will work in a fast-paced, hospital environment while maintaining great attention to detail and accuracy in all you do. While this position does not provide direct patient care, this role requires strong clinical knowledge and experience in the acute care hospital setting. As part of our practice, we're looking for someone with:
  • A minimum of 2 years of acute care nursing experience is required.
  • Applicants must hold an active RN licensure in good standing; a Bachelor of Science in Nursing (BSN) is preferred.
  • Candidates should be proficient in technology, including electronic medical systems and Microsoft Office.
  • Experience with quality improvement initiatives aimed at enhancing patient satisfaction is essential.
  • Experience in case management, quality, utilization review, transitional care, or post-acute services is helpful but not mandatory.

Scheduling:
  • The position offers a 40-hour work week.
  • The schedule is Monday through Friday, providing work-life balance.
  • No nights, no weekends, and paid holidays.

Key Responsibilities:
  • Demonstrate strong clinical knowledge and experience in an acute care setting.
  • Assess patients' clinical status and readiness for discharge.
  • Ensure effective communication across the care team as patients progress through their hospital stay.
  • Focus on improving the overall quality of patient care.
  • Participate in daily workflows and advocate for patient goals in the care plan.

Living and Working in Bridgeton:
  • As a CPN, you're an essential member of the team that partners with the medical director to engage and educate the hospitalist physicians and advanced practice providers in quality and process improvement initiatives. You'll use key metrics from our proprietary metrics software to measure and track performance outcomes.
  • Our guiding principle is patient-first care, which means we're focused on the people in our local community. You'll be part of a team that's making a real difference in the health of our neighbors.

Rewards and Compensation:
  • Compensation: $95K-$100K, plus bonus opportunities.

Marian Wright, Director, Clinical Recruitment | mwright@soundphysicians.com | (615) 377-5621
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About Sound Physicians

Sourced by ZipRecruiter

Sound Physicians is a leading physician partner to hospitals, health plans, physician groups, and post-acute providers seeking to transform outcomes for acute episodes of care. For 20 years our high-performing and affordable care models have combined physician leadership, clinical process, technology and analytics to consistently improve clinical and financial performance. We are pioneers in value, working together with our partners and community providers to bridge gaps in care, from hospital to home.

Industry

Health care and social assistance

Company size

1,001 - 5,000 Employees

Headquarters location

Tacoma, WA, US

Year founded

2001

Social media

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