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Utilization Review Rn Jobs in Missouri (NOW HIRING)

Responsible for the performance of Utilization Review services, including pre-admission ... Uses clinical/nursing skills to determine whether all aspects of a patient's care, at every level ...

Responsible for the performance of Utilization Review services, including pre-admission ... Uses clinical/nursing skills to determine whether all aspects of a patient's care, at every level ...

Currently seeking a Telephonic Nurse Case Manager. The qualified individual will need to be located ... Responsible for the performance of Utilization Review services, including pre-admission ...

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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 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:
What cities in Missouri are hiring for Utilization Review Rn jobs? Cities in Missouri with the most Utilization Review Rn job openings:
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.
Registered Nurse ( RN ), Home Health - Part Time

Registered Nurse ( RN ), Home Health - Part Time

AW Health Care

Arnold, MO • On-site

$75K - $90K/yr

Other

Medical, Life, Retirement, PTO

Posted 21 days ago


Job description

Description

Looking for More Time With Your Patients-and Your Family?

Do you love providing home health care but find documentation overwhelming? Are you searching for better work-life balance and tired of charting after hours? At AW Health Care, we understand that the best patient outcomes happen when clinicians can focus on care-not paperwork.

We've launched an exciting new program that allows you to do just that: deliver high-quality, 1:1 care while minimizing documentation requirements. With a flexible schedule, excellent clinical outcomes, and strong patient satisfaction, this role is designed for therapists who want to make a difference-without sacrificing personal time.


About AW Health Care: AW Health Care is a woman-owned, independent home health agency based in St. Louis, proudly serving Missouri and Illinois for over 25 years. With more than 500 team members supporting over 1,500 patients, we are committed to delivering innovative, patient-centered care that makes a difference.


Why Join AW Health Care?
We offer a comprehensive benefits package, including:

  • 401(k) with 4% Company Match
  • Paid Time Off (PTO)
  • $5,000 Sign-On Bonus (Part-Time)
  • Supplemental benefits (Short/Long-Term Disability, AD&D, Additional Life Insurance)

Job Summary:
We are seeking a compassionate and skilled Registered Nurse (RN) to provide intermittent in-home nursing care in alignment with physician orders and individualized care plans. Care is delivered under the guidance and supervision of the Director of Clinical Services or Nursing Supervisor. This role offers flexibility and the opportunity to make a direct impact in the lives of patients within their own homes.


Now Hiring - Part Time Opportunities Available in Missouri:


  • Jefferson County

The part time schedule must include three- 8 hour week days and at least one Monday or Friday each week.


Responsibilities:

  1. Provides services in accordance with the plan of care.
  2. Makes the initial evaluation visit and regularly reevaluates the patient's nursing needs.
  3. Initiates the plan of care and necessary revisions.
  4. Provides those services requiring substantial specialized nursing skills.
  5. Initiates appropriate preventive and rehabilitative nursing procedures.
  6. Prepares clinical and progress notes for each patient visit and summaries of care conferences on his/her patients in a timely manner as per Agency policy.
  7. Coordinates services.
  8. Informs personnel of changes in the condition and needs of the patient.
  9. Counsels the patient and family/significant others in meeting nursing and related needs.
  10. Participates in and presents inservice programs.
  11. Understands and adheres to established Agency policies and procedures.
  12. Processes orders and notifies physician of patient needs and changes in condition. Completes certification/ recertification orders and discharge summaries.
  13. Determines the amount and type of nursing needed by each individual patient.
  14. Refers to Physical Therapist, Speech Language Pathologist, Occupational Therapist and Licensed Clinical Social Worker those patients requiring their specialized skills.
  15. Supervises and teaches other nursing personnel.
  16. Conducts patient care conferences on patients assigned to his/her care.
  17. Participates in peer review and performance improvement as assigned.
  18. Participates in utilization review of medical records as assigned.
  19. Gives total patient care as needed.
  20. Takes on-call duty nights, weekends and holidays, as assigned.
  21. Completes and submits OASIS assessments, reassessments, transfers, resumptions of care, discharges and significant change in condition in accordance with Agency defined time frames.
  22. Appropriately utilizes ICD-9 codes.


Working Environment:

Works indoors in Agency office and patient homes and travels to/from patient homes.


Job Relationships:

  1. Supervised by: Director of Clinical Services/Nursing Supervisor
  2. Workers Supervised: Licensed Practical Nurse, Home Health Aide

Risk Exposure:

High risk


Requirements

Qualifications:

  1. Graduate of an approved school of professional nursing and currently licensed in the state(s) in which practicing.
  2. Two (2) years nursing experience, preferred.
  3. Acceptance of philosophy and goals of this Agency.
  4. Ability to exercise initiative and independent judgment.


Physical Requirements:

Ability to perform the following tasks if necessary:

  • Ability to participate in physical activity.
  • Ability to work for extended period of time while standing and being involved in physical activity.
  • Heavy lifting.
  • Ability to do extensive bending, lifting and standing on a regular basis.