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Utilization Review Rn Jobs in Nebraska (NOW HIRING)

Faith Health

RN-ARU

Norfolk, NE · On-site

The registered nurse (RN) is a professional nurse under the supervision and direction of the ... utilization review regarding clinical nursing issues. 4. Assumes all other duties and ...

Faith Health Services Inc

RN-ARU

Norfolk, NE · On-site

The registered nurse (RN) is a professional nurse under the supervision and direction of the ... utilization review regarding clinical nursing issues. 4. Assumes all other duties and ...

CommonSpirit Health

Care Coordinator Nurse Float

Omaha, NE · On-site

$32.70 - $48.65/hr

The RN Care Coordinator is responsible for performing utilization review activities, overseeing the progression of care and transition of care planning for identified patients requiring these ...

Gphealth

Case Manager RN

North Platte, NE · On-site

Case Manager-RN Cost Center: Case Management The Clinical Case Manager RN proactively consults with ... utilization reviews per InterQual criteria and national guidelines. Collaborates with the ...

Gphealth

Case Manager RN

North Platte, NE

Case Manager-RN Cost Center: Case Management The Clinical Case Manager RN proactively consults with ... utilization reviews per InterQual criteria and national guidelines. Collaborates with the ...

Great Plains Health

Case Manager RN

North Platte, NE · On-site

Case Manager-RN Cost Center: Case Management The Clinical Case Manager RN proactively consults with ... utilization reviews per InterQual criteria and national guidelines. Collaborates with the ...

Great Plains Health

Case Manager RN

North Platte, NE · On-site

Case Manager-RN Cost Center: Case Management The Clinical Case Manager RN proactively consults with ... utilization reviews per InterQual criteria and national guidelines. Collaborates with the ...

Imedica

Supervisor, Clinical Quality Review

Omaha, NE · Remote

This role provides direct supervision, coaching, and workload management for Clinical Quality Review RNs while ensuring audit deliverables, documentation standards, and regulatory timelines are met.

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Utilization Review Rn information

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How much do utilization review rn jobs pay per hour?

As of Jun 30, 2026, the average hourly pay for utilization review rn in Nebraska is $40.31, according to ZipRecruiter salary data. Most workers in this role earn between $31.88 and $46.30 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 Nebraska? The most popular types of Utilization Review Rn jobs in Nebraska are:
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What cities in Nebraska are hiring for Utilization Review Rn jobs? Cities in Nebraska 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 Nebraska as of June 2026, with employment types broken down into 88% Full Time, and 12% Contract. Highlights an 94% In-person, and 6% Remote job distribution, with an average salary of $83,852 per year, or $40.3 per hour.
Denials and Appeals RN

Denials and Appeals RN

Methodist Health System

Omaha, NE • On-site

Other

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

Job description

Why work for Nebraska Methodist Health System?
At Nebraska Methodist Health System, we focus on providing exceptional care to the communities we serve and people we employ. We call it The Meaning of Care - a culture that has and will continue to set us apart. It's helping families grow by making each delivery special, conveying a difficult diagnosis with a compassionate touch, going above and beyond for a patient's needs, or giving a high five when a patient beats a disease or conquers a personal health challenge. We offer competitive pay, excellent benefits and a great work environment where all employees are valued! Most importantly, our employees are part of a team that makes a real difference in the communities we live and work in.
Job Summary:
Location: Methodist Corporate Office
Address: 825 S 169th St. - Omaha, NE
Work Schedule: Mon - Fri, business hours
Responsible for overall management and communication of clinically-based appeals between Methodist Health System and payers.
Responsibilities:
Essential Functions
Promotes positive relations when interacting with physicians, visitors, families, customers and co-workers.
  • Greets, smiles and makes eye contact. Introduces self by name.
  • Volunteers to help co-workers and other employees.
  • Responds quickly to patients and/or other peoples' needs.
  • Knows and demonstrates customer complaint management process.
Responsible for overall management and communication of clinically-based appeals between Methodist Health System and payers.
  • Reviews each case identified/referred for appeal
  • Utilizes InterQual and/or Physician Advisor to determine the viability of the appeal.
  • Manage the appeal including documentation and communication to appropriate payer.
  • Monitor for response and evaluate findings and rationale on denial and appeal tracking software when received.
  • Follow - up with appropriate communication to payers when there is no response or questionable responses to appeals.
Performs Medicare, Medicaid and commercial payer reviews of patients in the acute care setting.
  • Construct a letter of appeal arguing a clinically-oriented, objective and measurable rebuttal to denied days/services based on InterQual guidelines, payor guidelines, and/or Physician Advisor.
  • Collaborate with Physician Advisor by delivering accurate clinical picture and to assure appropriate decision is made to appeal.
  • Demonstrates knowledge of appeal process for Medicare, Medicaid and commercial payers.
  • Construct letters for all levels of appeal and adhere to payer timelines to ensure timely appeal to include discussion level letters if applicable.
  • Communicates all pertinent information regarding denials of payment and/or levels of care to the billing office.
Monitor, identify and report suspected or emerging trends related to payer denials.
  • Demonstrates a working knowledge of regulations and provider contracts governing coverage of inpatient observation and outpatient services.
Conduct pre-emptive audits of high risk target areas and report findings, including the below items.
  • Review number of short stay admissions that do not meet medical necessity for inpatient. Communicate with business office if re-billing is required.
  • Review number of three day transfer to SNF that did not meet medical necessity.
  • Review number of Code 44 required.
  • Review number of Inpatient only procedures done as an outpatient.
Collaborates with Methodist Health System, its physicians and its affiliates through communication with payers regarding medical necessity and institutional process issues and to decrease appeals and denials.
  • Serves as a role model to promote collaborative relationships.
  • Makes sure communication will occur as soon as problems or concerns are identified recognizing that other members of the team will have valuable input into the case.
  • Facilitates communication among the Denials team members by communicating effectively to solve problems at a personal and unit level.
  • Collaborate with physicians providing pertinent clinical information in appeal letters to promote respected working relationship.
  • Remains approachable and professional at all times in working with other health professionals, ancillary staff, patients and family.
  • Remains calm in difficult situations and effectively diffuses crisis and refers to appropriate supervisory levels as needed.
Acts as a resource and provides education/training to physicians, physician office staff, nurses and coders in a variety of settings: One on one; Group presentations and Quick sessions.
  • Provides periodic education sessions of trends related to payer denials.
  • Recognizes payer source and understands the principles of reimbursement per payer.
  • Works in partnership with physicians, care coordinators, and utilization management to ensure the medical record accurately reflects medical necessity.
  • Promotes the education of all members of the Denials & Appeals team, physicians, office and hospital staff.
  • Is able to educate and explain the rationale and benefits for improving documentation of medical necessity.
  • Communicates issues/trends (positive/negative) to Supervisor and/or Physician Advisor.
Utilizes data bases from internal and external sources that will demonstrate the effectiveness of the Denials & Appeals process to promote documentation of medical necessity. Participation in the Performance Improvement process
  • Participates in data collection for Denials & Appeals and assures that the data is reliable and valid measures will be obtained through the use of data analysis tools and excel files.
  • Provides follow-up on data collection to track denials in progress, wins/partial wins/losses, and ensure no appeal cases exceed allowed periods of time for pursuit of appeal.
  • Uses the data collected to identify opportunities for improvement in Denials & Appeals process.
Schedule:
Mon - Fri, business hours
Job Description:
Job Requirements
Education
  • Bachelors of Science in Nursing required.
Experience
License/Certifications
  • Registered Nurse (RN) with current state license is required.
Skills/Knowledge/Abilities
  • Five years clinical experience in medical surgical nursing and/or ICU or case management with strong computer skills to include Word and Excel, use of laptops, and Internet.
  • Past experience in an acute care setting as a Denials and Appeals RN preferred.
  • Excellent communication skills; verbal, written and strong teaching skills, critical thinking skills and knowledge of healthcare delivery system.
Physical Requirements
Weight Demands
  • Light Work - Exerting up to 20 pounds of force.
Physical Activity
  • Not necessary for the position (0%):
    • Climbing
    • Crawling
    • Kneeling
  • Occasionally Performed (1%-33%):
    • Balancing
    • Carrying
    • Crouching
    • Distinguish colors
    • Grasping
    • Lifting
    • Pulling/Pushing
    • Standing
    • Stooping/bending
    • Twisting
    • Walking
  • Frequently Performed (34%-66%):
    • Fingering/Touching
    • Keyboarding/typing
    • Reaching
    • Repetitive Motions
    • Sitting
    • Speaking/talking
  • Constantly Performed (67%-100%):
    • Hearing
    • Seeing/Visual
Job Hazards
  • Not Related:
    • Chemical agents (Toxic, Corrosive, Flammable, Latex)
    • Physical hazards (noise, temperature, lighting, wet floors, outdoors, sharps) (more than ordinary office environment)
    • Equipment/Machinery/Tools
    • Explosives (pressurized gas)
    • Electrical Shock/Static
    • Radiation Alpha, Beta and Gamma (particles such as X-ray, Cat Scan, Gamma Knife, etc)
    • Radiation Non-Ionizing (Ultraviolet, visible light, infrared and microwaves that causes injuries to tissue or thermal or photochemical means)
    • Mechanical moving parts/vibrations
  • Rare (1-33%): - Biological agents (primary air born and blood born viruses) (Jobs with Patient contact) (BBF)

About Methodist:
Nebraska Methodist Health System is made up of four hospitals in Nebraska and southwest Iowa, more than 30 clinic locations, a nursing and allied health college, and a medical supply distributorship and central laundry facility. From the day Methodist Hospital was chartered in 1891, service to our communities has been a top priority. Financial assistance, health education, outreach to our diverse communities and populations, and other community benefit activities have always been central to our mission.
Nebraska Methodist Health System is an Affirmative Action/Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex, age, national origin, disability, veteran status, sexual orientation, gender identity, or any other classification protected by Federal, state or local law.

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