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Utilization Review Rn Jobs in Pennsylvania (NOW HIRING)

IntePros

Utilization Management RN

Philadelphia, PA · On-site

$63.18/hr

Care Management Coordinator/RN MAX BILL RATE: $63.18/hr Position is remote - candidate must reside ... Reviews treatment plans/plan of care with provider for requested services/procedures, inpatient ...

Wellpath

Director Utilization Mgmt

Lemoyne, PA · On-site

$199K - $249K/yr

How you make a difference The Medical Director of Utilization Management leads and oversees utilization review, case management, quality improvement, and related policy and practice initiatives ...

Wellpath

Director Utilization Mgmt

Lemoyne, PA

Overview The Medical Director of Utilization Management leads and oversees utilization review, case management, quality improvement, and related policy and practice initiatives within their assigned ...

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Utilization Review Rn information

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$21

$42

$69

How much do utilization review rn jobs pay per hour?

As of Aug 9, 2026, the average hourly pay for utilization review rn in Pennsylvania is $42.38, according to ZipRecruiter salary data. Most workers in this role earn between $33.51 and $48.65 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.

How to get into utilization review as a registered nurse?

To become a utilization review RN, you typically need a valid registered nurse license and experience in clinical settings. Additional certifications such as the Certified Professional in Healthcare Quality (CPHQ) or knowledge of medical coding and insurance processes can enhance your qualifications. Gaining experience in case management or health insurance companies can also improve your chances of entering the field.

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.
What are the most commonly searched types of Utilization Review Rn jobs in Pennsylvania? The most popular types of Utilization Review Rn jobs in Pennsylvania are:
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What job categories do people searching Utilization Review Rn jobs in Pennsylvania look for? The top searched job categories for Utilization Review Rn jobs in Pennsylvania are:
What cities in Pennsylvania are hiring for Utilization Review Rn jobs? Cities in Pennsylvania with the most Utilization Review Rn job openings:
What are popular job titles related to Utilization Review Rn jobs in PA? For Utilization Review Rn jobs in PA, the most frequently searched job titles are:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Pennsylvania as of August 2026, with employment types broken down into 68% Full Time, and 32% Part Time. Highlights an 100% In-person job distribution, with an average salary of $88,158 per year, or $42.4 per hour.

Utilization Review Per Diem Elkins Park

Thomas Jefferson University Hospitals, Inc.

Philadelphia, PA

Full-time, Part-time, Per diem

Medical, Dental, Vision, Life, Retirement

Re-posted 10 hours ago

Jefferson Health rating

7.7

Company rating: 7.7 out of 10

Based on 348 frontline employees who took The Breakroom Quiz

159th of 887 rated healthcare providers

Job description

Job Details

Provides social work services, assesses and enhances the patient's/family's/significant other's ability to cope with physical, emotional and environmental problems related to illness/convalescence and discharge plan. Works collaboratively with the multidisciplinary healthcare team to establish a discharge plan for the patient.
Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.(Do not delete, move or over-write this statement)
Conducts psychosocial assessment/reassignment of patients/significant others relating to the social, emotional and cognitive capabilities of patients in relationship to their illness and health maintenance needs.
Develops and implements a plan of intervention that addresses identified needs related to needs/problems identified during assessment.Collaborated with the multidisciplinary team to ensure appropriate discharge planningProvides counseling for patient/family/significant others to assist with coping with new diagnoses, chronic illness and palliative or terminal care
Advocates on behalf of the patients/families to enable them to obtain necessary services.

Job Description

Education - Required

  • Master's Degree Graduate from an accredited Masters of Social Work program required. Masters of Social Work required.

Experience - Required

  • 2 years hospital based social work experience.

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Magee Rehabilitation Hospital

Primary Location Address

1513 Race Street, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time(including per diemcolleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

For more benefits information, please click here

What Jefferson Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

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About Jefferson Health

Sourced by ZipRecruiter

Jefferson Health is a revered name in the healthcare sector, based in Philadelphia, Pennsylvania, US. This nonprofit health system is dedicated to delivering high-quality, compassionate clinical care and services across the region. The organization was founded in 1824 as Jefferson Medical College, and over the years, it has grown into a vast network of physicians and specialists, hospitals, outpatient and urgent care facilities. Offering a comprehensive range of healthcare services, Jefferson Health covers areas including cancer care, neuroscience, orthopedics, and cardiovascular care, among others. The organization's mission is to improve lives by promoting overall health and wellness, emphasizing value-based care, and making innovative medical advancements. Besides, one of their notable achievements includes being recognized by the National Academy of Medicine as a national leader in patient safety improvements.

Industry

Hospitals and health care and social assistance

Company size

10,000+ Employees

Headquarters location

Philadelphia, PA, US

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