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Utilization Review Rn Jobs in Rhode Island (NOW HIRING)

AMIVIE

Registered Nurse, RN

Lincoln, RI · On-site

Experienced Registered Nurse Needed An experienced RN is needed for a home care case, Monday ... Participate on an assigned advisory board or utilization review committee. * Review all client ...

AMIVIE

Registered Nurse, Sign-on bonus!

Woonsocket, RI · On-site

LPN/RN Needed in Woonsocket ***LPN/RN needed in Woonsocket, Monday and Tuesday 8am-5pm and Friday ... Participate on an assigned advisory board or utilization review committee. * Review all client ...

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All JobsUtilization Review Rn JobsUtilization Review Rn Jobs in Rhode Island

Utilization Review Rn information

See Rhode Island salary details

$20

$41

$67

How much do utilization review rn jobs pay per hour?

As of Aug 3, 2026, the average hourly pay for utilization review rn in Rhode Island is $41.41, according to ZipRecruiter salary data. Most workers in this role earn between $32.74 and $47.55 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 Rhode Island? The most popular types of Utilization Review Rn jobs in Rhode Island are:
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What cities in Rhode Island are hiring for Utilization Review Rn jobs? Cities in Rhode Island 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 Rhode Island as of July 2026, with employment types broken down into 1% As Needed, 80% Full Time, 15% Part Time, 1% Temporary, and 3% Contract. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $86,127 per year, or $41.4 per hour.

Behavioral Health Intake and Utilization Review Coordinator

CharterCARE of Rhode Island

Providence, RI

Full-time

Re-posted 16 days ago

Job description

Summary: The Behavioral Health Intake and Utilization Review Coordinator is responsible for bed management, reviewing intake assessments, verifying clinical appropriateness for services, coordinating admissions, and overseeing utilization review activities to ensure timely access to care and appropriate resource utilization. This role is actively involved with communicating with other community hospitals and Emergency Departments and will also facilitate outside admissions to our services to maximize hospital census. This role ensures adherence to regulatory and payer requirements while serving as a key liaison between patients, providers, and insurance carriers. 

Education: Bachelor’s degree Nursing required. Master’s degree preferred. 

Experience: Minimum 2–3 years of experience in behavioral health, preferably in intake or utilization review roles. 

License:  RI RN License required. 

Skills and Qualifications: 

  • Strong clinical assessment and diagnostic skills. 

  • Working knowledge of behavioral health levels of care and medical necessity criteria (e.g., MCG, InterQual). 

  • Familiarity with insurance authorization processes and managed care systems. 

  • Excellent organizational, communication, and interpersonal skills. 

  • Proficiency in EHR and Microsoft Office Suite. 

Working Conditions, Physical Environment and/or Safety Requirements: Lifting up to 30 lbs. and occasionally lifting and/or carrying such articles as files, books, etc. Involves sitting, walking, stooping, and reaching. However, as necessary, must be able to meet the physical requirements for staff level positions in the department(s).  

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