Utilization Specialist
Burns, TN · On-site
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...
Utilization Specialist
Burns, TN · On-site
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ... Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides ...
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication and denial reduction * Completes assigned goals. Specifications Experience Minimum Required * RN ...
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication and denial reduction * Completes assigned goals. Specifications Experience Minimum Required * RN ...
RN-Case Manager PRN
Memphis, TN · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication and denial reduction * Completes assigned goals. Specifications Experience Minimum Required * RN ...
RN-Case Manager PRN
Memphis, TN · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication and denial reduction * Completes assigned goals. Specifications Experience Minimum Required * RN ...
RN-Case Manager PRN
Memphis, TN · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication and denial reduction * Completes assigned goals. Specifications Experience Minimum Required * RN ...
RN-Case Manager PRN
Memphis, TN · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication and denial reduction * Completes assigned goals. Specifications Experience Minimum Required * RN ...
RN-Case Manager PRN
Memphis, TN · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication and denial reduction * Completes assigned goals. Specifications Experience Minimum Required * RN ...
RN-Case Manager PRN
Memphis, TN · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication and denial reduction * Completes assigned goals. Specifications Experience Minimum Required * RN ...
RN-Acute Care Case Manager
Memphis, TN · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication and denial reduction * Completes assigned goals. Specifications Experience Minimum Required * RN ...
RN-Acute Care Case Manager
Memphis, TN · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication and denial reduction * Completes assigned goals. Specifications Experience Minimum Required * RN ...
RN- Acute Care Case Manager
Memphis, TN · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication and denial reduction * Completes assigned goals. Specifications Experience Minimum Required * RN ...
RN- Acute Care Case Manager
Memphis, TN · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication and denial reduction * Completes assigned goals. Specifications Experience Minimum Required * RN ...
RN-Acute Care Case Manager
Memphis, TN · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication and denial reduction * Completes assigned goals. Specifications Experience Minimum Required * RN ...
RN-Acute Care Case Manager
Memphis, TN · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication and denial reduction * Completes assigned goals. Specifications Experience Minimum Required * RN ...
RN- Acute Care Case Manager
Memphis, TN · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication and denial reduction * Completes assigned goals. Specifications Experience Minimum Required * RN ...
RN- Acute Care Case Manager
Memphis, TN · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication and denial reduction * Completes assigned goals. Specifications Experience Minimum Required * RN ...
RN-Acute Care Case Manager
Memphis, TN · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication and denial reduction * Completes assigned goals. Specifications Experience Minimum Required * RN ...
RN-Acute Care Case Manager
Memphis, TN · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication and denial reduction * Completes assigned goals. Specifications Experience Minimum Required * RN ...
RN-Acute Care Case Manager
Memphis, TN · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication and denial reduction * Completes assigned goals. Specifications Experience Minimum Required * RN ...
RN-Acute Care Case Manager
Memphis, TN · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication and denial reduction * Completes assigned goals. Specifications Experience Minimum Required * RN ...
RN-Acute Care Case Manager
Memphis, TN · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication and denial reduction * Completes assigned goals. Specifications Experience Minimum Required * RN ...
RN-Acute Care Case Manager
Memphis, TN · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication and denial reduction * Completes assigned goals. Specifications Experience Minimum Required * RN ...
RN-Acute Care Case Manager
Memphis, TN · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication and denial reduction * Completes assigned goals. Specifications Experience Minimum Required * RN ...
RN-Acute Care Case Manager
Memphis, TN · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication and denial reduction * Completes assigned goals. Specifications Experience Minimum Required * RN ...
RN- Acute Care Case Manager
Memphis, TN · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication and denial reduction * Completes assigned goals. Specifications Experience Minimum Required * RN ...
RN- Acute Care Case Manager
Memphis, TN · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication and denial reduction * Completes assigned goals. Specifications Experience Minimum Required * RN ...
RN-Acute Care Case Manager
Memphis, TN · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication and denial reduction * Completes assigned goals. Specifications Experience Minimum Required * RN ...
RN-Acute Care Case Manager
Memphis, TN · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication and denial reduction * Completes assigned goals. Specifications Experience Minimum Required * RN ...
RN-Acute Care Case Manager
Memphis, TN · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication and denial reduction * Completes assigned goals. Specifications Experience Minimum Required * RN ...
RN-Acute Care Case Manager
Memphis, TN · On-site
Utilization Review * Discharge planning * Readmission Reduction Participation * Payer Communication and denial reduction * Completes assigned goals. Specifications Experience Minimum Required * RN ...
Utilization Review Rn information
See Tennessee salary details
$19.42 - $23.35
2% of jobs
$23.35 - $27.27
9% of jobs
$29.96 is the 25th percentile. Wages below this are outliers.
$27.27 - $31.20
21% of jobs
The median wage is $34.38 / hr.
$31.20 - $35.13
23% of jobs
$35.13 - $39.05
13% of jobs
$42.11 is the 75th percentile. Wages above this are outliers.
$39.05 - $42.98
10% of jobs
$42.98 - $46.91
8% of jobs
$46.91 - $50.84
5% of jobs
$50.84 - $54.76
5% of jobs
$54.76 - $58.69
2% of jobs
$58.69 - $62.62
2% of jobs
$19
$38
$62
How much do utilization review rn jobs pay per hour?
As of Jun 19, 2026, the average hourly pay for utilization review rn in Tennessee is $38.38, according to ZipRecruiter salary data. Most workers in this role earn between $30.34 and $44.09 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?
| Aspect | Utilization Review Rn | Case Manager |
|---|---|---|
| Credentials | RN license, certifications in utilization review | RN license, certifications in case management |
| Work Environment | Hospitals, insurance companies, healthcare facilities | Hospitals, community agencies, insurance companies |
| Primary Focus | Reviewing medical necessity and appropriateness of care | Coordinating 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 Tennessee? The most popular types of Utilization Review Rn jobs in Tennessee are:
What are popular job titles related to Utilization Review Rn jobs in Tennessee? For Utilization Review Rn jobs in Tennessee, the most frequently searched job titles are:
What job categories do people searching Utilization Review Rn jobs in Tennessee look for? The top searched job categories for Utilization Review Rn jobs in Tennessee are:
- Volunteer Aetna Utilization Review Nurse
- Temporary Aetna Utilization Review Nurse
- Utilization Review
- Aetna Utilization Review Nurse
- Remote Rn Utilization Review Nurse
- Per Diem Chart Review Nurse Practitioner
- Anthem Utilization Review Nurse
- Live In Cigna Utilization Review Nurse
- Seasonal Remote Utilization Review
- Remote Aetna Utilization Review Nurse
What cities in Tennessee are hiring for Utilization Review Rn jobs? Cities in Tennessee with the most Utilization Review Rn job openings:
What are popular job titles related to Utilization Review Rn jobs in TN? For Utilization Review Rn jobs in TN, the most frequently searched job titles are:
Acadia Healthcare rating
6.1
Based on 186 frontline employees who took The Breakroom Quiz
714th of 873 rated healthcare providers
Job description
PURPOSE STATEMENT:
Proactively monitor utilization of services for patients to optimize reimbursement for the facility.
ESSENTIAL FUNCTIONS:
- Act as liaison between managed care organizations and the facility professional clinical staff.
- Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.
- Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.
- Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office.
- Conduct quality reviews for medical necessity and services provided.
- Facilitate peer review calls between facility and external organizations.
- Initiate and complete the formal appeal process for denied admissions or continued stay.
- Assist the admissions department with pre-certifications of care.
- Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.
OTHER FUNCTIONS:
- Perform other functions and tasks as assigned.
EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:
- Required Education: High school diploma or equivalent.
- Preferred Education: Associate's, Bachelor's, or Master’s degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field.
- Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred
LICENSES/DESIGNATIONS/CERTIFICATIONS:
- Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.
- CPR and de-escalation and restraint certification required (training available upon hire and offered by facility.
- First aid may be required based on state or facility requirements.
ADDITIONAL REGULATORY REQUIREMENTS:
While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances
(e.g. emergencies, changes in workload, rush jobs or technological developments) dictate.
We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual’s characteristics protected by applicable state, federal and local laws.
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About Acadia Healthcare
Sourced by ZipRecruiter
Acadia Healthcare is a leading provider in the healthcare and hospital industry, based in Franklin, Tennessee, United States. The company is recognised for its commitment to creating a behavioural health network that provides accessible, high-quality treatment options for individuals suffering from mental health issues, addiction, eating disorders, and PTSD. Acadia Healthcare was founded in 2005, with the mission to create a world-class organization that sets the standard of excellence in the treatment of specialty behavioural health and addiction disorders.
Industry
Hospitals
Company size
10,000+ Employees
Headquarters location
Franklin, TN, US
Year founded
2005