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Utilization Review Rn Jobs in Tennessee (NOW HIRING)

UHS

UR Coordinator - Full-time

Memphis, TN · On-site

Valid TN RN license, LCSW, or LPC preferred. Knowledge: Must possess knowledge of psychiatric care, utilization review, insurance reimbursement procedures, DSM-V, etc. Advanced computer skills ...

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Utilization Review Rn information

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$19

$38

$62

How much do utilization review rn jobs pay per hour?

As of Jul 14, 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 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.
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Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Tennessee as of July 2026, with employment types broken down into 1% As Needed, 80% Full Time, 13% Part Time, 2% Temporary, and 4% Contract. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $79,822 per year, or $38.4 per hour.
RN- Acute Care Case Manager

RN- Acute Care Case Manager

Baptist Memorial Health Care Corporation

Memphis, TN • On-site

Full-time

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

Baptist Memorial Health Care rating

7.2

Company rating: 7.2 out of 10

Based on 112 frontline employees who took The Breakroom Quiz

327th of 884 rated healthcare providers

Job description

Overview
Job Summary
Manages the care for a specific population; facilitates the safe transition of patients throughout the continuum of care for appropriate utilization of resources, service delivery and compliance with federal and other payer requirements. Provides early assessment of transitional needs identified during their hospitalization, illness, and/or life situation. Performs other duties as assigned.
Responsibilities
  • Utilization Review
  • Discharge planning
  • Readmission Reduction Participation
  • Payer Communication and denial reduction
  • Completes assigned goals.

Specifications
Experience
Minimum Required
  • RN with at least one (1) year of clinical experience

Preferred/Desired
  • RN with 3 years of clinical experience with Case Management experience in a hospital or payer setting

Education
Minimum Required
  • Diploma or Associate Degree in Nursing

Preferred/Desired
  • BSN or MSN

Training
Minimum Required
Preferred/Desired
  • Certified Case Manager

Special Skills
Minimum Required
  • Critical thinking skills, communication, organization, interpersonal and computer skills. Problem solving; and governmental regulations.

Preferred/Desired
  • Critical thinking skills, communication, organization, interpersonal and computer skills. Knowledge of payer requirements; problem solving; and governmental regulations.

Licensure
  • RN

Minimum Required
  • RN

Preferred/Desired
  • RN;CCM;ACM

What Baptist Memorial Health Care employees say

Pay

Benefits

Hours and flexibility

Workplace

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About Baptist Memorial

Sourced by ZipRecruiter

Baptist Memorial, based in Memphis, TN, US, is a leading health care organization renowned in the healthcare industry. The company's official website is baptistonline.org which provides a comprehensive view of their services and operations. Baptist Memorial operates a myriad of hospitals, health clinics, and medical facilities providing expert and compassionate care. Founded in 1912, it has a rich legacy of over a hundred years of dedication to its community, offering services which include acute care, diagnostic services, and a broad range of speciality health services fulfilling various patient needs.

Industry

Hospitals

Company size

10,000+ Employees

Headquarters location

Memphis, TN, US

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