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How much do utilization review rn jobs pay per hour?

As of Aug 14, 2026, the average hourly pay for utilization review rn in Birmingham, AL is $39.63, according to ZipRecruiter salary data. Most workers in this role earn between $31.30 and $45.53 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 Birmingham, AL?

The most popular types of Utilization Review Rn jobs in Birmingham, AL are:

What are popular job titles related to Utilization Review Rn jobs in Birmingham, AL?

For Utilization Review Rn jobs in Birmingham, AL, the most frequently searched job titles are:

What job categories do people searching Utilization Review Rn jobs in Birmingham, AL look for?

The top searched job categories for Utilization Review Rn jobs in Birmingham, AL are:

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Birmingham, AL as of August 2026, with employment types broken down into 100% Full Time. Highlights an 83% In-person, and 17% Remote job distribution, with an average salary of $82,423 per year, or $39.6 per hour.

Quality Utilization Reviewer I

Children's of Alabama

Birmingham, AL • On-site

Other

Posted 23 days ago

Children's Of Alabama rating

6.5

Company rating: 6.5 out of 10

Based on 41 frontline employees who took The Breakroom Quiz

719th of 1,059 rated hospitals

Job description

In Utilization Management at Main Campus Lee Building
Work schedule will be 7on / 7off on the Day Shift, 7am- 3:30pm, Monday- Sunday every other week after completion of orientation.
Summary:
The UR Reviewer 1 is responsible for performing inpatient admission, concurrent, and observation reviews based on pre-established criteria exclusively for AL Medicaid and all commercial payers other than BCBS AL. Upon successful completion of training by UR Reviewer 2 and with the approval of the UR Manager & Department Director, UR Reviewer 1 with LPN/RN licensure may advance to Reviewer 2 (if position becomes available).
Other information:
Education

  • Graduate of an accredited School of Nursing or Social Work
Experience
  • 2 years in hospital setting or related field (i.e. third-party payer)
  • Utilization review experience preferred
Licensures, Certifications, and/or Registries
  • Current AL licensure as RN or LPN
Knowledge, Skills, and Abilities
  • Knowledge of third-party payer requirements in utilization review preferred

Credentials with Equivalent Qualifications:
Essential:
* Registered Nurse AL Single State or any of the following equivalent qualifications below:
- Registered Nurse AL NLC Multi State
- Registered Nurse Non-AL NLC Multi State
- Licensed Practical Nurse AL Only
- Licensed Practical Nurse AL NLC Multi State
- Licensed Practical Nurse Non-AL NLC Multi State
- Licensed Independent Clinical Social Worker
Education with Equivalent Qualifications:
Essential:
* Associate of Science Nursing in Nursing or Bachelors of Science or Arts in Nursing
Experience with Equivalent Qualifications:
Essential:
* 2 Years Staff Level

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About Children's of Alabama

Sourced by ZipRecruiter

Since 1911, Children’s of Alabama has provided specialized medical care for ill and injured children. Ranked among the best children’s hospitals in the nation by U.S. News & World Report, Children’s serves patients from every county in Alabama and nearly every state. With more than 3.5 million square feet, it is one of the largest pediatric medical facilities in the United States. Children’s offers inpatient and outpatient services at its Russell Campus on Birmingham’s historic Southside with additional specialty services provided at Children’s South, Children’s on 3rd and in Huntsville and Montgomery. Primary medical care is provided in more than a dozen communities across central Alabama. Children’s is the only health system in Alabama dedicated solely to the care and treatment of children. It is a private, not-for-profit medical center that serves as the teaching hospital for the University of Alabama at Birmingham (UAB) pediatric medicine, surgery, psychiatry, research and residency programs. The medical staff consists of UAB faculty and Children’s full-time physicians as well as private practicing community physicians. Our staff is committed to providing the finest pediatric healthcare to all children. We built our legacy on our core values of trust, teamwork, compassion, innovation and commitment. We know that every time we come through these doors we will live up to our high standards as we work to make a difference in children's lives. You've chosen a career that’s all about care. If you want to make a difference the life of children and their families, if you want to advance in your profession, if you appreciate good benefits, and want to work with outstanding medical professionals in a variety of areas, then Children’s of Alabama is where you belong.

Industry

Health care and social assistance

Company size

5,001 - 10,000 Employees

Headquarters location

Birmingham, AL, US

Year founded

1911

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