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Utilization Review Rn Jobs in Cincinnati, OH (NOW HIRING)

Interim HealthCare

RN Case Manager

Cincinnati, OH · On-site

... utilization review experience preferred. · OASIS experience preferred. · Practical trach and/or ventilator experience preferred, not required. At Interim HealthCare, we know that being our best is ...

New

Interim HealthCare

RN Case Manager

Cincinnati, OH · On-site

... utilization review experience preferred. · OASIS experience preferred. · Practical trach and/or ventilator experience preferred, not required. At Interim HealthCare, we know that being our best is ...

New

Salo, Inc Career Site

RN Case Manager

Cincinnati, OH · On-site

... utilization review experience preferred. • OASIS experience preferred. • Practical trach and/or ventilator experience preferred, not required. At Interim HealthCare, we know that being our best ...

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All JobsUtilization Review Rn JobsUtilization Review Rn Jobs in Cincinnati, OH

Utilization Review Rn information

See Cincinnati, OH salary details

$19

$39

$63

How much do utilization review rn jobs pay per hour?

As of Jul 20, 2026, the average hourly pay for utilization review rn in Cincinnati, OH is $39.00, according to ZipRecruiter salary data. Most workers in this role earn between $30.82 and $44.81 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 Cincinnati, OH? The most popular types of Utilization Review Rn jobs in Cincinnati, OH are:
What are popular job titles related to Utilization Review Rn jobs in Cincinnati, OH? For Utilization Review Rn jobs in Cincinnati, OH, the most frequently searched job titles are:
What job categories do people searching Utilization Review Rn jobs in Cincinnati, OH look for? The top searched job categories for Utilization Review Rn jobs in Cincinnati, OH are:
What cities near Cincinnati, OH are hiring for Utilization Review Rn jobs? Cities near Cincinnati, OH with the most Utilization Review Rn job openings:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Cincinnati, OH 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 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $81,125 per year, or $39 per hour.
Utilization Review RN

Utilization Review RN

Healthcare Support Staffing

Mason, OH

Other

Medical, Dental, Vision

Re-posted 23 days ago

Job description

Company Description

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Job Description

Daily Responsibilities:

  • Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting 
  • Applies clinical knowledge to work with facilities and providers for care coordination
  • Works with medical directors in interpreting appropriateness of care and accurate claims payment
  • May also manage appeals for services denied
  • Conducts pre-certification, inpatient, retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts
  • Ensures member access to medical necessary, quality healthcare in a cost effective setting according to contract
  • Facilitates member care transition through the healthcare continuum 
  • Refers treatment plans/plan of care to clinical reviewers as required and does not issue non-certifications


Hours for this Position: Monday-Friday (40 hours/week)


Advantages of this Opportunity:

  • Competitive salary, negotiable based on experience
  • Benefits offered, Medical, Dental, and Vision
  • Fun and positive work environment
  • Weekly deposit options


Qualifications

Requirements: 

  • Must have clear and active RN license in the state of OH
  • AS/BS in Nursing
  • Experience in acute clinical care
  • Experience with medical record review/utilization review/utilization management
Additional Information

Are you an experienced Registered Nurse with Utilization review experience looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered "yes" to any of these questions - this is the position for you!

Interested in hearing more about this great opportunity? Please click apply or call Amanda Hammer at 407-636-7030 ext.201 for additional details. 

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About Healthcare Support

Sourced by ZipRecruiter

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Maitland, FL, US

Year founded

2003

Social media

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