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

Community Based Care

Registered Nurse

Beachwood, OH · On-site

Participate on an assigned advisory board or utilization review committee. * Review all client ... Maintain current RN license and required continuing education. * Obtain annual TB testing/screening ...

Harvard Gardens Rehabilitation & Care Center

STNA

Beachwood, OH · On-site

$14.50 - $19.25/hr

As the MDS Nurse (RN or LPN), you will be responsible for the timely, accuracy, completing, and ... Utilization Review Coordinator * Manage the Care Planning process * Manage certification signed by ...

Cleveland Clinic

RN Case Manager

Cleveland, OH

$106K/yr

Two years of recent experience in utilization review, quality or care management * Knowledge of ... : RN, Registered Nurse, Case Management, Case Manager, RN Case Manager, Registered Nurse Case ...

Signature Health Inc

RN

Willoughby, OH · On-site

... Nursing-Psychiatry the Registered Nurse (RN), Psychiatry will be instrumental in providing ... Participate in quality assurance and utilization review activities. * Maintain clear communication ...

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Utilization Review Rn information

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$66

How much do utilization review rn jobs pay per hour?

As of Jun 17, 2026, the average hourly pay for utilization review rn in Cleveland, OH is $40.94, according to ZipRecruiter salary data. Most workers in this role earn between $32.36 and $47.02 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?

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 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 Cleveland, OH? The most popular types of Utilization Review Rn jobs in Cleveland, OH are:
What are popular job titles related to Utilization Review Rn jobs in Cleveland, OH? For Utilization Review Rn jobs in Cleveland, OH, the most frequently searched job titles are:
What job categories do people searching Utilization Review Rn jobs in Cleveland, OH look for? The top searched job categories for Utilization Review Rn jobs in Cleveland, OH are:
What cities near Cleveland, OH are hiring for Utilization Review Rn jobs? Cities near Cleveland, OH with the most Utilization Review Rn job openings:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Cleveland, OH as of June 2026, with employment types broken down into 86% Full Time, 10% Part Time, and 4% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $85,163 per year, or $40.9 per hour.
RN UTILIZATION SPECIALIST - DENIALS & APPEALS

RN UTILIZATION SPECIALIST - DENIALS & APPEALS

Southwest General

Middleburg Heights, OH • On-site

Full-time

Posted 14 days ago

Southwest General Health Center rating

7.0

Company rating: 7.0 out of 10

Based on 45 frontline employees who took The Breakroom Quiz

477th of 999 rated hospitals

Job description

  • POSITION INFORMATION
    • Position summary:  Utilization Specialist – Denials & Appeals will support the clinical staff, utilization specialists, denials management, and the Physician Advisors. This role will review patient medical records to ensure accurate documentation, proper level of care, and compliance with regulatory standards to prevent denials in the acute care setting.
       
  • MINIMUM QUALIFICATIONS
    • Education:
      • Bachelor’s degree in nursing (BSN) preferred

    • Required length and type of experience:
      • Minimum of three years of clinical nursing experience, with strong preference for experience in case management, utilization review, or CDI, in the acute care setting.
      • Knowledge of ICD-10 coding guidelines, Medicare/Medicaid regulations, MCG, Cerner (EMR), MS office tools, such as Word, Excel, PowerPoint.
      • Ability to analyze complex medical records and identify gaps in documentation.
      • Strong verbal and written communication skills to interact with physicians and insurance payers.
      • Ability to collaborate with diverse teams including nurses, physicians, and administrative staff.

    • Required licensure, certification or registry:
      • Current RN License by the Ohio State Board of Nursing.
         
      • Preferred certification(s): ACM/ACM-RN, CCM, CMAC, CPHQ.

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