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

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

RN

Willoughby, OH

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

Signature Health Inc

RN

Willoughby, OH

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

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 ...

Pacs

RN

Willoughby, OH

Performs utilization review activities to provide resident appropriate, timely and cost effective ... Registered Nurse (RN) license preferred. Licensed (LVN or LPN) nurse acceptable. Two (2) year ...

PACS

RN

Willoughby, OH · On-site

Performs utilization review activities to provide resident appropriate, timely and cost effective ... Registered Nurse (RN) license preferred. Licensed (LVN or LPN) nurse acceptable. Two (2) year ...

Imh

RN Care Manager - PRN

Cleveland, OH · On-site

$40.39 - $60.96/hr

The RN Hospital Care Manager I delivers comprehensive care management services to designated ... Demonstrated experience in case management, utilization review, value-based care, and/or discharge ...

Select Medical

PPS Manager

Beachwood, OH · On-site

... Nurse (RN), PT, OT or SLP required * Minimum of two years experience in rehabilitation or a closely related field required. Preferred Experience * Experience in Utilization Review preferred

Certus Healthcare

MDS Nurse- Hybrid

Cleveland, OH · On-site

$82K/yr

Valid nursing license in the state of Ohio, Registered Nurse (RN) Preferred. * Proven experience ... related to MDS and utilization review. * Familiarity with EMR/EHR systems such as Cerner ...

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Utilization Review Rn information

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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 Case Manager

RN Case Manager

Cleveland Clinic

Cleveland, OH

$106K/yr

Full-time

Medical, Dental, Vision, Retirement

Posted 16 days ago

Cleveland Clinic rating

7.2

Company rating: 7.2 out of 10

Based on 883 frontline employees who took The Breakroom Quiz

330th of 872 rated healthcare providers

Job description

Join Cleveland Clinic’s Main Campus where research and surgery are advanced, technology is leading-edge, patient care is world class and caregivers are family. Here, you will work alongside a passionate and dedicated team, receive endless support and appreciation, and build a rewarding career with one of the most respected healthcare organizations in the world.

As an RN Case Manager, you will collaborate with inter-professional teams across the continuum of care to facilitate and ensure effective transitional care coordination. Essential to this role are the core values of patient advocacy, holistic assessment, care planning and the empowerment of patients and families to self-manage.

A caregiver in this position works 8:00am to 4:30pm with three weekend shifts per quarter. This is an on-site position that will float throughout CC Main Campus.

A caregiver who excels in this role will:

  • Ensure compliance with standards of the accrediting bodies, state mandated revised code and the CMS Conditions of Participation.
  • Promote interprofessional synchronization throughout the acute episode.
  • Complete effective handoffs to the next level of care or community to ensure continuity of care.
  • Proactively assess, identify and work to mitigate the risk posed by barriers to patients’ transitions of care.
  • Work with the patient and/or care partner(s) to develop a comprehensive, individualized transitional care plan.
  • Participate and lead in patient rounding activities, huddles and committee meetings.

Minimum qualifications for the ideal future caregiver include:

  • Graduate from an accredited school of Professional Nursing
  • Current state licensure as a Registered Nurse (RN)
  • Basic Life Support (BLS) Certification through the American Heart Association (AHA) or American Red Cross
  • Three years of recent RN experience

Preferred qualifications for the ideal future caregiver include:

  • Bachelor’s of Science in Nursing (BSN)
  • CTM, ACM, CCM or AHA Certification by an approved entity
  • Two years of recent experience in utilization review, quality or care management
  • Knowledge of acute care and accreditation requirements
  • Experience in discharge planning and quality improvement

Physical Requirements:

  • Requires full range of motion, manual and finger dexterity and eye-hand coordination.
  • Requires standing and walking for extensive periods of time.
  • Requires normal or corrected hearing and vision to normal range.
  • Sedentary work exerting up to 10 pounds of force occasionally (Occasionally: active or condition exists up to 1/3 of the time) and /or a negligible amount of force frequently (Frequently: activity or condition exists from 1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

Personal Protective Equipment:

  • Follows Standard Precautions using personal protective equipment as required for procedures

Keywords: : RN, Registered Nurse, Case Management, Case Manager, RN Case Manager, Registered Nurse Case Manager, Critical Care RN, Critical Care Registered Nurse, ED RN, Care Management, Care Manager, Discharge RN, Experienced RN, Experienced Registered Nurse

Pay Range

Minimum Annual Salary: $69,600.00

Maximum Annual Salary: $106,132.50

The pay range displayed on this job posting reflects the anticipated range for new hires. A successful candidate’s actual compensation will be determined after taking factors into consideration such as the candidate’s work history, experience, skill set and education. The pay range displayed does not include any applicable pay practices (e.g., shift differentials, overtime, etc.). The pay range does not include the value of Cleveland Clinic’s benefits package (e.g., healthcare, dental and vision benefits, retirement savings account contributions, etc.).

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