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

Southwest General

UTILIZATION SPECIALIST

Brunswick, OH · On-site

Minimum of five (5) years recent experience in clinical nursing or related nursing field. (e.g. Utilization Review or Case Management) * Previous Care Management, Case Management or Utilization ...

Southwest General

UTILIZATION SPECIALIST

Berea, OH

Minimum of five (5) years recent experience in clinical nursing or related nursing field. (e.g. Utilization Review or Case Management) * Previous Care Management, Case Management or Utilization ...

UnitiMed

RN Case Manager

Middleburg Heights, OH · On-site

  • Medical

  • Dental

  • Vision

Referral bonus up to $700 Registered Nurse (RN),Case Management/Utilization Review, About the Company: Uniti Med is an award-winning healthcare staffing company with a mission to provide staffing ...

Harvard Gardens Rehabilitation & Care Center

STNA

Cleveland, OH

$14.50 - $19.25/hr

  • Medical

  • Dental

  • Vision

  • Life

  • PTO

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 ...

Signature Health Inc

RN

Willoughby, OH · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

... 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

RN

Willoughby, OH · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

... 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

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

... 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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Showing results 21-40

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

Utilization Review Rn information

See Cleveland, OH salary details

$21

$41

$68

How much do utilization review rn jobs pay per hour?

As of Aug 13, 2026, the average hourly pay for utilization review rn in Cleveland, OH is $41.98, according to ZipRecruiter salary data. Most workers in this role earn between $33.17 and $48.22 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 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 August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, and 4% Contract. Highlights an 91% Physical, 3% Hybrid, and 6% Remote job distribution, with an average salary of $87,317 per year, or $42 per hour.

UTILIZATION SPECIALIST

Southwest General

Brook Park, OH • On-site

Full-time

Posted 13 days ago

Southwest General Health Center rating

6.9

Company rating: 6.9 out of 10

Based on 46 frontline employees who took The Breakroom Quiz

554th of 1,059 rated hospitals

Job description

Summary

  • POSITION INFORMATION
    • Position summary:
      • The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital resources, and quality of care rendered. Accurate and efficient application of screening criteria will be applied to identify and support patients being placed in the appropriate hospital level of care via emergency, scheduled, or direct admission processes. Combines clinical, business, and regulatory knowledge and skill to reduce significant financial risk and exposure caused by concurrent and retrospective denial of payments for services provided. Through continuous assessments, problem identification, and education, the Utilization Specialist facilitates the quality of health care delivery in the most cost-effective manner. The Utilization Specialist must be able to demonstrate the knowledge and skills necessary to provide services appropriate to age groups according to specific chronological age, developmental age, and/or psycho-social maturity. The Utilization Specialist will work collaboratively with management, staff, and departments involved in the patients plan of care. The Utilization Specialists responsibility is to collect data and clinical review summaries on patients concurrently for both utilization review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The Utilization Specialist will communicate with physicians, hospital staff, outside agencies such as insurance companies, and patients regarding the assigned level of care and associated resource utilization.
  • MINIMUM QUALIFICATIONS
    • Education:
      • Graduation from an accredited School of Nursing. BSN graduate preferred.

    • Required length and type of experience:
      • Minimum of five (5) years recent experience in clinical nursing or related nursing field. (e.g. Utilization Review or Case Management)
      • Previous Care Management, Case Management or Utilization Management Experience preferred
      • Previous experience with screening criteria (i.e. Interqual, MCG) preferred
      • Excellent critical thinking and communication skills
      • Strong computer skills

    • Required licensure, certification or registry:
      • Current licensure by Ohio State Board of Nursing.
      • ACM/CCM Certification helpful

What Southwest General Health Center employees say

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