ZipRecruiter

Log In

1

Utilization Review Rn Jobs in Columbia, MO (NOW HIRING)

Centene

Supervisor, Utilization Management (RN)

Columbia, MO · On-site +1

$75K - $135K/yr

Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team ... Knowledge of utilization management principles preferred. License/Certification: * RN - Registered ...

Acadia Healthcare

PRN Registered Nurse (RN)

Columbia, MO · On-site

$38 - $49/hr

Responsibilities REGISTERED NURSE ESSENTIAL FUNCTIONS * Provide and coordinate care by assessing ... Demonstrate knowledge and utilization of universal precautions in providing direct patient care.

Acadia Healthcare

PRN Registered Nurse (RN)

Columbia, MO · On-site

$38 - $49/hr

Responsibilities REGISTERED NURSE ESSENTIAL FUNCTIONS * Provide and coordinate care by assessing ... Demonstrate knowledge and utilization of universal precautions in providing direct patient care.

Acadia Healthcare

Outpatient RN - Days

Columbia, MO

$38 - $49/hr

Demonstrate knowledge and utilization of universal precautions in providing direct patient care ... Must possess a current Registered Nurse (RN) license as required by Missouri or be eligible to ...

New

Acadia Healthcare

Outpatient RN - Days

Columbia, MO · On-site

$38 - $49/hr

Demonstrate knowledge and utilization of universal precautions in providing direct patient care ... Must possess a current Registered Nurse (RN) license as required by Missouri or be eligible to ...

New

next page

Showing results 1-20

All JobsUtilization Review Rn JobsUtilization Review Rn Jobs in Columbia, MO

Utilization Review Rn information

See Columbia, MO salary details

$20

$40

$65

How much do utilization review rn jobs pay per hour?

As of Aug 3, 2026, the average hourly pay for utilization review rn in Columbia, MO is $40.24, according to ZipRecruiter salary data. Most workers in this role earn between $31.78 and $46.20 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 popular job titles related to Utilization Review Rn jobs in Columbia, MO? For Utilization Review Rn jobs in Columbia, MO, the most frequently searched job titles are:
What job categories do people searching Utilization Review Rn jobs in Columbia, MO look for? The top searched job categories for Utilization Review Rn jobs in Columbia, MO are:
What cities near Columbia, MO are hiring for Utilization Review Rn jobs? Cities near Columbia, MO with the most Utilization Review Rn job openings:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Columbia, MO as of July 2026, with employment types broken down into 1% As Needed, 75% Full Time, 20% Part Time, 2% Temporary, and 2% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $83,690 per year, or $40.2 per hour.

Supervisor, Utilization Management (RN)

Centene

Jefferson City, MO • On-site, Remote

$75K - $135K/yr

Full-time

Medical, Retirement, PTO

Posted 14 days ago

Centene rating

8.4

Company rating: 8.4 out of 10

Based on 401 frontline employees who took The Breakroom Quiz

26th of 887 rated healthcare providers

Job description

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team.
  • Monitors and tracks UM resources to ensure adherence to performance, compliance, quality, and efficiency standards
  • Collaborates with utilization management team to resolve complex care member issues
  • Maintains knowledge of regulations, accreditation standards, and industry best practices related to utilization management
  • Works with utilization management team and senior management to identify opportunities for process and quality improvements within utilization management
  • Educates and provides resources for utilization management team on key initiatives and to facilitate on-going communication between utilization management team, members, and providers
  • Monitors prior authorization, concurrent review, and/or retrospective clinical review nurses and ensures compliance with applicable guidelines, policies, and procedures
  • Works with the senior management to develop and implement UM policies, procedures, and guidelines that ensure appropriate and effective utilization of healthcare services
  • Evaluates utilization management team performance and provides feedback regarding performance, goals, and career milestones
  • Provides coaching and guidance to utilization management team to ensure adherence to quality and performance standards
  • Assists with onboarding, hiring, and training utilization management team members
  • Leads and champions change within scope of responsibility
  • Performs other duties as assigned
  • Complies with all policies and standards

Education/Experience: Requires Graduate of an Accredited School Nursing or Bachelor's degree and 4+ years of related experience.
Knowledge of utilization management principles preferred.
License/Certification:

  • RN - Registered Nurse - State Licensure and/or Compact State Licensure required
  • CA RN LICENSE REQUIRED
Pay Range: $75,300.00 - $135,400.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.


Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

What Centene employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply