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Utilization Review Rn Jobs in Greensburg, PA (NOW HIRING)

UPMC Senior Communities

UM Care Manager (RN)

Pittsburgh, PA · On-site

$34.49 - $56.83/hr

The Utilization Management (UM) Care Manager is responsible for utilization review of health plan ... PA RN license preferred. * Strong organizational, task prioritization and problem-solving skills.

UPMC Health Plan

UM Care Manager (RN)

Pittsburgh, PA · Remote

The Utilization Management (UM) Care Manager is responsible for utilization review of health plan ... PA RN license preferred. * Strong organizational, task prioritization and problem-solving skills.

Community LIFE

RN Case Manager

Wilkinsburg, PA · On-site

As a Registered Nurse Case Manager (RNCM), you'll be part of a compassionate, interdisciplinary ... Familiarity with managed care, quality assurance, and utilization review * Basic computer ...

Community LIFE

RN Case Manager

Pittsburgh, PA · On-site

Registered Nurse Case Manager (RNCM) Currently offering a $5000 sign on bonus for this position ... Familiarity with managed care, quality assurance, and utilization review * Basic computer ...

Community LIFE

RN Case Manager

Homestead, PA · On-site

Registered Nurse Case Manager (RNCM) Currently offering a $5000 sign on bonus for this position ... Familiarity with managed care, quality assurance, and utilization review * Basic computer ...

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All JobsUtilization Review Rn JobsUtilization Review Rn Jobs in Greensburg, PA

Utilization Review Rn information

See Greensburg, PA salary details

$19

$38

$63

How much do utilization review rn jobs pay per hour?

As of Aug 30, 2026, the average hourly pay for utilization review rn in Greensburg, PA is $38.90, according to ZipRecruiter salary data. Most workers in this role earn between $30.72 and $44.66 per hour, depending on experience, location, and employer.

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.

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.

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 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 case management certification can enhance job prospects, and familiarity with electronic health records (EHR) systems is often required.

What are popular job titles related to Utilization Review Rn jobs in Greensburg, PA?

For Utilization Review Rn jobs in Greensburg, PA, the most frequently searched job titles are:

What job categories do people searching Utilization Review Rn jobs in Greensburg, PA look for?

The top searched job categories for Utilization Review Rn jobs in Greensburg, PA are:

What cities near Greensburg, PA are hiring for Utilization Review Rn jobs?

Cities near Greensburg, PA with the most Utilization Review Rn job openings:

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Greensburg, PA as of August 2026, with employment types broken down into 1% As Needed, 85% Full Time, 11% Part Time, 2% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $80,922 per year, or $38.9 per hour.

REGISTERED NURSE CARE MANAGER UTILIZATION MANAGEMENT

Pittsburgh, PA • On-site

St. Clair Health
Health Care and Social Assistance • 1 - 5K employees

6.8

Company rating: 6.8 out of 10

Based on 31 frontline employees who took The Breakroom Quiz

500th of 895 rated healthcare providers

People enjoy working here

Recommended by students

Recommended by parents

Learn more about St. Clair Healthexternal

Other

Posted 27 days ago

Job description

Summary
Completes all aspects of Utilization Management for assigned patient population by evaluating appropriate status and physician orders for admission, observation, or outpatient at all points of entry to St. Clair Hospital, and ensures that appropriate orders are placed in the electronic medical record.
Minimum Qualifications

  1. Current licensure as a Registered Nurse in Pennsylvania.
  2. Five years of clinical experience as a Registered Nurse in an acute care setting.
  3. Two years of experience in Utilization Review.
  4. Highly effective communication skills.
  5. Ability to identify appropriate status and physician orders for the level of care the patient is or will be placed in.
  6. Ability to navigate electronic medical records and web-based applications.
  7. Possesses the ability to manage multiple tasks in a fast-paced environment.
Preferred Qualifications
  1. Bachelor's degree in nursing or health related field.
  2. Certification in Case Management.
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About St. Clair Health

Sourced by ZipRecruiter

St. Clair Hospital is a highly honored, independent, 329 bed acute-care medical center that provides advanced, high quality health care to the residents of southwestern Pennsylvania. A member of the Mayo Clinic Care Network, St. Clair has 600 physicians and 2,500 employees. St. Clair Hospital is the largest employer in Pittsburgh’s South Hills. Providing virtually every health care service that residents may need throughout their lives, the Hospital is focused on continuously enhancing its services and technologies to ensure that the community’s health needs are met. The Hospital offers a comprehensive array of high-quality inpatient and outpatient services, including advanced cardiovascular services; specialized care for women and children; oncology services; orthopedics; emergency care; urgent care; and psychiatry and mental health services.

Industry

Health care and social assistance

Company size

1,001 - 5,000 Employees

Headquarters location

Pittsburgh, PA, US

Year founded

1954

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What St. Clair Health employees say

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Hours and flexibility

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