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$39

$64

How much do utilization review rn jobs pay per hour?

As of Jul 16, 2026, the average hourly pay for utilization review rn in Greenville, SC is $39.76, according to ZipRecruiter salary data. Most workers in this role earn between $31.44 and $45.67 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 the most commonly searched types of Utilization Review Rn jobs in Greenville, SC? The most popular types of Utilization Review Rn jobs in Greenville, SC are:
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What job categories do people searching Utilization Review Rn jobs in Greenville, SC look for? The top searched job categories for Utilization Review Rn jobs in Greenville, SC are:
What cities near Greenville, SC are hiring for Utilization Review Rn jobs? Cities near Greenville, SC with the most Utilization Review Rn job openings:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Greenville, SC as of July 2026, with employment types broken down into 1% As Needed, 78% Full Time, 16% Part Time, 2% Temporary, and 3% Contract. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $82,695 per year, or $39.8 per hour.
OASIS Review RN - Hospice

OASIS Review RN - Hospice

Spartanburg Regional Healthcare System

Spartanburg, SC • On-site

$72K - $91K/yr

Full-time

This job post has expired 1 day ago. Applications are no longer accepted.

Spartanburg Regional Healthcare System rating

6.7

Company rating: 6.7 out of 10

Based on 117 frontline employees who took The Breakroom Quiz

529th of 886 rated healthcare providers

Job description

Job Requirements

We are hiring an OASIS Review RN to join our Hospice team!

  • Full-Time; 8:30am - 5:00pm

The Clinical Review RN is responsible for the review of admission and discharge data as assigned to ensure appropriateness, completeness, and compliance with state and federal regulations. Ensures appropriate Coding and sequencing as it relates to the patient's medical condition, including any co-morbidities and current guidelines. Consults with the appropriate clinician to clarify data integrity and documentation. Evaluates the accuracy of admission and discharge data at each time point to ensure the data is collected, encoded, and reflects the patient's status at the time of the assessment, based on the clinician's documentation. Provides ongoing Quality Reporting Program (QRP) and documentation education to clinicians as needed. Follows up with clinicians to ensure timeliness of admission and discharge data corrections. Review's admission and discharge and Plan of Care data for accuracy, appropriateness, and congruency.  Ensures the completion of all necessary documentation by all disciplines for the completion and transmission process based on state and federal regulation. Notifies management of trends noted in QRP

documentation as a result of data review. Assists with billing audits and issues as needed. Participates in quality assessment performance improvement process.  Performs other duties as assigned.

Minimum Requirements  

Education

• Graduate of an approved nursing program

Experience

• One (1) year Home Health/Hospice experience or Quality experience

 

License/Registration/Certifications

• Current license to practice as a Registered Nurse in South Carolina

Core Job Responsibilities 

• Review's admission/discharge data and plan of care for appropriateness, completeness, and compliance with federal and state regulations

• Submits Quality Reporting Data assessments based on federal and state regulation.

• Evaluates the accuracy of Quality Reporting Data at each time point to ensure the data is collected, encoded, and reflects the patient's status at the time of the assessment, based on the clinician's documentation.

• Performs review of admission/discharge assessments as assigned to ensure appropriateness, completeness, and compliance with state and federal regulations

• Consults with appropriate clinical staff to clarify any data integrity issues and works with clinician to make appropriate corrections

• Works with Clinical Leadership to address trends that affect the agency's outcome and process measure noted during clinical review

• Train and function as a field RN clinician, as needed

• Other duties as assigned


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About Spartanburg Regional Healthcare System

Sourced by ZipRecruiter

Spartanburg Regional Healthcare System is a leader in the healthcare industry, located in Spartanburg, SC, US. As a comprehensive health system, it offers services encompassing everything from wellness, prevention, and care coordination to specific medical treatments for a wide range of diseases and health issues. Spartanburg Regional Healthcare System was founded in 1921 and has since developed a reputation for excellence and innovative care, growing to include six hospitals, 100 medical offices, 8,000 associates and more than 900 medical staff.

Industry

Recruiting and staffing services

Company size

5,001 - 10,000 Employees

Headquarters location

Spartanburg, SC, US

Year founded

1921

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