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

Ramp Health

Registered Nurse (RN)

Reading, PA · On-site

Reduce non-emergent ER and urgent care utilization through early intervention and appropriate ... Review results with participants and collaborate on personalized action plans * Administer ...

UHS

Registered Nurse (RN) - Day Shift

Lancaster, PA · On-site

Benefits for our Registered Nurses (RN) include: * Up to $4,800/Year in Tuition Assistance ... After you apply online and submit your resume, a member of our HR team will review your ...

MEDIKO INC

Registered Nurse-PRN

Harrisburg, PA

The Registered Nurse (RN) will provide direct patient care in a correctional setting, including ... Perform comprehensive physical assessments and history reviews to determine patient health status ...

MEDIKO INC

Registered Nurse PM

Harrisburg, PA

$25K/yr

Exceptional team adding three more RN's * Competitive pay, unparalleled payoff * $25,000 signing ... Perform comprehensive physical assessments and history reviews to determine patient health status ...

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

Utilization Review Rn information

See Lititz, PA salary details

$19

$39

$63

How much do utilization review rn jobs pay per hour?

As of Jul 7, 2026, the average hourly pay for utilization review rn in Lititz, PA is $39.17, according to ZipRecruiter salary data. Most workers in this role earn between $30.96 and $45.00 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 job categories do people searching Utilization Review Rn jobs in Lititz, PA look for? The top searched job categories for Utilization Review Rn jobs in Lititz, PA are:
What cities near Lititz, PA are hiring for Utilization Review Rn jobs? Cities near Lititz, PA with the most Utilization Review Rn job openings:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Lititz, PA as of July 2026, with employment types broken down into 1% As Needed, 76% Full Time, 19% Part Time, 1% Temporary, 2% Contract, and 1% Nights. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $81,478 per year, or $39.2 per hour.
Care Manager (Registered Nurse/RN)

Care Manager (Registered Nurse/RN)

Hickory House Nursing Home

Honey Brook, PA • On-site

Other

Posted 5 days ago

Job description

Live the Mission

SIGN ON BONUS!!

Position Summary

The RN Care Manager is responsible for the coordination of the patient's care and services. Promotes quality care using a collaborative process that coordinates, monitors, and evaluates services according to the needs of patients. Works together with the patient and family, care team, payers, and external entities to promote a safe transition from the facility to the next provider or care setting care team, payers, and external entities to promote a safe transition from the facility to the next provider or care setting in accordance with all applicable laws, regulations, and Life Care standards.

Education, Experience, and Licensure Requirements
  • Nursing diploma (associate's or bachelor's degree in nursing)
  • Currently licensed/registered in applicable State. Must maintain an active Registered Nurse (RN) license in good standing throughout employment.
  • One (1) year of clinical experience in post acute care setting preferred
  • Prior case management, utilization review, and discharge planning experience preferred
  • Certified Case Manager (CCM) or Board Certification in Nursing Case Management (RN BC) preferred
Specific Job Requirements
  • Generate written communication that is clear, concise, and well organized
  • Excellent organizational skills and be efficient in prioritizing and managing time and assignments
  • Contribute to the organization's goals and objectives and support the organizational strategic plans
  • Expert knowledge in field of practice
  • Make independent decisions when circumstances warrant such action
  • Knowledgeable of practices and procedures as well as the laws, regulations, and guidelines governing functions in the post acute care facility
  • Implement and interpret the programs, goals, objectives, policies, and procedures of the department
  • Perform proficiently in all competency areas including but not limited to: patient rights, and safety and sanitation
  • Maintains professional working relationships with all associates, vendors, etc.
  • Maintains confidentiality of all proprietary and/or confidential information
  • Understand and follow company policies including harassment and compliance procedures
  • Displays integrity and professionalism by adhering to Life Care's Code of Conduct and completes mandatory Code of Conduct and other appropriate compliance training
Essential Functions
  • Demonstrate efficient use of relevant computer systems including but not limited to the ability to enter and retrieve data
  • Serve as liaison to external case managers, family, physicians, and community resources
  • Train and education patients, families, associates, and other providers of care
  • Implement the standards of practice for care management, ethical performance, and functions relevant to coordination of care
  • Exhibit excellent customer service and a positive attitude towards patients
  • Assist in the evacuation of patients
  • Demonstrate dependable, regular attendance
  • Concentrate and use reasoning skills and good judgment
  • Communicate and function productively on an interdisciplinary team
  • Sit, stand, bend, lift, push, pull, stoop, walk, reach, and move intermittently during working hours
  • Read, write, speak, and understand the English language

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