Responsible for the review of clinical documentation in the Electronic Medical Record (EMR ... Currently licensed to practice as a Registered Nurse by the state of employment or holds a ...
Responsible for the review of clinical documentation in the Electronic Medical Record (EMR ... Currently licensed to practice as a Registered Nurse by the state of employment or holds a ...
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 ...
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 ...
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 ...
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 ...
Director - Care Transitions
Hershey, PA · On-site
... Nurse (RN) leader in case management, care coordination, or utilization management ready to drive ... review, pediatric case management, care coordination, discharge planning, and clinical social work.
Director - Care Transitions
Hershey, PA · On-site
... Nurse (RN) leader in case management, care coordination, or utilization management ready to drive ... review, pediatric case management, care coordination, discharge planning, and clinical social work.
... utilization review to assess appropriateness of therapy; appropriate strain, dosage, route, and ... O., licensed registered nurse practitioner, or physician's assistant.
... utilization review to assess appropriateness of therapy; appropriate strain, dosage, route, and ... O., licensed registered nurse practitioner, or physician's assistant.
As a skilled RN Utilization Manager, you will play a vital role in delivering exceptional patient care while collaborating with a passionate group of healthcare professionals. Enjoy the regular ...
As a skilled RN Utilization Manager, you will play a vital role in delivering exceptional patient care while collaborating with a passionate group of healthcare professionals. Enjoy the regular ...
Reduce non-emergent ER and urgent care utilization through early intervention and appropriate ... Review results with participants and collaborate on personalized action plans * Administer ...
Reduce non-emergent ER and urgent care utilization through early intervention and appropriate ... Review results with participants and collaborate on personalized action plans * Administer ...
$65/Hr Temp Registered Nurse (RN)
Reading, PA · On-site
$65/hr
Registered Nurse Position at Tower Behavioral Health This is a $65/hour temporary assignment and ... Demonstrate knowledge and utilization of universal precautions in providing direct patient care.
$65/Hr Temp Registered Nurse (RN)
Reading, PA · On-site
$65/hr
Registered Nurse Position at Tower Behavioral Health This is a $65/hour temporary assignment and ... Demonstrate knowledge and utilization of universal precautions in providing direct patient care.
MDS Coordinator (Registered Nurse/RN)
$35.25 - $42.50/hr
Live the Mission Position Summary The RN MDS Coordinator coordinates and assists with completion ... Review Final Validation Reports and attest that all assessments have been completed and accepted ...
MDS Coordinator (Registered Nurse/RN)
$35.25 - $42.50/hr
Live the Mission Position Summary The RN MDS Coordinator coordinates and assists with completion ... Review Final Validation Reports and attest that all assessments have been completed and accepted ...
MDS Coordinator (Registered Nurse/RN)
Honey Brook, PA · On-site
$35.25 - $42.50/hr
Live the Mission Position Summary The RN MDS Coordinator coordinates and assists with completion ... Review Final Validation Reports and attest that all assessments have been completed and accepted ...
MDS Coordinator (Registered Nurse/RN)
Honey Brook, PA · On-site
$35.25 - $42.50/hr
Live the Mission Position Summary The RN MDS Coordinator coordinates and assists with completion ... Review Final Validation Reports and attest that all assessments have been completed and accepted ...
MDS Coordinator (Registered Nurse/RN)
Honey Brook, PA · On-site
$35.25 - $42.50/hr
Live the Mission Position Summary The RN MDS Coordinator coordinates and assists with completion ... Review Final Validation Reports and attest that all assessments have been completed and accepted ...
MDS Coordinator (Registered Nurse/RN)
Honey Brook, PA · On-site
$35.25 - $42.50/hr
Live the Mission Position Summary The RN MDS Coordinator coordinates and assists with completion ... Review Final Validation Reports and attest that all assessments have been completed and accepted ...
... utilization and associated costs across patient populations and health care settings. * Daily ... PA Registered Nurse License * BLS Certification Required Skills * Excellent Communication Skills
... utilization and associated costs across patient populations and health care settings. * Daily ... PA Registered Nurse License * BLS Certification Required Skills * Excellent Communication Skills
Participates in the review of policy and procedures on an ongoing basis providing evidenced-based ... Assists with the collection and analysis of utilization patterns including avoidable days and ...
Participates in the review of policy and procedures on an ongoing basis providing evidenced-based ... Assists with the collection and analysis of utilization patterns including avoidable days and ...
Registered Nurse (RN) Opportunity at Lancaster Behavioral Health Hospital Lancaster Behavioral ... After you apply online and submit your resume, a member of our HR team will review your ...
Registered Nurse (RN) Opportunity at Lancaster Behavioral Health Hospital Lancaster Behavioral ... After you apply online and submit your resume, a member of our HR team will review your ...
Registered Nurse (RN) Lancaster Behavioral Health Hospital is hiring full-time RNs for day shift ... After you apply online and submit your resume, a member of our HR team will review your ...
Registered Nurse (RN) Lancaster Behavioral Health Hospital is hiring full-time RNs for day shift ... After you apply online and submit your resume, a member of our HR team will review your ...
Registered Nurse (RN) Opportunity at Lancaster Behavioral Health Hospital Lancaster Behavioral ... After you apply online and submit your resume, a member of our HR team will review your ...
Registered Nurse (RN) Opportunity at Lancaster Behavioral Health Hospital Lancaster Behavioral ... After you apply online and submit your resume, a member of our HR team will review your ...
Registered Nurse (RN) Position Lancaster Behavioral Health Hospital is hiring full-time RNs for day ... After you apply online and submit your resume, a member of our HR team will review your ...
Registered Nurse (RN) Position Lancaster Behavioral Health Hospital is hiring full-time RNs for day ... After you apply online and submit your resume, a member of our HR team will review your ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
Utilization Review Rn information
See Lititz, PA salary details
$19.82 - $23.83
2% of jobs
$23.83 - $27.84
9% of jobs
$30.58 is the 25th percentile. Wages below this are outliers.
$27.84 - $31.85
21% of jobs
The median wage is $35.09 / hr.
$31.85 - $35.86
23% of jobs
$35.86 - $39.86
13% of jobs
$42.98 is the 75th percentile. Wages above this are outliers.
$39.86 - $43.87
10% of jobs
$43.87 - $47.88
8% of jobs
$47.88 - $51.89
5% of jobs
$51.89 - $55.90
5% of jobs
$55.90 - $59.91
2% of jobs
$59.91 - $63.92
2% of jobs
$19
$39
$63
How much do utilization review rn jobs pay per hour?
As of Jun 15, 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 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.
How do I become a utilization review RN?
To become a utilization review RN, you typically need to hold a valid registered nurse (RN) license and have experience in clinical nursing. Additional certifications such as the Certified Professional in Healthcare Quality (CPHQ) or Utilization Review Certification (URAC) can enhance job prospects, and strong knowledge of medical coding, insurance policies, and healthcare regulations is important.
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 does an RN utilization review do?
An RN utilization review evaluates medical records and treatment plans to determine the appropriateness, necessity, 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.
How to make $300,000 a year as a nurse?
To earn $300,000 annually as a Utilization Review RN, professionals typically need extensive experience, advanced certifications such as CCM or ANCC, and may work in high-paying settings like insurance companies or healthcare consulting firms. Increasing specialization, taking on leadership roles, or working overtime can also boost income, but reaching this level often requires a combination of skills, experience, and strategic career moves.
What is the difference between Utilization Review Rn vs Case Manager?
| Aspect | Utilization Review Rn | Case Manager |
|---|---|---|
| Credentials | RN license, certifications in utilization review | RN license, certifications in case management |
| Work Environment | Hospitals, insurance companies, healthcare facilities | Hospitals, community agencies, insurance companies |
| Primary Focus | Reviewing medical necessity and appropriateness of care | Coordinating 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 CCM or ANCC, and working in high-paying settings like insurance companies or managed care organizations. Advanced skills in case management, strong clinical knowledge, and sometimes working overtime or in leadership roles can also contribute to higher earnings.
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:
Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Posted 18 days ago
Penn State Health rating
7.0
Based on 241 frontline employees who took The Breakroom Quiz
403rd of 872 rated healthcare providers
Job description
Penn State Health - Hershey Medical Center
Location: US:PA: Hershey
Work Type: Full Time
FTE: 1.00
Shift: Day
Hours: 8:00a - 4:30p
Recruiter Contact: Denisse M. Rosado at drosado1@pennstatehealth.psu.edu
SUMMARY OF POSITION:
Responsible for the review of clinical documentation in the Electronic Medical Record (EMR), comparing it to the nationally accepted and evidence-based criteria to certify an admission to the facility, and for concurrent/continued stay review as appropriate. Also responsible for maintaining compliance with the CMS Conditions of Participation for Utilization Management.
MINIMUM QUALIFICATION(S):
PREFFERED QUALIFICATION(S):
WHY PENN STATE HEALTH?
Penn State Health offers exceptional opportunities to learn and grow, exposure to a wide patient population, and the ability to provide individualized, innovative, and specialized care to patients in the community.
Penn State Health offers an exceptional benefits package including medical, dental and vision with no waiting period as well as a Total Rewards Program that highlights a few of the many additional offerings below:
WHY PENN STATE HEALTH MILTON HERSHEY MEDICAL CENTER?
Penn State Hershey Medical Center is Central Pennsylvania's only Academic Medical Center, Level 1 Regional Adult and Pediatric Trauma Center, and Tertiary Care Provider. As a four-time Magnet-designated hospital, Hershey Medical Center values the hard work and dedication that our employees exhibit every day. Through our core values of Respect, Integrity, Teamwork, and Excellence, our employees are a team committed to compassionate care for our diverse patient population, our community and each other. As a valued team member, we promote continued professional development, specialty certification, continuing education, and career growth.
YOU TAKE CARE OF THEM. WE'LL TAKE CARE OF YOU. State-of-the-art equipment, endless learning, and a culture of excellence - that's Penn State Health. But what makes our healthcare award-winning? That's all you.
This job posting is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position. Eligibility for shift differential pay based on the terms outlined in company policy or union contract. All individuals (including current employees) selected for a position will undergo a background check appropriate for the position's responsibilities.
Penn State Health is an Equal Opportunity Employer and does not discriminate on the basis of any protected class including disability or veteran status. Penn State Health's policies and objectives are in direct compliance with all federal and state constitutional provisions, laws, regulations, guidelines, and executive orders that prohibit or outlaw discrimination.
Union: SEIU Healthcare Pennsylvania
Location: US:PA: Hershey
Work Type: Full Time
FTE: 1.00
Shift: Day
Hours: 8:00a - 4:30p
Recruiter Contact: Denisse M. Rosado at drosado1@pennstatehealth.psu.edu
SUMMARY OF POSITION:
Responsible for the review of clinical documentation in the Electronic Medical Record (EMR), comparing it to the nationally accepted and evidence-based criteria to certify an admission to the facility, and for concurrent/continued stay review as appropriate. Also responsible for maintaining compliance with the CMS Conditions of Participation for Utilization Management.
MINIMUM QUALIFICATION(S):
- Bachelor's Degree in Nursing or Master's Degree in Nursing required
- 3 years of advanced clinical experience in a hospital setting required.
- Currently licensed to practice as a Registered Nurse by the state of employment or holds a multistate RN license through the Interstate Nurse Licensure Compact.
- Demonstrated ability to problem-solve complex, multidimensional situations required.
- Ability to successfully manage conflict and negotiate "win-win" solutions required.
- Strong organizational, task prioritization, and delegation skills required.
- Strong oral and written communication skills required.
- Ability to work independently required.
PREFFERED QUALIFICATION(S):
- Financial Counseling experience preferred.
WHY PENN STATE HEALTH?
Penn State Health offers exceptional opportunities to learn and grow, exposure to a wide patient population, and the ability to provide individualized, innovative, and specialized care to patients in the community.
Penn State Health offers an exceptional benefits package including medical, dental and vision with no waiting period as well as a Total Rewards Program that highlights a few of the many additional offerings below:
- Be Well with Employee Wellness Programs, and Fitness Discounts (University Fitness Center, Peloton).
- Be Balanced with Generous Paid Time Off, Personal Time, and Paid Parental Leave.
- Be Secured with Retirement, Extended Illness Bank, Life Insurance, and Identity Theft Protection.
- Be Rewarded with Competitive Pay, Tuition Reimbursement, and PAWS UP employee recognition program.
- Be Supported by the HR Solution Center, Learning and Organizational Development and Virtual Benefits Orientation, Employee Exclusive Concierge Service for scheduling.
WHY PENN STATE HEALTH MILTON HERSHEY MEDICAL CENTER?
Penn State Hershey Medical Center is Central Pennsylvania's only Academic Medical Center, Level 1 Regional Adult and Pediatric Trauma Center, and Tertiary Care Provider. As a four-time Magnet-designated hospital, Hershey Medical Center values the hard work and dedication that our employees exhibit every day. Through our core values of Respect, Integrity, Teamwork, and Excellence, our employees are a team committed to compassionate care for our diverse patient population, our community and each other. As a valued team member, we promote continued professional development, specialty certification, continuing education, and career growth.
YOU TAKE CARE OF THEM. WE'LL TAKE CARE OF YOU. State-of-the-art equipment, endless learning, and a culture of excellence - that's Penn State Health. But what makes our healthcare award-winning? That's all you.
This job posting is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position. Eligibility for shift differential pay based on the terms outlined in company policy or union contract. All individuals (including current employees) selected for a position will undergo a background check appropriate for the position's responsibilities.
Penn State Health is an Equal Opportunity Employer and does not discriminate on the basis of any protected class including disability or veteran status. Penn State Health's policies and objectives are in direct compliance with all federal and state constitutional provisions, laws, regulations, guidelines, and executive orders that prohibit or outlaw discrimination.
Union: SEIU Healthcare Pennsylvania
What Penn State Health employees say
Pay
Benefits
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Get the full story on Breakroom
About Penn State Health
Sourced by ZipRecruiter
Penn State Health is one of the leading teaching and research hospitals in the country. It is a multi-hospital health system, Academic Medical Center and Level 1 adult and pediatric trauma center serving patients and communities across Central Pennsylvania. The system includes Penn State Health Milton S. Hershey Medical Center, Penn State Children's Hospital, and Penn State Cancer Institute in scenic Hershey, PA. It also includes Penn State Health Saint Joseph's Medical Center in Reading, PA, Penn State Health Holy Spirit Medical Center in Camp Hill, PA, and Penn State Health Hampden Medical Center in Enola, PA. Penn State Health shares an integrated strategic plan and operations with Penn State College of Medicine.
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Hershey, PA, US
Year founded
1963