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

WellSpan Health

Care Management Nurse

Ephrata, PA · On-site

Performs initial reviews for medical necessity and appropriateness of setting for the assigned case ... Utilization management, care management, or clinical nursing specialty. Preferred * Previous ...

WellSpan Health

Care Management Nurse

Ephrata, PA · On-site

Performs initial reviews for medical necessity and appropriateness of setting for the assigned case ... Utilization management, care management, or clinical nursing specialty. Preferred * Previous ...

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

$42 - $52/hr

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 ...

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 ...

Mediko

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 ...

DOCS Health

Registered Nurse

Annville, PA · On-site

Independent Contractor Registered Nurse Attention all Registered Nurses, we are calling you to ... Review health history, service member medical records, and medical questionnaires. * Interview ...

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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 Aug 21, 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.

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 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 August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 15% Part Time, 3% Contract, and 1% Nights. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution, with an average salary of $81,478 per year, or $39.2 per hour.

Care Management Nurse

WellSpan Health

Ephrata, PA • On-site

Part-time

Medical, Retirement, PTO

Posted 13 days ago

WellSpan Health rating

7.6

Company rating: 7.6 out of 10

Based on 304 frontline employees who took The Breakroom Quiz

191st of 891 rated healthcare providers

Job description


8:30am to 9:00pm
Shifts primarily covering the Emergency Departments but also flexing to in house units based upon department needs
Weekend and holiday rotations required
Previous experience in care management, discharge planning, previous nursing experience in ED, critical care, trauma, step down units, medical, surgical, geriatrics are all strongly preferred
General Summary
Performs a variety of duties and applies utilization and care management techniques to determine the most efficient use of resources to support the provision of appropriate, cost effective and quality health care. Works in a team type assignment or Care Coordination Team (CCT) Model (Care Manager and Social Worker teams are assigned to patients by physician practice) to address patient care transition needs. Provides leadership in the integration of utilization and care management principles throughout the hospital.
Responsibilities
Duties and Responsibilities
  • Performs initial reviews for medical necessity and appropriateness of setting for the assigned case load.
  • Conducts concurrent reviews to ensure medical necessity for continued hospitalization and initiates problem-solving techniques as needed to prevent over and/or under utilization.
  • Liaisons between third party payers and the treatment team regarding the identified treatment plan in accordance with contractual guidelines or System policy.
  • Assists the patient care team with the identification and coordination of alternative treatment settings which will provide appropriate care, maintain quality of care and reduce cost.
  • Identifies conditions which require care management across the continuum. Collaborates with the members of the patient care team to identify interdisciplinary needs.
  • Makes arrangements for discharge needs (DME, Home Health, IV antibiotics, etc.) in collaboration with patients, families and care team as needed.
  • Assists with the collection and analysis of utilization patterns and denied cases.
  • Brings known or suspected problems of under-, over-, or inappropriate utilization of resources to the attention of the appropriate manager(s).

Common Expectations:
  • Prepares and maintains appropriate documentation as required.
  • Maintains established policies and procedures, objectives, quality assessment and safety standards.
  • Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.

Qualifications
Qualifications
Minimum Education:
  • Associates Degree Required

Work Experience:
  • 2 years Recent acute care experience. Required
  • Utilization management, care management, or clinical nursing specialty. Preferred
  • Previous experience in care management, discharge planning, previous nursing experience in ED, critical care, trauma, step down units, medical, surgical, geriatrics are all strongly preferred

Licenses:
  • Licensed Registered Nurse Upon Hire Required or
  • Registered Nurse Multi State License Upon Hire Required and
  • Basic Life Support Upon Hire Required

Knowledge, Skills, and Abilities:
  • Excellent interpersonal/communication skills.

Benefits Offered:
  • Comprehensive health benefits
  • Retirement savings plan
  • Paid time off (PTO)
  • Education assistance
  • Financial education and support, including DailyPay
  • Expanded Paid Parental Leave

For additional details: Benefits & Incentives | WellSpan Careers (joinwellspan.org)
About Us
WellSpan Health's vision is to reimagine healthcare through the delivery of comprehensive, equitable health and wellness solutions throughout our continuum of care. As an integrated delivery system focused on leading in value-based care, we encompass more than 2,300 employed providers, 250 locations, nine award-winning hospitals, home care and a behavioral health organization serving central Pennsylvania and northern Maryland. Our high-performing Medicare Accountable Care Organization (ACO) is the region's largest and one of the best in the nation. With a team 23,000 strong, WellSpan experts provide a range of services, from wellness and employer services solutions to advanced care for complex medical and behavioral conditions. Our clinically integrated network of 3,000 aligned physicians and advanced practice providers is dedicated to providing the highest quality and safety, inspiring our patients and communities to be their healthiest.
About the Team
WellSpan Ephrata Community Hospital
One of eight premier hospitals in the WellSpan system, WellSpan Ephrata Community Hospital offers a full range of leading-edge inpatient, outpatient and emergent care services. The hospital is noted for its distinct ability to combine state-of-the-art medical technology with quality, compassionate care to meet the needs of the more than 550,000 residents of northern Lancaster County and the surrounding area. As a full-service, non-profit acute-care hospital, with a 141 licensed bed capacity, WellSpan Ephrata Community Hospital admits approximately 5,500 patients annually. Nearby WellSpan Ephrata Cancer Center supports the hospital as part of WellSpan's regional network of five cancer centers. WellSpan Ephrata Community Hospital was one of several WellSpan Health hospitals honored by U.S. News & World Report with the High Performing recognition for 2022-23.

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