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

Maxim Health Systems

RN Homecare

Lancaster, PA

$40/hr

RN Homecare Lancaster, Pennsylvania Hourly Pay: $40hr Maxim Healthcare in the Exton office is ... Reviews plan of care and program protocols and identifies areas for healthcare teaching/education ...

MEDIKO INC

Registered Nurse AM

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 ...

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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 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?

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 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:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Lititz, PA as of June 2026, with employment types broken down into 86% Full Time, 11% Part Time, and 3% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $81,478 per year, or $39.2 per hour.

LPN - Shift Date: 03/01/2026 - 03/01/2026

Care Coordination Services LLC

Shillington, PA

$30 - $38/hr

Other

Posted 18 days ago

Job description

Job Description POSITION TITLE: Licensed Practical Nurse (LPN) DEPARTMENT: Nursing REPORTS TO: RN Nursing Supervisor/Unit Manager/Center Nurse Executive POSITION SUMMARY: Under the direction of a Registered Nurse (RN), the Licensed Practical Nurse delivers efficient and effective nursing care while achieving positive clinical outcomes and patient/family satisfaction. He/she operates within the scope of practice defined by the State Nurse Practice Act. The LPN contributes to nursing assessments and care planning, provides direct patient care, and supervises patient care provided by unlicensed staff.

RESPONSIBILITIES/ACCOUNTABILITIES: Patient Evaluation: Collects, reports and documents objective and subjective data. Observes conditions and reports changes in condition to RN. Care Planning: Contributes to establishing individualized patient goals.

Assists in developing interventions to achieve goals. Implements the plan of care. Evaluates effectiveness of interventions to achieve patient goals and minimize re-hospitalizations.

Participate in review and revision of care plans. Provision of Direct Patient Care: Administers medications and performs treatments per physician orders. Communicates pertinent data to RN and/or physician.

Documents accurately and thoroughly. Consults and seeks guidance from the RN as necessary. At the direction of the RN, participates in Utilization Management or Interdisciplinary Care Management Meeting to facilitate appropriate discharge planning: Communicates team's recommendations for discharge to the attending physician, patient, and family.

Prepares patient/family for discharge including patient and family education. Monitors patient care provided by unlicensed staff: Assigns duties as specified by State Nurse Practice Act, Genesis policy, and staff training. Communicates patient information with unlicensed staff during and between shifts.

Monitors, evaluates and follows up on assigned responsibilities of unlicensed staff. Ensures that assigned tasks are performed in accordance with policies and procedures. Uses Point Click Care (PCC) according to the Business Processes.

Performs drug count when beginning and ending shift and whenever necessary. Assists physician in rounds and examination of patients, as needed. Participates in shift-to-shift communication between incoming and outgoing nursing staff.

Collaborates and coordinates with other departments to provide timely effective care consistent with individual's needs, choices, and preferences. Contributes to an environment that is respectful, team-oriented, and responsive to the concerns of staff, patients, and families. Enhances nursing practice by attending all mandated in-service programs.

Assists with the orientation of newly hired nursing staff. Promotes a culture of safety to ensure a healthy practice and living environment. Maintains confidentiality and protects sensitive Protected Health Information (PHI) at all times.

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