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Utilization Review Rn Jobs in Louisville, KY (NOW HIRING)

ScionHealth

Case Manager II

Louisville, KY · On-site

... utilization review and management, and discharge planning. Essential Functions Care Coordination ... BSN, MSN, BSW or MSW (Preferred) Licenses/Certifications * RN - Registered Nurse - State Licensure ...

Dinsmore

Nurse Consultant

Louisville, KY · On-site

... (RN) license required * Bachelor of Science in Nursing (BSN) required; advanced degree preferred * Minimum 5 years of clinical nursing experience (critical care, ER, utilization review, or case ...

Dinsmore Inc

Nurse Consultant

Louisville, KY · On-site

... (RN) license required * Bachelor of Science in Nursing (BSN) required; advanced degree preferred * Minimum 5 years of clinical nursing experience (critical care, ER, utilization review, or case ...

UHS

Utilization Coordinator PRN

Louisville, KY

$20/hr

... Review Coordinator to join our team. Hourly pay: $20 Since 1985 The Brook Hospital has been ... Required: LPN, and/or Bachelor/Masters Degree in Social Work or Psychology LICENSURE ...

UHS

Utilization Coordinator PRN

Louisville, KY · On-site

$20/hr

... Review Coordinator to join our team. Hourly pay: $20 Since 1985 The Brook Hospital has been ... Required: LPN, and/or Bachelor/Masters Degree in Social Work or Psychology LICENSURE ...

ScionHealth

Case Manager II PRN

Louisville, KY · On-site

Utilization Management Conducts medical necessity review for appropriate utilization of services ... BSN, MSN, BSW or MSW (Preferred) Licenses/Certifications * RN - Registered Nurse - State Licensure ...

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Utilization Review Rn information

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How much do utilization review rn jobs pay per hour?

As of Aug 14, 2026, the average hourly pay for utilization review rn in Louisville, KY is $40.61, according to ZipRecruiter salary data. Most workers in this role earn between $32.12 and $46.63 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.

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 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 knowledge of medical coding and insurance processes can enhance your qualifications. Gaining experience in case management or health insurance companies can also improve your chances of entering the field.

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.

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 Louisville, KY?

The most popular types of Utilization Review Rn jobs in Louisville, KY are:

What are popular job titles related to Utilization Review Rn jobs in Louisville, KY?

For Utilization Review Rn jobs in Louisville, KY, the most frequently searched job titles are:

What job categories do people searching Utilization Review Rn jobs in Louisville, KY look for?

The top searched job categories for Utilization Review Rn jobs in Louisville, KY are:

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Louisville, KY as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 15% Part Time, and 3% Contract. Highlights an 89% Physical, 4% Hybrid, and 7% Remote job distribution, with an average salary of $84,470 per year, or $40.6 per hour.

Utilization Management Nurse RN

Signature HealthCARE

Louisville, KY • On-site

$75K - $82K/yr

Other

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 29 days ago

Signature Healthcare rating

5.3

Company rating: 5.3 out of 10

Based on 170 frontline employees who took The Breakroom Quiz

190th of 240 rated social care providers

Job description

Signature HealthCARE

Signature HealthCARE is a family-based healthcare company offering integrated services across multiple states. Our continuum of care includes skilled nursing, rehabilitation, assisted and memory care, and home-based services supported by innovative technologies like telehealth and Care.ai-enabled solutions.

We are committed to advancing person-directed care and quality outcomes. Many of our facilities continue to receive high performance ratings and accreditations. As an award-winning organization recognized over the years by national outlets such as U.S. News & World Report, we take pride in fostering compassionate care environments and being an employer of choice in the healthcare industry.

Overview

Collaboration with Managed Care Organizations (MCO) and care providers is vital to ensure care is being delivered in the right setting at the right time.

How You Will Make a Difference
  • Collaborate regularly and maintain open communication with leadership, patients, families, internal care givers, and external Utilization Management Nurses.
  • Coordinate internal and external health care team activities related to resident care, transitions and discharge planning with agencies, and other healthcare organizations.
  • Conduct initial baseline assessment of resident care needs and communicate that effectively to the Managed Care Organization (MCO) ensuring all aspects of care services are communicated accurately.
  • Verify all care needs and the authorization for services and outliers.
  • Communicate/collaborate with the Managed Care Organization (MCO) at required intervals as determined by the MCO
  • Negotiate appropriate levels based on services provided and contractual arrangements with the facility and the MCO.
  • Document all authorizations and continued stay activity in Case Management software to ensure appropriate reporting and billing
  • Prepare all Managed Care documentation to facility accurate billing.
What You Need to Make a Difference
  • Registered Nurse (RN) in good standing with required current state license.
  • Associates degree required, but Bachelor's degree preferred.
  • Basic knowledge of medical necessity criteria such as Milliman Care Guidelines or Interqual.
  • Minimum of three (3) years related case management experience.
  • Minimum of three (3) years of hospital, SNF or Acute Rehab clinical experience
  • Certified in Case Management through ACMA, CCMC or other credentialed agencies, preferred or willing to obtain after one year of employment.
  • Knowledge of Medicare payment methodology and the MDS RUG system. Previous experience with MDS and assessment preferred
Our Exceptional Benefits Package and Signature Perks Include the Following and More!
  • Medical, Dental and Vision – Voluntary Life/Disability
  • Free Telemedicine with Medical Plan
  • 401(K) and Roth 401(K)
  • Tuition Forgiveness/Education Reimbursement
  • A variety of additional specialized Insurances
  • Pay Advance and Next Day Pay!
  • Paid Time Off (PTO)
  • Partner Perks and Discounts!
  • Reward & Recognition Program (HEART)
  • Vital Links

At Signature HealthCARE, our team members are permitted – no, encouraged – to employ their talents and abilities to solve problems. Our culture is built on three distinct pillars: Learning, Spirituality and Intra-preneurship. Each pillar has its own staff and initiatives, ensuring that our unique culture permeates the entire organization. Come see what the revolution is all about!

Signature HealthCARE is an Equal Opportunity-Affirmative Action Employer – Minority / Female / Disability / Veteran and other protected categories

Salary Range USD $75,000.00 - USD $82,000.00 /Yr. ##LI-HB1

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