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Utilization Review Rn Jobs in Memphis, TN (NOW HIRING)

Sedgwick

RN Utilization Review

Memphis, TN · On-site

$63K - $65K/yr

... RN Utilization Review As a nurse at Sedgwick, you can build a meaningful and rewarding career while advocating for patients in a nontraditional clinical setting. * Apply your RN clinical knowledge ...

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Utilization Review Rn information

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$20

$41

$67

How much do utilization review rn jobs pay per hour?

As of Aug 6, 2026, the average hourly pay for utilization review rn in Memphis, TN is $41.08, according to ZipRecruiter salary data. Most workers in this role earn between $32.45 and $47.16 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 popular job titles related to Utilization Review Rn jobs in Memphis, TN? For Utilization Review Rn jobs in Memphis, TN, the most frequently searched job titles are:
What job categories do people searching Utilization Review Rn jobs in Memphis, TN look for? The top searched job categories for Utilization Review Rn jobs in Memphis, TN are:
What cities near Memphis, TN are hiring for Utilization Review Rn jobs? Cities near Memphis, TN with the most Utilization Review Rn job openings:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Memphis, TN as of July 2026, with employment types broken down into 1% As Needed, 80% Full Time, 15% Part Time, 1% Temporary, and 3% Contract. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $85,437 per year, or $41.1 per hour.

RN-Utilization Review

Baptist Memorial Health Care Corporation

Memphis, TN • On-site

Other

Re-posted 10 days ago

Baptist Memorial Health Care rating

7.2

Company rating: 7.2 out of 10

Based on 112 frontline employees who took The Breakroom Quiz

345th of 887 rated healthcare providers

Job description

Description
Job Summary
Manages the care for a specific population; facilitates the safe transition of patients throughout the continuum of care for appropriate utilization of resources, service delivery and compliance with federal and other payer requirements. Provides early assessment of transitional needs identified during their hospitalization, illness, and/or life situation. Performs other duties as assigned.
Responsibilities
  • Utilization Review
  • Discharge planning
  • Readmission Reduction Participation
  • Payer Communication and denial reduction
  • Completes assigned goals.
Specifications
Experience
Minimum Required
  • RN with at least one (1) year of clinical experience
Preferred/Desired
  • RN with 3 years of clinical experience with Case Management experience in a hospital or payer setting
Education
Minimum Required
  • Diploma or Associate Degree in Nursing
Preferred/Desired
  • BSN or MSN
Training
Minimum Required
Preferred/Desired
  • Certified Case Manager
Special Skills
  • .
Minimum Required
  • Critical thinking skills, communication, organization, interpersonal and computer skills. Problem solving; and governmental regulations.
Preferred/Desired
  • Critical thinking skills, communication, organization, interpersonal and computer skills. Knowledge of payer requirements; problem solving; and governmental regulations.
Licensure
  • RN
Minimum Required
  • RN
Preferred/Desired
  • RN;CCM;ACM

What Baptist Memorial Health Care employees say

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About Baptist Memorial

Sourced by ZipRecruiter

Baptist Memorial, based in Memphis, TN, US, is a leading health care organization renowned in the healthcare industry. The company's official website is baptistonline.org which provides a comprehensive view of their services and operations. Baptist Memorial operates a myriad of hospitals, health clinics, and medical facilities providing expert and compassionate care. Founded in 1912, it has a rich legacy of over a hundred years of dedication to its community, offering services which include acute care, diagnostic services, and a broad range of speciality health services fulfilling various patient needs.

Industry

Hospitals

Company size

10,000+ Employees

Headquarters location

Memphis, TN, US

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