ZipRecruiter

Log In

1

Utilization Review Rn Jobs in New Orleans, LA (NOW HIRING)

AbsoluteCARE Inc

Utilization Review Nurse

New Orleans, LA · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

The Utilization Review Nurse ensures appropriate utilization of health services by performing ... Active Registered Nurse license by the State of Louisiana and/or the state(s) in which the nurse is ...

AbsoluteCARE Inc

Utilization Review Nurse

New Orleans, LA · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

The Utilization Review Nurse ensures appropriate utilization of health services by performing ... Active Registered Nurse license by the State of Louisiana and/or the state(s) in which the nurse is ...

AbsoluteCARE Inc

Utilization Review Nurse

New Orleans, LA · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

The Utilization Review Nurse ensures appropriate utilization of health services by performing ... Active Registered Nurse license by the State of Louisiana and/or the state(s) in which the nurse is ...

AbsoluteCare

Utilization Review Nurse

New Orleans, LA · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

The Utilization Review Nurse ensures appropriate utilization of health services by performing ... Active Registered Nurse license by the State of Louisiana and/or the state(s) in which the nurse is ...

AbsoluteCARE

Utilization Review Nurse

New Orleans, LA · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

The Utilization Review Nurse ensures appropriate utilization of health services by performing ... Active Registered Nurse license by the State of Louisiana and/or the state(s) in which the nurse is ...

Ochsner Health

RN Case Manager

Bay Saint Louis, MS · On-site

Preferred - 3 years of hospital-based experience in discharge planning, case management or utilization review. Certifications Required - Current registered nurse license in state of practice. Basic ...

Ochsner Health

RN Case Manager

Bay Saint Louis, MS · On-site

Preferred - 3 yearsof hospital-based experience in discharge planning, case management or utilization review. Certifications Required -Current registered nurse license in state of practice. Basic ...

Ochsner Health

RN Case Manager

New Orleans, LA · On-site

Preferred - 3 yearsof hospital-based experience in discharge planning, case management or utilization review. Certifications Required -Current registered nurse license in state of practice. Basic ...

Ochsner Health

RN Case Manager

New Orleans, LA · On-site

Preferred - 3 yearsof hospital-based experience in discharge planning, case management or utilization review. Certifications Required -Current registered nurse license in state of practice. Basic ...

Ochsner Health

RN Case Manager - PRN

Slidell, LA · On-site

Preferred - 3 yearsof hospital-based experience in discharge planning, case management or utilization review. Certifications Required -Current registered nurse license in state of practice. Basic ...

next page

Showing results 1-20

All JobsUtilization Review Rn JobsUtilization Review Rn Jobs in New Orleans, LA

Utilization Review Rn information

See New Orleans, LA salary details

$19

$38

$63

How much do utilization review rn jobs pay per hour?

As of Aug 13, 2026, the average hourly pay for utilization review rn in New Orleans, LA is $38.99, according to ZipRecruiter salary data. Most workers in this role earn between $30.82 and $44.76 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 New Orleans, LA? The most popular types of Utilization Review Rn jobs in New Orleans, LA are:
What are popular job titles related to Utilization Review Rn jobs in New Orleans, LA? For Utilization Review Rn jobs in New Orleans, LA, the most frequently searched job titles are:
What job categories do people searching Utilization Review Rn jobs in New Orleans, LA look for? The top searched job categories for Utilization Review Rn jobs in New Orleans, LA are:
What cities near New Orleans, LA are hiring for Utilization Review Rn jobs? Cities near New Orleans, LA with the most Utilization Review Rn job openings:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in New Orleans, LA as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 14% Part Time, and 2% Contract. Highlights an 88% Physical, 2% Hybrid, and 10% Remote job distribution, with an average salary of $81,091 per year, or $39 per hour.

Utilization Review Nurse

AbsoluteCARE Inc

New Orleans, LA • On-site

Full-time

Medical, Dental, Vision, Life, Retirement

This job post has expired 1 day ago. Applications are no longer accepted.

Job description

Description AbsoluteCare offers concierge health services using a risk-bearing, PCP-driven care model. We treat the most clinically complex and vulnerable members of the communities we serve, many of whom suffer from behavioral health, substance use, and SDoH challenges. We use population health management tools to employ a holistic approach to caring for the highest utilizers of healthcare services in our comprehensive care centers and in the community. AbsoluteCare tends exclusively to the needs of the top four to six percent of the population who persistently represent a disproportionate amount of unnecessary utilization and cost, regardless of whether they are engaged with other PCPs. In our more than 20 years of service, AbsoluteCare has focused on fulfilling the needs of this population. And we have consistently achieved unprecedented outcomes by addressing medical and psychosocial issues, in addition to the hardships of life that can exacerbate chronic health conditions and complicate access to care. Our Values:
  • Accountability - We have the integrity to do what we say we will do
  • Caring - The needs of our team and members matter
  • Trust - Our members can rely on us
  • Teamwork - We act together as one inclusive group
Description: The Utilization Review Nurse ensures appropriate utilization of health services by performing initial, concurrent and retrospective clinical case reviews. This role collaborates and communicates with health plans and different providers/care teams to help ensure inpatient bed days and associated discharge/transitional care plans are appropriate. The Utilization Review Nurse provides clinical review for different healthcare services requiring authorization- including acute inpatient, skilled nursing facility, acute rehab, home nursing as well as others. Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity and appropriateness of treatment setting by utilizing the applicable policies and guidelines. Utilizes decision making and critical thinking skills in the review and determination of coverage for medically necessary health care services. Is part of a team that accountable for facilitating and providing care coordination services and associated quality outcomes for patients across the continuum of discharge planning and transitional care. Collaborates with different teams to develop and/or implement comprehensive discharge care plans based on assessment of member's clinical and social needs.
  • Reviews and interprets medical records and compares against industry guidelines and company policies to determine medical appropriateness and necessity of care.
  • Apply critical thinking and decision-making skills to determine if the medical record documentation supports the need for service while maintaining quality standards.
  • Continuously reviewing the patients' medical record to ensure that members will not receive unnecessary procedures, ineffective treatment, or unnecessarily extensive hospital stays.
  • As needed, perform onsite of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies.
  • Understands key aspects of discharge planning, transitional care management and drivers of readmissions when coordinating care for complex, vulnerable populations.
  • Ability to work with multidisciplinary teams and embrace teamwork.
  • Identifies members for referral opportunities to integrate with other products, services and/or programs Identifies opportunities to promote quality effectiveness
  • Demonstrates proficiency with case load and the ability to manage complex cases effectively
  • Works with less structured, more complex issues and ability to identify solutions to non-standard requests and problems.
  • Demonstrates a solid understanding of managed care, Medicare, and Medicaid regulations.
  • Schedule: Monday thru Friday daytime hours, along with rotating weekends and holidays.
Experience
  • Ability to interpret clinical data.
  • Active Registered Nurse license by the State of Louisiana and/or the state(s) in which the nurse is required to practice.
  • Bachelor's Degree in Nursing from an accredited school of nursing
  • Understanding of complex vulnerable populations and their associated care coordination needs.
  • Knowledge of medical appropriateness criteria such as InterQual, Milliman Care Guidelines
  • Experience and knowledge with Medicaid and Medicare managed care organizations, regulations and populations.
  • Must have excellent oral, written, and interpersonal communication skills, and must be a creative problem solver.
  • Proven ability to meet deadlines and work under pressure.
  • Must have good typing skills and proficiency using MS Office Word, Excel and Outlook
  • 3-5 years of acute care clinical experience required working in any of the following areas: ER, Critical Care, ICU, Ortho, Med Surg, Telemetry.
  • Health plan, ACO or IPA experience.
Our employeesare offered the following benefits
  • Free parking
  • Free Vision Plan
  • Medical and Dental plans
  • Life Insurance
  • Short Term Disability
  • 401 k Retirement plan
AbsoluteCare provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, age, disability, genetics, protected Veteran status, or any other characteristic protected by law or policy.

Apply