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Utilization Review Rn Jobs in New York, NY (NOW HIRING)

CareConnect

Utilization Review RN

Greenvale, NY · On-site

Reviews and coordinates prospective, concurrent and retrospective activities related to utilization ... Bachelor's Degree in Nursing, preferred. Must be enrolled in an accredited program within 24 months ...

CareConnect

Utilization Review RN

Greenvale, NY · On-site

Reviews and coordinates prospective, concurrent and retrospective activities related to utilization ... Bachelor's Degree in Nursing, preferred. Must be enrolled in an accredited program within 24 months ...

Jacobi Medical Center

RN - Utilization Review

Bronx, NY · On-site

$2.8K/wk

Details Client Name Jacobi Medical Center - NYCHH Job Type Travel Offering Nursing Profession RN Specialty Utilization Review Job ID 18960406 Weekly Pay $2816.09 Shift Details Shift 5x8 Days ...

GQR Global Markets

RN Case Manager

Bronx, NY · On-site

$3.0K - $3.1K/wk

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: West Bronx, New York Start Date: July 4, 2026 Profession: Registered Nurse (RN) Facility: Short Term Acute Care ...

GQR Global Markets

RN Case Manager

Mount Vernon, NY · On-site

$2.8K - $2.9K/wk

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Mount Vernon, New York Start Date: August 3, 2026 Profession: Registered Nurse (RN) Facility: Estimated Pay: $2840 ...

GQR Global Markets

RN Case Manager

Morristown, NJ · On-site

$2.6K - $2.7K/wk

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Morristown, New Jersey Start Date: September 14, 2026 Profession: Registered Nurse (RN) Facility: Short Term Acute ...

GQR

RN - Case Manager

Mount Vernon, NY · On-site

$2.5K/wk

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Mount Vernon, New York Start Date: August 3, 2026 Profession: Registered Nurse (RN) Facility: Estimated Pay: $2500 ...

GQR

RN - Case Manager

Morristown, NJ · On-site

$2.6K - $2.7K/wk

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Morristown, New Jersey Start Date: September 14, 2026 Profession: Registered Nurse (RN) Facility: Short Term Acute ...

GQR

RN - Case Manager

Bronx, NY · On-site

$3.0K - $3.1K/wk

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: West Bronx, New York Start Date: July 4, 2026 Profession: Registered Nurse (RN) Facility: Short Term Acute Care ...

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How much do utilization review rn jobs pay per hour?

As of Aug 24, 2026, the average hourly pay for utilization review rn in New York, NY is $46.40, according to ZipRecruiter salary data. Most workers in this role earn between $36.68 and $53.27 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 are the most commonly searched types of Utilization Review Rn jobs in New York, NY?

The most popular types of Utilization Review Rn jobs in New York, NY are:

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For Utilization Review Rn jobs in New York, NY, the most frequently searched job titles are:

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Cities near New York, NY with the most Utilization Review Rn job openings:

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in New York, NY as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 13% Part Time, 3% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $96,952 per year, or $46.6 per hour.

Utilization Review RN

Greenvale, NY • On-site

CareConnect
Health Care and Social Assistance • 11 - 50 employees
Learn more about CareConnectexternal

Full-time

Re-posted 25 days ago

Job description

Company Description
The first commercial provider-owned health plan in New York State, CareConnect was created by Northwell Health, formerly North Shore-LIJ Health System to make it easy for people to get and stay healthy. Its innovative model is designed to provide access to care that's both excellent and affordable. CareConnect was founded in 2013 and offers a variety of plans for individuals, families and businesses. CareConnect's network has grown to more than 20,000 providers at hospitals and physician practices throughout downstate New York.
Job Description
Reviews and coordinates prospective, concurrent and retrospective activities related to utilization. Monitors documentations for accuracy and clinical compliance. Organizes and coordinates activities within the organization in accordance with standards of State and Federal regulations; and in accordance with accreditation and other guidelines.
  1. Performs medical necessity reviews for selected procedures and services.
  2. Provides timely and thorough case screening to identify case management needs and make appropriate referrals to case managers.
  3. Collaborates with members/designees, families and members of the health care team to maximize outcomes.
  4. Identifies discharge needs and collaborates with health care providers to facilitate a timely discharge to an appropriate level and location of care.
  5. Educates providers and members to promote self-care and self-advocacy.
  6. Realizes positive outcomes in terms of the quality, safety and cost-effectiveness of health care services provided.
  7. Responds to outstanding utilization management issues and inquiries made via overnight voicemail and /or emails.
  8. Develops and maintains cooperative relationships with other parts of the organization. Consults with colleagues/experts as needed.
  9. Develops and maintains cooperative relationships with other parts of the organization. Consults with colleagues/experts as needed.
  10. Performs related duties, as required.

ADA Essential Functions
Qualifications
Graduate from an accredited School of Nursing. Bachelor's Degree in Nursing, preferred.
Must be enrolled in an accredited program within 24 months of employment, if hired after September 1, 2010 and obtain a BSN Degree within five (5) years of employment date.
Minimum of five (5) years clinical experience, required. Previous experience in case management, disease management, quality management or patient education, preferred.
Additional Information
To apply for this position submit your resume through this link:
http://jobs.northwell.edu/job-3/7480228/care-connector-utilization-nurse-greenvale-ny/#tab-id-1

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