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How much do utilization review rn jobs pay per hour?

As of Sep 8, 2026, the average hourly pay for utilization review rn in Oklahoma City, OK is $39.30, according to ZipRecruiter salary data. Most workers in this role earn between $31.06 and $45.14 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 Oklahoma City, OK?

The most popular types of Utilization Review Rn jobs in Oklahoma City, OK are:

What are popular job titles related to Utilization Review Rn jobs in Oklahoma City, OK?

For Utilization Review Rn jobs in Oklahoma City, OK, the most frequently searched job titles are:

What job categories do people searching Utilization Review Rn jobs in Oklahoma City, OK look for?

The top searched job categories for Utilization Review Rn jobs in Oklahoma City, OK are:

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Oklahoma City, OK as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 3% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $81,740 per year, or $39.3 per hour.

RN Claims Review and Utilization Management

MedTrust

Oklahoma City, OK • On-site

Other

Re-posted 17 days ago

Job description

Utilization Review And Management (Um) Component Program

The utilization review and management (UM) component program ensures that external healthcare services provided across MedTrust/MedHealth contracted facilities are medically necessary, clinically appropriate, evidence-based, and delivered at the appropriate level of care, while supporting regulatory compliance and organizational risk management. The Joint Commission Compliance component ensures MedTrust stays compliant with applicable Joint Commission (JC) standards. MedTrust proudly holds the Gold Seal of Approval from the Joint Commission, recognizing our commitment to quality, safety, and excellence in healthcare staffing. This position ensures that MedTrust/MedHealth is fully compliant in both areas. These two components are referred to below as UMJC.

Essential Functions:

  1. Oversee UMJC: Handle the utilization review and management process to ensure the appropriate and cost-effective use of healthcare resources. This includes evaluating treatment plans and ensuring compliance with regulatory requirements. Ensure compliance with JC standards, including file reviews, monthly safety plans and uploading data to the JC web page. This will include assisting with the logging and documentation of claims along the process chain.
  2. Collaboration: Work closely with medical staff, case managers, and other healthcare professionals to assess the medical necessity of treatments and coordinate care effectively
  3. Data Analysis: Analyze utilization data and trends to identify opportunities for improving efficiency and reducing unnecessary costs. This involves monitoring the performance of healthcare providers and implementing corrective action plans as needed
  4. Documentation and Compliance: Maintain accurate documentation of all UMJC activities, ensuring compliance with organizational policies and regulatory requirements. This includes collaborating with hospitals and providers and resolving any utilization-related issues
  5. Timeliness: Ensure that claims received are accurately logged and reviewed within seven (7) days of receipt and forwarded promptly to the next step in the process to ensure all claims are ultimately paid timely. It will be this person's responsibility to notify appropriate management if claims are not being timely received for processing.
  6. Quality Improvement Initiatives: Participate in the development and implementation of quality improvement initiatives to enhance patient care outcomes and operational efficiency
  7. Joint Commission (JC) Functions: Maintain accurate and up-to-date documentation and compliance records. Serves as the medical lead during joint commission surveys and audits, including preparation of staff and materials. Keeps up-to-date on JC requirements and rules.

Qualifications

  • Registered nurse with active, unincumbered nursing license in Oklahoma and willing and able to get licensed in other states where MedTrust/MedHealth do business. Master's degree is preferred.
  • Relevant experience in utilization review, utilization management/case management is essential.
  • Prior experience with Joint Commission compliance is a plus.
  • 3-5 years of healthcare experience required.

Knowledge and Skills

  • Analytical Skills: Strong analytical and problem-solving skills to assess data and make informed decisions regarding patient care and resource utilization
  • Communication Skills: Excellent communication and interpersonal skills to collaborate effectively with healthcare teams and patients
  • Knowledge of Regulations: Familiarity with healthcare regulations, insurance policies, and quality improvement processes is crucial for success in these roles
  • Knowledge of Joint Commission: Familiarity with joint commission requirements and duties.
  • Working knowledge of and familiarity with Microsoft Word and Excel.
  • Strong organization skills, with ability to work in fast paced environment.

Working Conditions and Environment

  • Must pay attention to detail-visual & mental
  • Must be able to multi-task
  • Ability to work independently without direct supervision
  • Ability to perform under stress
  • Ability to work with individuals at all levels of the organization to foster teamwork
  • While varied hours are required occasionally, normal office hours are 8 am – 5 pm with one hour for lunch
  • This is an in-office, no remote work capability position

Travel

  • Some travel may be required, but should be minimal and notice will be provided if necessary

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