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Utilization Review Rn information

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$63

How much do utilization review rn jobs pay per hour?

As of Jul 26, 2026, the average hourly pay for utilization review rn in Omaha, NE is $38.88, according to ZipRecruiter salary data. Most workers in this role earn between $30.72 and $44.66 per hour, depending on experience, location, and employer.

How to get into utilization review as a nurse?

To become a utilization review RN, candidates typically need a valid nursing license and experience in clinical settings. Additional certifications such as Certified Professional in Healthcare Quality (CPHQ) or case management credentials can enhance prospects, and familiarity with electronic health records and insurance policies is beneficial.

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 make $300,000 as a nurse?

A Utilization Review RN can earn $300,000 by gaining extensive experience, obtaining certifications such as Certified Review Officer (CRO), working in high-paying settings like insurance companies or managed care organizations, and taking on leadership or specialized roles that offer higher compensation. Advanced skills in clinical assessment, documentation, and understanding of healthcare policies can also contribute to higher earnings.

What does an RN utilization review do?

An RN utilization review evaluates medical records and treatment plans to determine the necessity, appropriateness, and efficiency of healthcare services. They ensure compliance with insurance policies and clinical guidelines, often using electronic health records and requiring knowledge of coding and documentation standards. This role supports cost-effective patient care and involves collaboration with healthcare providers and insurance companies.

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 make $150,000 as a nurse?

A Utilization Review RN can earn $150,000 by gaining extensive experience, obtaining certifications such as Certified Review Officer (CRO), working in high-demand settings, and possibly taking on leadership or specialized roles. Increasing your workload, working overtime, or pursuing advanced education can also contribute to higher earnings within this field.

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 Omaha, NE? The most popular types of Utilization Review Rn jobs in Omaha, NE are:
What are popular job titles related to Utilization Review Rn jobs in Omaha, NE? For Utilization Review Rn jobs in Omaha, NE, the most frequently searched job titles are:
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Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Omaha, NE as of July 2026, with employment types broken down into 1% As Needed, 85% Full Time, 11% Part Time, 1% Temporary, and 2% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $80,867 per year, or $38.9 per hour.
Utilization Review Nurse

Utilization Review Nurse

Berkshire Hathaway Homestate Companies

Omaha, NE • On-site

Other

Medical, Dental, Vision, Life, PTO

Posted 18 days ago

Job description

WHAT WE'RE LOOKING FOR
We have openings in our Omaha, Nebraska office for Utilization Review Nurses. The Utilization Review Nurse ensures all aspects of an injured worker's treatment are effective, efficient, and in accordance with applicable legal requirements.
This is a full-time, permanent position within our Medical Management team and that will allow experienced nurses to put their years of clinical knowledge to use in an office environment and learn new skills in this growing industry. No UR experience required!
ESSENTIAL RESPONSIBILITIES
  • Review complex workers compensation medical treatment requests to ensure accordance with evidence-based medical treatment guidelines, which are generally recognized by the national medical community and are scientifically based.
  • Research claim file in relation to the requested medical treatment while interpreting medical reports/claims summaries and applies appropriate established guidelines to requested treatment. Refers treatment requests, which do not meet guidelines, for peer review and determination.
  • Advocate for the injured worker and claims department, ensuring proposed treatment requests are appropriate for the diagnosis.
  • Performs daily tasks within the appropriate established workflow processes, utilizes accepted guidelines and meets legislative and departmental timeframes.
  • Maintain patient confidentiality in discussions of treatment, disease process and conditions.
  • Routinely contacts providers to clarify treatment requests, examination findings, as well as obtain additional medical information as needed.
  • Maintains clear, concise, and accurate documentation of requested medical treatments to include clinical findings, treatment guidelines, and determination.
  • Provide appropriate notices to providers, injured workers, claims staff, and attorneys.
  • Act as a medical resource in regards to utilization review to Claims Support Nurse, Bill Review, and Claims department.
  • Foster a positive and close working relationship with other Company staff, including the claims staff, medical bill review, claims support nurse, special investigations, legal, liens, the call center, and client services.
  • Communicate effectively with individuals outside the company, including clients, medical providers, and vendors.

WHAT WILL SET YOU APART
  • EDUCATION: Bachelor of Science Nursing degree (BSN), or Registered Nursing degree (RN) from four-year college or university, or an accredited college.
  • LICENSES/EXPERIENCE: A current RN license as well as 5+ years of recent, hands-on clinical experience in a Critical care unit such as Medical Surgery, Emergency Room, ICU, Oncology, Orthopedics, Neuro or other similar settings. Must have an active state license and eligible to obtain additional state licenses.
  • TECHNICAL SKILLS: Knowledge of current recognized evidence-based medicine guidelines required. Proficient in Microsoft Office suite of applications. Able to perform independent internet medical research. Able to quickly master proprietary and vendor software applications.
  • LANGUAGE ABILITY: Able to read, analyze, and interpret common scientific and technical journals, statutes, regulations, medical reports, medical coding, medical bills, financial reports, and legal documents. Able to respond to technical inquiries or complaints from Company employees, external sources, and regulatory or auditing entities.
  • REASONING ABILITY: Able to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Able to deal with problems involving several concrete variables in standardized situations.

WHAT WE OFFER
  • Work From Home (Up to 2 days per week upon eligibility)
  • Onsite Gym
  • Garage Parking
  • Within walking distance of the Old Market District
  • Paid Time Off
  • Paid Holidays
  • Retirements Savings Match
  • Group Health Insurance (Medical, Dental, and Vision)
  • Life and AD&D Insurance
  • Long Term Disability Insurance
  • Paid Community Volunteer Day
  • Employee Assistance Program
  • Tuition Reimbursement Program
  • Employee Referral Program
  • Diversity, Equity and Inclusion Program

ABOUT US
With more than 50 years in business, Berkshire Hathaway Homestate Companies (BHHC) has grown from a regional organization to a national insurance group, offering insurance products from coast to coast. Relationships are the cornerstone of our culture, and we believe in doing the right thing. That means we invest in our business in every way possible to deliver on our mission and demonstrate that people are what powers our success. Our commitment to financial strength and integrity means our customers can rest assured that we will be there when it counts.
At BHHC we embrace diversity and foster an environment where our people can be their authentic selves. Our differences make us stronger and better together, which fosters a harmonious workplace-something we truly value. We've created an approachable and collaborative atmosphere. Here you'll find a welcoming workplace where everyone can feel valued, supported, and inspired to do great work. Together, we raise the bar by being curious, remaining customer-focused, and operating with integrity.

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