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Utilization Review Rn Jobs in Philadelphia, PA (NOW HIRING)

IntePros

Utilization Management RN

Philadelphia, PA · On-site

PA RN License Required We are seeking an experienced Care Management Coordinator to join our ... This role is responsible for performing utilization management reviews to determine the medical ...

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How much do utilization review rn jobs pay per hour?

As of Sep 7, 2026, the average hourly pay for utilization review rn in Philadelphia, PA is $42.67, according to ZipRecruiter salary data. Most workers in this role earn between $33.70 and $48.99 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 Philadelphia, PA?

The most popular types of Utilization Review Rn jobs in Philadelphia, PA are:

What are popular job titles related to Utilization Review Rn jobs in Philadelphia, PA?

For Utilization Review Rn jobs in Philadelphia, PA, the most frequently searched job titles are:

What job categories do people searching Utilization Review Rn jobs in Philadelphia, PA look for?

The top searched job categories for Utilization Review Rn jobs in Philadelphia, PA are:

What cities near Philadelphia, PA are hiring for Utilization Review Rn jobs?

Cities near Philadelphia, PA with the most Utilization Review Rn job openings:

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Philadelphia, PA as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 15% Part Time, 2% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $88,746 per year, or $42.7 per hour.

Clinical Review RN PRN

Cooper University Hospital

Camden, NJ

$61/hr

Full-time, Part-time, Per diem

Medical, Dental, Vision, Life, Retirement

Re-posted 15 days ago

Cooper University Health Care rating

7.5

Company rating: 7.5 out of 10

Based on 133 frontline employees who took The Breakroom Quiz

231st of 898 rated healthcare providers

Job description

About Us

At Cooper University Health Care, our commitment to providing extraordinary health care begins with our team. Our extraordinary professionals are continuously discovering clinical innovations and enhanced access to the most up-to-date facilities, equipment, technologies and research protocols. We have a commitment to our employees to provide competitive rates and compensation programs.  Cooper offers full and part-time employees a comprehensive benefits program, including health, dental, vision, life, disability, and retirement. We also provide attractive working conditions and opportunities for career growth through professional development.

Discover why Cooper University Health Care is the employer of choice in South Jersey.

Short Description
  • Utilizes Payer specific screening tools as a resource to assist in the determination process regarding level of service and medical necessity. Performs utilization review in accordance with all state mandated regulations.
  • Consults with Physician Advisor to discuss medical necessity, length of stay, and appropriateness of care issues.
  •  Identify and manage concurrent and retroactive denials through communication with attending physicians, case management, multidisciplinary team, external physician resource group and payers.
  • Completes documentation of review and denial processes in the EPIC Case Management Module. Responds to requests from the payer for all required information and treatment plans.
  • Reviews and validates physician's orders, reports progress and unusual occurrences on patients to the payer.  
Experience Required

3-5 years of recent clinical experience, preferably in area of population specialty. 

Experience in utilization management or review preferred. 

Knowledge and understanding of disease protocols and clinical pathways for commercial and government payors. Familiarity with Interqual and Millimen guidelines and regulatory mandates preferred. 

Strong communication (written and verbal) and critical thinking skills required.  Professional and effective presentation skills required.

Education Requirements

Bachelor's degree in Nursing preferred 

License/Certification Requirements

Current NJ-RN License required. 

Special Requirements

Monday availability is required. 

Salary Min ($)USD $37.00Salary Max ($)USD $61.00Employment Type: OTHER

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