ZipRecruiter

Log In

1

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

IntePros

Utilization Management RN

Philadelphia, PA · On-site

$63.18/hr

Care Management Coordinator/RN MAX BILL RATE: $63.18/hr Position is remote - candidate must reside ... Reviews treatment plans/plan of care with provider for requested services/procedures, inpatient ...

previous pagenext page

Showing results 21-40

All JobsUtilization Review Rn JobsUtilization Review Rn Jobs in Philadelphia, PA

Utilization Review Rn information

See Philadelphia, PA salary details

$21

$42

$69

How much do utilization review rn jobs pay per hour?

As of Aug 15, 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.

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 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, 77% Full Time, 17% Part Time, 1% Temporary, and 4% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $88,746 per year, or $42.7 per hour.

RN Case Manager - Utilization Review (Temple Hospital Jeanes Campus)

Temple Health

Philadelphia, PA • On-site

Other

Posted 9 days ago

Temple University Health System rating

8.1

Company rating: 8.1 out of 10

Based on 76 frontline employees who took The Breakroom Quiz

69th of 887 rated healthcare providers

Job description

Utilization Management Nurse

Utilizing InterQual and other appropriate criteria, responsible for reviewing all admissions and continued stay of patients in conformance with the established criteria set forth in the hospital's utilization management and quality assurance plan. Will determine the medical necessity for admission and continued stays for patients within department's scope of service and to meet the hospital's objectives for assuring a high quality of patient care as well as assuring the effective and efficient utilization of available health services. Identifies appropriate level of care for inpatients and outpatients requiring overnight care.

Education

  • Graduate of an accredited school of nursing Required
  • Bachelor's Degree BSN Required

Experience

  • 2 years experience in clinical nursing preferably in acute care Preferred
  • General Experience in utilization review, case management, PreCertification, or discharge planning Preferred
  • General Experience and knowledge of Medicare, Medicaid, and commercial insurance guidelines Preferred
  • General Experience and knowledge of MCG and InterQual criteria tools Preferred

Licenses

  • PA Registered Nurse License Required or
  • Multi State Compact RN License Required

This position follows a hybrid schedule of 8:00 AM to 4:30 PM and includes a rotating requirement to work every third weekend.

What Temple University Health System employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Temple Health logo

About Temple Health

Sourced by ZipRecruiter

Temple Health is a major Philadelphia-based academic health system that is driving medical advances through clinical innovation, pioneering research and world-class education. The health system’s 1,550+ physicians and scientists share a common mission of bringing tomorrow’s treatments to the bedside today, helping them achieve outcomes once thought impossible.

Industry

Hospitals

Company size

5,001 - 10,000 Employees

Headquarters location

Philadelphia, PA, US

Year founded

1995

View All Temple Health Jobs

Apply