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

Prime Staffing

Travel RN Case Manager

Doylestown, PA · On-site

Strong assessment, discharge planning, and utilization review skills Description: The RN Case Manager coordinates patient care plans and services across the continuum of care. Works closely with ...

Hunterdon Health

Documentation Review Nurse

Flemington, NJ

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Registered Nurse (RN) with an active and unencumbered license Preferred: Bachelor of Science in ... Experience in clinical documentation improvement (CDI), coding or utilization review is highly ...

Hunterdon Health

Documentation Review Nurse

Flemington, NJ · On-site

$93K - $116K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Registered Nurse (RN) with an active and unencumbered license Preferred: Bachelor of Science in ... Experience in clinical documentation improvement (CDI), coding or utilization review is highly ...

Innova Solutions

Utilization Management RN

Philadelphia, PA · On-site

$40 - $45/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Philadelphia, PA (Remote) As a Utilization Management RN, you will: * Apply critical thinking and ... Review treatment plans/plan of care with provider for requested services/procedures, inpatient ...

Humana

Compliance UM Nurse (Wed - Sun)

Trenton, NJ · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Become a part of our caring community The Compliance Nurse 2 reviews utilization management ... Licensed Registered Nurse (RN) in a compact state with no disciplinary action.?? * Must have?valid ...

Acadia Healthcare

RN Admissions

New Castle, DE · On-site

$39.53 - $43.66/hr

  • Medical

  • Dental

  • Vision

MeadowWood Behavioral is adding an RN's in Admissions to our team! Available Shifts and Hours ... utilization review processes to assure continuity for the most appropriate level of care for ...

New

Acadia Healthcare

RN Admissions Part Time

New Castle, DE · On-site

$39.53 - $43.66/hr

  • Medical

  • Dental

  • Vision

PRN And Part Time Rn's In Admissions Wanted MeadowWood Behavioral is searching for PRN and PT RN's ... utilization review processes to assure continuity for the most appropriate level of care for ...

Acadia Healthcare

RN Admissions

New Castle, DE · On-site

$39.53 - $43.66/hr

  • Medical

  • Dental

  • Vision

Overview MeadowWood Behavioral is adding an RN's in Admissions to our team! Available Shifts and ... utilization review processes to assure continuity for the most appropriate level of care for ...

New

MTM, Inc.

Medical Director

Trenton, NJ · On-site

$80/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Review and approve medical policies related to transportation eligibility and utilization * Develop ... Licensed physician (MD/DO), registered nurse (RN), or nurse practitioner (NP) in the State of New ...

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

Utilization Review Rn information

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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.

Utilization Review Per Diem Elkins Park

Jefferson

Philadelphia, PA • On-site

Other

Medical, Dental, Vision, Life, Retirement

Re-posted 2 days ago

Job description

Social Work Services

Provides social work services, assesses and enhances the patient's/family's/significant other's ability to cope with physical, emotional and environmental problems related to illness/convalescence and discharge plan. Works collaboratively with the multidisciplinary healthcare team to establish a discharge plan for the patient.

Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.

Conducts psychosocial assessment/reassignment of patients/significant others relating to the social, emotional and cognitive capabilities of patients in relationship to their illness and health maintenance needs.

Develops and implements a plan of intervention that addresses identified needs related to needs/problems identified during assessment. Collaborated with the multidisciplinary team to ensure appropriate discharge planning.

Provides counseling for patient/family/significant others to assist with coping with new diagnoses, chronic illness and palliative or terminal care. Advocates on behalf of the patients/families to enable them to obtain necessary services.

Education
  • Master's Degree Graduate from an accredited Masters of Social Work program required.
Experience
  • 2 years hospital based social work experience.

Work Shift: Day (United States of America)

Worker Sub Type: Regular

Employee Entity: Magee Rehabilitation Hospital

Primary Location Address: 1513 Race Street, Philadelphia, Pennsylvania, United States of America

Jefferson, principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research.

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

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