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

HealthSkil

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Fully Remote Registered Nurse (RN) Care Manager

Philadelphia, PA · Remote

$84K - $90K/yr

As an RN Care Manager, you will play a vital role in delivering holistic, patient-centered care ... with utilization review or risk management, technical proficiency with Microsoft Office ...

MTM

Medical Director

Trenton, NJ

$45/hr

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 ...

MTM, Inc.

Medical Director

Trenton, NJ · On-site

$80/hr

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 ...

Integrated Resources INC

Register Nurse

Trenton, NJ

... utilization review Responsibilities: Assesses patient's clinical need against established ... Requires an active New Jersey Registered Nurse License. Knowledge: Prefers proficiency in the use ...

American Traveler

Travel RN Care Coordinator

Paoli, PA

$18.75 - $25.50/hr

Travel RN - Case Management/Utilization Review - Case Management About American Traveler With over 25 years of experience, American Traveler has established a reputation for outstanding customer ...

CVS Health

Case Manager, Registered Nurse

Trenton, NJ · Remote

$54K - $155K/yr

A RN who resides in a compact state is required to have an active multistate license through the ... Utilization Review. * CCM and/or other URAC recognized accreditation preferred. * 1+ years ...

Erickson

Clinical Manager, RN

Glen Mills, PA

$115K/yr

... Utilization Review, and Performance Improvement/Risk Management/Safety (PI/RM/S) Committee ... Current Registered Nurse license for the state in which they operate. * Current CPR required

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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 Jun 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.

How do I become a utilization review RN?

To become a utilization review RN, you typically need to hold a valid registered nurse (RN) license and have experience in clinical nursing. Additional certifications such as the Certified Professional in Healthcare Quality (CPHQ) or Utilization Review Certification (URAC) can enhance job prospects, and strong knowledge of medical coding, insurance policies, and healthcare regulations is important.

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 does an RN utilization review do?

An RN utilization review evaluates medical records and treatment plans to determine the appropriateness, necessity, 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.

How to make $300,000 a year as a nurse?

To earn $300,000 annually as a Utilization Review RN, professionals typically need extensive experience, advanced certifications such as CCM or ANCC, and may work in high-paying settings like insurance companies or healthcare consulting firms. Increasing specialization, taking on leadership roles, or working overtime can also boost income, but reaching this level often requires a combination of skills, experience, and strategic career moves.

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 CCM or ANCC, and working in high-paying settings like insurance companies or managed care organizations. Advanced skills in case management, strong clinical knowledge, and sometimes working overtime or in leadership roles can also contribute to higher earnings.

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
RN CV Patient Care Coordinator

RN CV Patient Care Coordinator

Doylestown Health

Doylestown, PA

Other

Posted 20 days ago

Doylestown Health rating

7.7

Company rating: 7.7 out of 10

Based on 21 frontline employees who took The Breakroom Quiz

Job description

Job Description:
  1. ESSENTIAL FUNCTIONS:
  1. To perform psychosocial and discharge screening assessments, provide clinical counseling, develop and implement a safe plan for discharge with appropriate referrals to other health care team members, community agencies / resources and after care facilities, as well as be an advocate to the client/families and significant others served by Doylestown Hospital.
  1. Coordinate a seamless experience for the acute in-patient, significant others and family members from pre-admission testing through discharge by developing and implementing a safe discharge plan.
  1. Document in the medical record and on departmental worksheets.
  1. Participate in collection, collation, analysis, and plan development and orientation to promote the delivery of efficient, quality services.
  1. Coordinate, develop and facilitate quality cardiac education for the person with cardiac disease, the nursing staff, physicians or family members taking care of a cardiac patient at Doylestown Hospital.
  1. Participates in the collection and entering of data for cardiac surgery database registry. Coordinates denial management appeals, medical assistance clinical reviews and utilization reviews.
Job Qualifications:
  1. < > qualifications

A. Education: Graduate of an accredited School of Nursing, Bachelor's Degree required. Current licensure in the Commonwealth of PA as an RN, preferred Case Management certification.
B. Experience: Minimum of three (3) years inpatient clinical experience with cardiac patients and experience with Case Management, Utilization Review, Discharge Planning, or other appropriate health-related relevant clinical experience.
C. Other Skills: Excellent verbal and written skills necessary. Highly refined assessment skills, computer skills, and strong organizational and decision making skills are required. Ability to work independently with excellent interpersonal skills. Ability to develop and maintain collaborative relationships. Certified in CPR. Ability to manage and perform well under stress.
D. Training time once hired: Three (3) months

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