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

Community LIFE

RN Case Manager

Homestead, PA · On-site

$72K - $85K/yr

As a Registered Nurse Case Manager (RNCM), you'll be part of a compassionate, interdisciplinary ... Familiarity with managed care, quality assurance, and utilization review * Basic computer ...

Community LIFE

RN Case Manager

Pittsburgh, PA · On-site

$72K - $85K/yr

As a Registered Nurse Case Manager (RNCM), you'll be part of a compassionate, interdisciplinary ... Familiarity with managed care, quality assurance, and utilization review * Basic computer ...

Community LIFE

RN Case Manager

Pittsburgh, PA · On-site

Registered Nurse Case Manager (RNCM) Currently offering a $5000 sign on bonus for this position ... Familiarity with managed care, quality assurance, and utilization review * Basic computer ...

Community LIFE

RN Case Manager

Homestead, PA · On-site

Registered Nurse Case Manager (RNCM) Currently offering a $5000 sign on bonus for this position ... Familiarity with managed care, quality assurance, and utilization review * Basic computer ...

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

Utilization Review Rn information

See Pittsburgh, PA salary details

$20

$41

$66

How much do utilization review rn jobs pay per hour?

As of Aug 17, 2026, the average hourly pay for utilization review rn in Pittsburgh, PA is $41.05, according to ZipRecruiter salary data. Most workers in this role earn between $32.45 and $47.16 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 Pittsburgh, PA?

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

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

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

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

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

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

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

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Pittsburgh, PA as of August 2026, with employment types broken down into 81% Full Time, and 19% Part Time. Highlights an 100% In-person job distribution, with an average salary of $85,380 per year, or $41 per hour.

REGISTERED NURSE CARE MANAGER UTILIZATION MANAGEMENT

St. Clair Hospital

Pittsburgh, PA • On-site

Full-time

Re-posted 17 days ago

St. Clair Health rating

6.8

Company rating: 6.8 out of 10

Based on 31 frontline employees who took The Breakroom Quiz

495th of 887 rated healthcare providers

Job description

Summary

Completes all aspects of Utilization Management for assigned patient population by evaluating appropriate status and physician orders for admission, observation, or outpatient at all points of entry to St. Clair Hospital, and ensures that appropriate orders are placed in the electronic medical record.

Minimum Qualifications

  1. Current licensure as a Registered Nurse in Pennsylvania.
  2. Five years of clinical experience as a Registered Nurse in an acute care setting.
  3. Two years of experience in Utilization Review.
  4. Highly effective communication skills.
  5. Ability to identify appropriate status and physician orders for the level of care the patient is or will be placed in.
  6. Ability to navigate electronic medical records and web-based applications.
  7. Possesses the ability to manage multiple tasks in a fast-paced environment.

Preferred Qualifications

  1. Bachelor's degree in nursing or health related field.
  2. Certification in Case Management.

What St. Clair Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

St. Clair Health logo

About St. Clair Health

Sourced by ZipRecruiter

St. Clair Hospital is a highly honored, independent, 329 bed acute-care medical center that provides advanced, high quality health care to the residents of southwestern Pennsylvania. A member of the Mayo Clinic Care Network, St. Clair has 600 physicians and 2,500 employees. St. Clair Hospital is the largest employer in Pittsburgh’s South Hills. Providing virtually every health care service that residents may need throughout their lives, the Hospital is focused on continuously enhancing its services and technologies to ensure that the community’s health needs are met. The Hospital offers a comprehensive array of high-quality inpatient and outpatient services, including advanced cardiovascular services; specialized care for women and children; oncology services; orthopedics; emergency care; urgent care; and psychiatry and mental health services.

Industry

Health care and social assistance

Company size

1,001 - 5,000 Employees

Headquarters location

Pittsburgh, PA, US

Year founded

1954

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