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

WVU

Registered nurse critical care nights

Weirton, WV · On-site

$60 - $80/hr

Provides critical review and/or evaluation of policies, procedures, and guidelines to improve ... Demonstrates understanding of importance of data collection and utilization.14. Disseminates ...

WVU Medicine

Registered Nurse Stepdown

Weirton, WV · On-site

Provides critical review and/or evaluation of policies, procedures, and guidelines to improve ... Demonstrates understanding of importance of data collection and utilization. 14. Disseminates ...

WVU Medicine

Registered Nurse- Endoscopy

Weirton, WV · On-site

Provides critical review and/or evaluation of policies, procedures, and guidelines to improve ... Demonstrates understanding of importance of data collection and utilization. 14. Disseminates ...

UPMC Senior Communities

CDI Specialist

Pittsburgh, PA · On-site

$29.92 - $51.79/hr

... Insights/Utilization review background is highly preferred. * Ability to communicate with staff ... Certified Coding Specialist (CCS) OR Certified Registered Nurse Practitioner OR Doctor of Medicine ...

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

Utilization Review Rn information

See Pittsburgh, PA salary details

$19

$39

$64

How much do utilization review rn jobs pay per hour?

As of Sep 7, 2026, the average hourly pay for utilization review rn in Pittsburgh, PA is $39.51, according to ZipRecruiter salary data. Most workers in this role earn between $31.20 and $45.38 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 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 33% Full Time, and 67% Part Time. Highlights an 33% In-person, and 67% Remote job distribution, with an average salary of $85,380 per year, or $41 per hour.

Registered Nurse (RN)

Mon Valley Healthcare

Monongahela, PA • On-site

$40/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 7 days ago

Job description

Registered Nurse (RN) Supervisor

Pay: From $40.00 per hour Job Type: Full-time, Part-time, PRN Sign-On Bonus: $1,000

BONUS: SIGN ON BONUS UP TO $3000

Benefits and Perks:

  • Medical, Dental, and Vision Insurance

  • Generous PTO

  • Holiday Pay

  • 401k

  • Competitive Rates

  • Overtime Opportunities

Why Join Our Nursing Leadership Team?

We are seeking a dedicated RN Supervisor to oversee our clinical operations and mentor our nursing staff. We offer a highly competitive wage, clear shift differentials, and a supportive environment where your leadership directly impacts patient outcomes.

Compensation & Shift Differentials

  • Base Rate: $40.00 per hour

  • PM Shift Differential: Additional $3.00/hr

  • NOC (Overnight) Shift Differential: Additional $1.50/hr

  • Sign-On Bonus: $1,000 for eligible new hires.

Available Hours

  • Full-Time: 36 – 40 hours per week

  • Part-Time: 35 hours per week

  • PRN: Flexible scheduling up to 30 hours per week

Core Responsibilities

  • Clinical Leadership: Supervise RNs, LPNs, and STNAs to ensure high-quality care and regulatory compliance.

  • Operational Oversight: Manage daily unit operations, including staff scheduling and inventory management.

  • Quality Assurance: Audit medical records (HIPAA compliance) and evaluate patient care plans.

  • Staff Development: Lead the orientation of new staff and conduct ongoing clinical training and performance reviews.

Requirements

  • Licensure: Active Registered Nurse (RN) license.

  • Experience: Previous clinical experience required; leadership or supervisory experience preferred.

  • Skills: Strong communication, clinical auditing, and staff management skills.


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