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Utilization Review Rn Jobs in Reno, NV (NOW HIRING)

CCMSI

Nurse Case Manager Senior

Carson City, NV · On-site

$90K - $100K/yr

This position is ideal for an experienced Registered Nurse who combines strong clinical knowledge with Workers' Compensation, utilization review, and case management expertise. Candidates with ...

CCMSI

Nurse Case Manager Senior

Carson City, NV · Remote

$90K - $100K/yr

This position is ideal for an experienced Registered Nurse who combines strong clinical knowledge with Workers' Compensation, utilization review, and case management expertise. Candidates with ...

CCMSI

Nurse Case Manager Senior

Carson City, NV · Remote

$90K - $100K/yr

This position is ideal for an experienced Registered Nurse who combines strong clinical knowledge with Workers' Compensation, utilization review, and case management expertise. Candidates with ...

Fastaff Travel Nursing

Travel Med Surg Telemetry RN

Reno, NV · On-site

$2.0K - $2.7K/wk

MS/Tele RNs closely monitor the patients' condition, including heart function, so you must be able to accurately review telemetry readouts. Fastaff Travel Nursing Job ID #2179747. Pay package is ...

Sevita

Registered Nurse

Reno, NV · On-site

REGISTERED NURSE- PRN SUMMARY The Registered Nurse is responsible for providing nursing services ... Reviews documents and revises all nursing/nursing related care plans on a regular basis * Ensures ...

Sevita Health

Registered Nurse

Reno, NV · On-site

REGISTERED NURSE- PRN SUMMARY The Registered Nurse is responsible for providing nursing services ... Reviews documents and revises all nursing/nursing related care plans on a regular basis * Ensures ...

SimonMed Imaging

Registered Nurse (RN)

Reno, NV

... in, exam review, preparation for procedures, and patient education. * Collaborate with ... Current Registered Nurse (RN) license in the state of employment * Current BLS * Additional ...

SMI IMAGING LLC

Registered Nurse (RN)

Reno, NV · On-site

... in, exam review, preparation for procedures, and patient education. * Collaborate with ... Current Registered Nurse (RN) license in the state of employment * Current BLS * Additional ...

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Utilization Review Rn information

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How much do utilization review rn jobs pay per hour?

As of Sep 2, 2026, the average hourly pay for utilization review rn in Reno, NV is $42.16, according to ZipRecruiter salary data. Most workers in this role earn between $33.32 and $48.41 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 Reno, NV?

The most popular types of Utilization Review Rn jobs in Reno, NV are:

What are popular job titles related to Utilization Review Rn jobs in Reno, NV?

For Utilization Review Rn jobs in Reno, NV, the most frequently searched job titles are:

What job categories do people searching Utilization Review Rn jobs in Reno, NV look for?

The top searched job categories for Utilization Review Rn jobs in Reno, NV are:

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Reno, NV as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 16% Part Time, 3% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $87,689 per year, or $42.2 per hour.

UTILIZATION REVIEW AND APPEALS RN

Carson Tahoe Health

Carson City, NV • On-site

Full-time

Posted 21 days ago

Carson Tahoe Health rating

7.9

Company rating: 7.9 out of 10

Based on 10 frontline employees who took The Breakroom Quiz

Job description

US:NV:Carson City Case Management
Full Time Day Shift
Summary
This position is responsible for facilitating care along a continuum through effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources while respecting patient's right to self-determination. This position has the overall responsibility to maintain current knowledge of disease processes, available resources, treatment options appropriate to patient population and reviewing medical necessity, responding to authorization concerns, and/or reconciling coverage related issues. This position collaborates with medical staff, interdisciplinary team, and external resources to screen for accurate medical necessity and appeal appropriate accounts according to internal guidelines.
Qualifications
Required:
  • Minimum (2) years of acute care hospital patient care experience
  • Current unrestricted registered nurse license in the State of Nevada
  • Organizational skills, excellent verbal & written communication skills, ability to lead, coordinate diverse group in fast paced environment, critical thinking, problem solving and negotiation skills

Preferred:
  • Two (2) years of experience as acute care case manager
  • Bachelor of Science in Nursing
  • Ability to obtain Accredited Case Manager (ACM) certification

Essential Functions
  • Transition management - Assigns appropriate length of stay, participates in readmission prevention, transition level of care and patient satisfaction
  • Utilization management - Screens for accurate medical necessity using approved evidenced based criteria, application of supporting medical necessity and denial prevention utilizing physician advisor when necessary
  • Reviews clinical denials and initiates process, if determined appeal appropriate according to internal guidelines
  • Clinical Appeals - Responsible for drafting, finalizing, and sending clinical appeal letters in order to reverse a denial for payment on an insurance claim
  • Uses provided tools and patient medical records, working within and through the regulations to develop a documented response to the denial and overturn the payer's decision
  • Stays current with assigned accounts and follow-up on the appeal after submission to determine next steps to ensure appeals are overturned or upheld
  • Responsible for appealing denials using clinical based rationale, the need to produce high quality work with meeting compliance timeframes and production goals
  • Supports billing and authorization coordination staff in reviewing high-risk and high-dollar accounts before claim submission to prevent clinical denial
  • Works in partnership with Integrated Care Management Authorization Coordinators and Admin Staff
  • Assists staff in care coordination and demonstrates efficient throughput while assuring care is sequenced and at appropriate level of care
  • Accurately conducts a thorough, objective assessment of patient's current status, including psychosocial, physical, financial, educational needs, treatment course and services needed
  • Compliance with state and federal regulations, The Joint Commission's standards, Center for Improvement in Healthcare Quality (CIHQ), Conditions of Participation and hospital policy
  • Maintains current knowledge of disease processes, available resources, and treatment options appropriate to patient population
  • Collaborates with interdisciplinary team to promote patient throughput and efficient use of resources
  • Continuously demonstrates a positive attitude and understanding of case management philosophy, supports team building, and is motivated to fulfill department objectives
  • Utilizes Evidence -based clinical guideline tool (Milliman Care Guidelines ® or InterQual ®)
  • Documents all activity according to policy, including the electronic automated systems
  • Precepts new staff members and is a resource to all staff
  • Participates in department quality improvement initiatives and projects as assigned
  • Ability to perform role remotely and maintain collaboration with interdisciplinary team
  • Performs other related duties as assigned

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