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

Molina Healthcare

Medical Review Nurse (RN)

Reno, NV · Remote

$30.50 - $59.47/hr

Resolves escalated complaints regarding utilization management and long-term services and supports ... Reviews medically appropriate clinical guidelines and other appropriate criteria with medical ...

Molina Healthcare

Medical Review Nurse (RN)

Reno, NV · Remote

$30.50 - $59.47/hr

Resolves escalated complaints regarding utilization management and long-term services and supports ... Reviews medically appropriate clinical guidelines and other appropriate criteria with medical ...

Molina Healthcare

Medical Review Nurse (RN)

Sparks, NV · Remote

$30.50 - $59.47/hr

Resolves escalated complaints regarding utilization management and long-term services and supports ... Reviews medically appropriate clinical guidelines and other appropriate criteria with medical ...

Molina Healthcare

Medical Review Nurse (RN)

Sparks, NV · Remote

$30.50 - $59.47/hr

Resolves escalated complaints regarding utilization management and long-term services and supports ... Reviews medically appropriate clinical guidelines and other appropriate criteria with medical ...

CVS Health

Case Manager, Registered Nurse

Carson City, NV · Remote

$54.10K - $155.54K/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 ...

CVS Health

Case Manager, Registered Nurse

Carson City, NV · Remote

$54.10K - $155.54K/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 ...

State of Nevada (NV)

PSYCHIATRIC NURSE 2

Carson City, NV · On-site

$79.62K - $119.20K/yr

Essential Qualifications Current license to practice as a Registered Nurse and two years of ... Perform quality assurance and/or utilization review audits and compliance activities; ensure ...

State of Nevada (NV)

PSYCHIATRIC NURSE 2

Carson City, NV · On-site

$79.62K - $119.20K/yr

Essential Qualifications Current license to practice as a Registered Nurse and two years of ... Perform quality assurance and/or utilization review audits and compliance activities; ensure ...

State of Nevada (NV)

PSYCHIATRIC NURSE 2

Carson City, NV · On-site

$79.62K - $119.20K/yr

Essential Qualifications Current license to practice as a Registered Nurse and two years of ... Perform quality assurance and/or utilization review audits and compliance activities; ensure ...

State of Nevada (NV)

PSYCHIATRIC NURSE 2

Carson City, NV · On-site

$79.62K - $119.20K/yr

Essential Qualifications Current license to practice as a Registered Nurse and two years of ... Perform quality assurance and/or utilization review audits and compliance activities; ensure ...

tmn

Registered Nurse

Reno, NV · On-site

Registered Nurse The Registered Nurse is responsible for providing nursing services, training, and ... Reviews documents and revises all nursing/nursing related care plans on a regular basis * Ensures ...

tmn

Registered Nurse

Reno, NV

Registered Nurse The Registered Nurse is responsible for providing nursing services, training, and ... Reviews documents and revises all nursing/nursing related care plans on a regular basis * Ensures ...

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Utilization Review Rn information

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$42

$68

How much do utilization review rn jobs pay per hour?

As of May 28, 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 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 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 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 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 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 May 2026, with employment types broken down into 100% Full Time. Highlights an 71% In-person, and 29% Remote job distribution, with an average salary of $87,689 per year, or $42.2 per hour.
Medical Review Nurse (RN)

Medical Review Nurse (RN)

Molina Healthcare

Reno, NV • Remote

$30.50 - $59.47/hr

Full-time

Posted 21 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 191 frontline employees who took The Breakroom Quiz

147th of 258 rated insurance

Job description

Job Description

Job Summary

Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Contributes to overarching strategy to provide quality and cost-effective member care. 

 
Job Duties
  • Facilitates clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases in which an appeal has been made, or is likely to be made, to ensure medical necessity and appropriate/accurate billing and claims processing. 
  • Reevaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of relevant and applicable state and federal regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of services provided, length of stay, level of care, and inpatient readmissions.
  • Validates member medical records and claims submitted/correct coding, to ensure appropriate reimbursement to providers. 
  • Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues.
  • Identifies and reports quality of care issues.
  • Assists with complex claim review including diagnosis-related group (DRG) validation, itemized bill review, appropriate level of care, inpatient readmission, and any opportunities identified by the payment integrity analytical team; makes decisions and recommendations pertinent to clinical experience.
  • Prepares and presents cases representing Molina, along with the chief medical officer (CMO), for administrative law judge pre-hearings, state insurance commissions, and judicial fair hearings.                                                                   
  • Reviews medically appropriate clinical guidelines and other appropriate criteria with medical directors on denial decisions. 
  • Supplies criteria supporting all recommendations for denial or modification of payment decisions.
  • Serves as a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/appeals. 
  • Provides training and support to clinical peers. 
  • Identifies and refers members with special needs to the appropriate Molina program per applicable policies/protocols.
 
Job Qualifications
REQUIRED QUALIFICATIONS:
  • At least 2 years clinical nursing experience, including at least 1 year of utilization review, medical claims review, long-term services and supports (LTSS), claims auditing, medical necessity review and/or coding experience, or equivalent combination of relevant education and experience. 
  • Registered Nurse (RN) in Nevada. License must be active and unrestricted in state of practice. 
  • Experience demonstrating knowledge of ICD-10, Current Procedural Technology (CPT) coding and Healthcare Common Procedure Coding (HCPC).
  • Experience working within applicable state, federal, and third-party regulations.
  • Analytic, problem-solving, and decision-making skills.              
  • Organizational and time-management skills.
  • Attention to detail.
  • Critical-thinking and active listening skills. 
  • Common look proficiency.
  • Effective verbal and written communication skills.
  • Microsoft Office suite and applicable software program(s) proficiency.
PREFERRED QUALIFICATIONS:
  • Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care certifications.
  • Utilization Management Experience
  • Experience with MCG, PEGA and/or Salesforce  
  • Billing and coding experience.
 
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.  
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $30.5 - $59.47 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Employment Type: Full Time

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About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

Social media

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