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Utilization Review Rn Jobs in St Louis, MO (NOW HIRING)

Athene Nursing and Rehabilitation

Clinical Liaison (RN/LPN)

MO · On-site

$64K - $86K/yr

Clinical Liaison (RN/LPN) We are seeking a compassionate and driven Clinical Liaison to join our ... Work with utilization review and internal admissions teams to ensure efficient transfers * Provide ...

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Utilization Review Rn information

See St Louis, MO salary details

$20

$41

$67

How much do utilization review rn jobs pay per hour?

As of Jul 19, 2026, the average hourly pay for utilization review rn in St. Louis, MO is $41.11, according to ZipRecruiter salary data. Most workers in this role earn between $32.50 and $47.21 per hour, depending on experience, location, and employer.

How to get into utilization review as a nurse?

To become a utilization review RN, candidates typically need a valid nursing license and experience in clinical settings. Additional certifications such as Certified Professional in Healthcare Quality (CPHQ) or case management credentials can enhance prospects, and familiarity with electronic health records and insurance policies is beneficial.

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 make $300,000 as a nurse?

A Utilization Review RN can earn $300,000 by gaining extensive experience, obtaining certifications such as Certified Review Officer (CRO), working in high-paying settings like insurance companies or managed care organizations, and taking on leadership or specialized roles that offer higher compensation. Advanced skills in clinical assessment, documentation, and understanding of healthcare policies can also contribute to higher earnings.

What does an RN utilization review do?

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

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 Certified Review Officer (CRO), working in high-demand settings, and possibly taking on leadership or specialized roles. Increasing your workload, working overtime, or pursuing advanced education can also contribute to higher earnings within this field.

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 St. Louis, MO? The most popular types of Utilization Review Rn jobs in St. Louis, MO are:
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What job categories do people searching Utilization Review Rn jobs in St. Louis, MO look for? The top searched job categories for Utilization Review Rn jobs in St. Louis, MO are:
What cities near St. Louis, MO are hiring for Utilization Review Rn jobs? Cities near St. Louis, MO with the most Utilization Review Rn job openings:
Utilization Review Rn jobs near you
RN Utilization Review Case Manager

RN Utilization Review Case Manager

Gateway Regional Medical Center

Granite City, IL • On-site

$32 - $48/hr

Other

Medical, Dental, Vision, Retirement, PTO

Re-posted 27 days ago

Gateway Regional Medical Center rating

4.4

Company rating: 4.4 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

987th of 1,020 rated hospitals

Job description

Utilization Review Specialist RN

Full-Time | Case Management | Gateway Regional Medical Center | Granite City, Illinois

Gateway Regional Medical Center is hiring a Utilization Review Specialist Registered Nurse (RN) to join our Case Management team.

This role is ideal for an experienced acute care nurse who is ready to move into a more analytical, process-driven role focused on appropriate utilization of services, payer compliance, and supporting high-quality, cost-effective patient care.

What You'll Do

In this role, you will support appropriate patient care utilization and financial stewardship by:

  • Completing admission and concurrent chart reviews for medical necessity
  • Working to prevent denials from all payers through timely review and documentation
  • Managing and coordinating appeals for denied or at-risk accounts
  • Collaborating with physicians, case managers, and interdisciplinary teams
  • Monitoring payer requirements and regulatory compliance standards
  • Identifying denial trends and opportunities for process improvement
  • Supporting efficient patient flow and appropriate level-of-care placement
  • Ensuring accurate and timely documentation to support reimbursement
What We're Looking For
  • Graduate of an accredited School of Nursing (RN required)
  • Current Illinois RN license
  • Current BLS certification required
  • Minimum 5 years of acute care clinical nursing experience required
  • Experience in case management, discharge planning, utilization review, or appeals preferred
  • Familiarity with InterQual and/or Milliman criteria preferred
Ideal Candidate

This role is a great fit if you:

  • Have strong critical thinking and clinical judgment skills
  • Enjoy reviewing clinical documentation and problem-solving
  • Are detail-oriented and comfortable working with payer guidelines
  • Thrive in a structured, policy-driven environment
  • Want to transition out of bedside nursing into a more administrative clinical role
Why Join Gateway?
  • Competitive pay: $32.00–$48.00/hr
  • Comprehensive medical, dental, and vision insurance
  • Paid vacation and holiday time
  • Retirement plan with employer match
  • Stable weekday schedule (no nights or weekends, if applicable you can insert)
  • Supportive case management and interdisciplinary team environment
  • Opportunity to directly impact quality metrics and hospital performance
Location

Gateway Regional Medical Center
2100 Madison Ave
Granite City, IL 62040

Compensation

Compensation is based on education, experience, certifications, and relevant skills. Final offers are determined through our compensation review process to ensure fairness and internal equity.

Join a team where your clinical expertise helps ensure patients receive the right level of care at the right time-while supporting quality, compliance, and patient outcomes. Apply today.

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