ZipRecruiter

Log In

1

Utilization Review Rn Jobs in Warwick, RI (NOW HIRING)

Brownhealth

Utilization Care Manager

Providence, RI · On-site

In collaboration with the physician of record and the Utilization Review Committee physician ... Licensure as Registered Nurse in the State of Rhode Island by the Rhode Island Board of Nursing or ...

UnitiMed

RN Case Manager

Fall River, MA

Referral bonus up to $700 Registered Nurse (RN),Case Management/Utilization Review, About the Company: Uniti Med is an award-winning healthcare staffing company with a mission to provide staffing ...

AMIVIE

Registered Nurse (CB HomeCare)

Lincoln, RI

Experienced RN needed for a home care case, Mon-Fri 8am-4pm in Lincoln, RI*** *** Competitive pay ... Participate on an assigned advisory board or utilization review committee. * Review all client ...

Ourhrconnect

Medical Reviewer I

Carolina, RI · On-site +1

May provide any of the following in support of medical claims review and utilization review ... Active, unrestricted RN licensure from the United States and in the state of hire, OR, active ...

New

next page

Showing results 1-20

All JobsUtilization Review Rn JobsUtilization Review Rn Jobs in Warwick, RI

Utilization Review Rn information

See Warwick, RI salary details

$21

$42

$69

How much do utilization review rn jobs pay per hour?

As of Jun 13, 2026, the average hourly pay for utilization review rn in Warwick, RI is $42.40, according to ZipRecruiter salary data. Most workers in this role earn between $33.51 and $48.70 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.

How do I become a utilization review RN?

To become a utilization review RN, you typically need to hold a valid registered nurse (RN) license and have experience in clinical nursing. Additional certifications such as the Certified Professional in Healthcare Quality (CPHQ) or Utilization Review Certification (URAC) can enhance job prospects, and strong knowledge of medical coding, insurance policies, and healthcare regulations is important.

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 does an RN utilization review do?

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

How to make $300,000 a year as a nurse?

To earn $300,000 annually as a Utilization Review RN, professionals typically need extensive experience, advanced certifications such as CCM or ANCC, and may work in high-paying settings like insurance companies or healthcare consulting firms. Increasing specialization, taking on leadership roles, or working overtime can also boost income, but reaching this level often requires a combination of skills, experience, and strategic career moves.

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 CCM or ANCC, and working in high-paying settings like insurance companies or managed care organizations. Advanced skills in case management, strong clinical knowledge, and sometimes working overtime or in leadership roles can also contribute to higher earnings.

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 Warwick, RI? The most popular types of Utilization Review Rn jobs in Warwick, RI are:
What are popular job titles related to Utilization Review Rn jobs in Warwick, RI? For Utilization Review Rn jobs in Warwick, RI, the most frequently searched job titles are:
What job categories do people searching Utilization Review Rn jobs in Warwick, RI look for? The top searched job categories for Utilization Review Rn jobs in Warwick, RI are:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Warwick, RI as of June 2026, with employment types broken down into 49% Full Time, 13% Part Time, and 38% Contract. Highlights an 100% In-person job distribution, with an average salary of $88,186 per year, or $42.4 per hour.

RN - Case Management / Utilization Review - RNRR

NavitasPartners

New Bedford, MA • On-site

Other

Posted 8 days ago

Job description

Registered Nurse (RN) - Case Management / Utilization Review

Location: Hyannis, MA 02601
Duration: 27 Weeks
Shift: Day Shift
Hours: 40 Hours Per Week
Schedule: Monday - Friday | 8-Hour Shifts
On-Call: Rotating Weekend and Holiday Coverage Required
We are seeking an experienced Registered Nurse (RN) with a strong background in Case Management, Utilization Review, and Care Coordination for a long-term assignment in Hyannis, Massachusetts. This leadership-focused role is responsible for overseeing case management operations, supporting utilization review activities, facilitating discharge planning, and promoting quality patient outcomes within an acute care environment.

Requirements:

  • Active Massachusetts Registered Nurse (RN) License required.

  • Bachelor of Science in Nursing (BSN) required.

  • Minimum 5 years of acute care Case Management experience required.

  • Minimum 3 years of recent acute care hospital experience within the last 5 years required.

  • Working knowledge of InterQual or equivalent utilization review system.

  • Strong knowledge of discharge planning, utilization management, and care coordination.

  • Experience with process improvement initiatives.

  • Experience developing and presenting professional education programs.

  • Knowledge of CMS regulations.

  • Strong computer proficiency and familiarity with Windows-based systems.

  • Excellent leadership, communication, analytical, and organizational skills.

Preferred Qualifications:

  • Master's Degree in Nursing or related healthcare field.

  • Case Management Certification (CCM, ACM) preferred.

  • Clinical Documentation Integrity certification preferred.

  • Previous management or supervisory experience.

  • Experience leading multidisciplinary teams.

Responsibilities:

  • Oversee daily operations of Case Management, Utilization Review, and Social Work services.

  • Manage staff scheduling, workflow coordination, evaluations, and team development.

  • Support Clinical Documentation Improvement (CDI) initiatives.

  • Conduct patient care rounds to identify discharge barriers and facilitate care transitions.

  • Develop and deliver educational programs for healthcare professionals.

  • Monitor departmental performance metrics and regulatory compliance.

  • Create and maintain operational and quality performance dashboards.

  • Identify process improvement opportunities and implement corrective action plans.

  • Mentor and coach interdisciplinary teams to improve collaboration and patient outcomes.

  • Analyze program data and departmental performance trends.

  • Ensure compliance with CMS regulations and industry best practices.

  • Promote a culture of continuous improvement and operational excellence.

For more details contact at hdavda@navitashealth.com or Call / Text at 516-862-1169.

About Navitas Healthcare, LLC:
About Navitas Healthcare, LLC certified WBENC and one of the fastest-growing healthcare staffing firms in the US providing Medical, Clinical and Non-Clinical services to numerous hospitals. We offer the most competitive pay for every position we cater. We understand this is a partnership. You will not be blindsided and your salary will be discussed upfront.

Apply