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

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Medical Review Supervisor

Carolina, RI · On-site +1

Active, unrestricted RN licensure from the United States and in the state of hire, OR active ... Three years-utilization/medical review, quality assurance, OR home health, plus 5 years clinical ...

AMIVIE

Registered Nurse, RN

Cumberland, RI · On-site

Registered Nurse (RN) Opportunity We are hiring for RN's or LPN's to work with a client in ... Participate on an assigned advisory board or utilization review committee. * Review all client ...

AMIVIE

Registered Nurse, RN

Lincoln, RI · On-site

Home Care Registered Nurse *** Experienced RN needed for a Home care case, Mon-Fri 8am-4pm in ... Participate on an assigned advisory board or utilization review committee. * Review all client ...

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Utilization Review Rn information

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$41

$67

How much do utilization review rn jobs pay per hour?

As of Aug 29, 2026, the average hourly pay for utilization review rn in Warwick, RI is $41.31, according to ZipRecruiter salary data. Most workers in this role earn between $32.64 and $47.45 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 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 August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 15% Part Time, 2% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $85,930 per year, or $41.3 per hour.

Utilization Review Nurse

Providence, RI • On-site

US Tech Solutions
IT Services • 1 - 5K employees
Learn more about US Tech Solutionsexternal

Other

Re-posted 4 days ago

Job description

Please note: Actual location may vary., RI

Contract

Job Description:

· Participates in the development and ongoing implementation of QM Work Plan activities.

· Improve quality products and services, by using measurement and analysis to process, evaluate and make recommendations to meet QM objectives

Responsibilities:

· Reviews documentation and evaluates Potential Quality of Care issues based on clinical policies and benefit determinations.

· Considers all documented system information as well as any additional records/data presented to develop a determination or recommendation.

· Data gathering requires navigation through multiple system applications.

· Staff may be required to contact the providers of record, vendors, or internal Aetna departments to obtain additional information.

· Evaluates documentation/information to determine compliance with clinical policy, regulatory and accreditation guidelines.

· Responsible for the review and evaluation of clinical information and documentation.

· Reviews documentation and interprets data obtained form clinical records or systems to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and/or provider issues.

· Works Potential Quality of Care cases across all lines of business (Commercial and Medicare).

· Independently coordinates the clinical resolution with internal/external clinician support as required.

· Processes and evaluates complex data and information sets -Converts the results of data analysis into meaningful business information and reaches conclusions about the data

· Prepares and completes QM documents based on interpretation and application of business requirements

· Documents QM activities to demonstrate compliance with business, regulatory, and accreditation requirements

· Assists in the development and implementation of QM projects and activities

· Accountable for completing and implementation of QM Work Plan Activities

Experience:

· 3+ years of experience as an RN

· 1+ years of inpatient hospital experience

· Registered Nurse in state of residence

· Must have prior authorization utilization experience

· Able to work in multiple IT platforms/systems

Skills:

· MUST HAVE MEDCOMPASS or ASSURECARE exp.

· MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge.

· MUST HAVE UM experience, inpatient utilization management review.

· MUST HAVE 1 YEAR OF UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG.

· MUST HAVE 6 months of Prior Authorization.

Education:

· Active and unrestricted RN licensure in state of residence

About US Tech Solutions:

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com (http://www.ustechsolutionsinc.com/) .

US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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About US Tech Solutions

Sourced by ZipRecruiter

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions.

Industry

It services

Company size

1,001 - 5,000 Employees

Headquarters location

Jersey City, NJ, US

Year founded

2000

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