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

Sturdy Memorial

RN Case Manager - Per Diem

Attleboro, MA

$42.86 - $66.80/hr

The RN Case Manager must achieve this through early assessment of pre-admission level of care, post ... utilization review * Demonstrated ability to use critical thinking and problem solving skills in ...

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Utilization Review Rn information

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$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.

Manager - Clinical Resource / Case Management - MGRCM 0603 NS#03

NavitasPartners

Fall River, MA • On-site

$3K/wk

Other

Posted 11 days ago

Job description

Job Title: Manager - Clinical Resource / Case Management
Location: Hyannis, MA
Duration: 13 Weeks (Extendable)

Shift Details:

  • Monday - Friday, 8-hour day shifts
  • Rotating on-call for weekends and holidays

Weekly Compensation: Up to $3,000 (based on experience)

Position Summary

The Manager of Clinical Resource / Case Management is responsible for overseeing daily operations and providing clinical leadership for Case Management, Utilization Review, and Social Work services. This role supports care coordination, discharge planning, and high-risk patient management while ensuring compliance with regulatory standards and optimizing patient outcomes.

The position also plays a key role in staff development, process improvement initiatives, and collaboration across multidisciplinary teams.

Key ResponsibilitiesLeadership & Department Operations
  • Oversee day-to-day operations of Case Management and Social Work teams
  • Manage staff scheduling, workflow, and performance evaluations
  • Support clinical documentation processes in collaboration with leadership
  • Mentor, coach, and develop team members to enhance performance
Care Coordination & Discharge Planning
  • Conduct patient rounds to identify discharge barriers and facilitate transitions of care
  • Ensure effective discharge planning and utilization management
  • Collaborate with physicians, nurses, and interdisciplinary teams
Education & Staff Development
  • Develop and deliver continuing education programs
  • Provide onboarding and role-specific training for new staff
  • Educate clinical teams on utilization review and discharge planning processes
Quality Improvement & Compliance
  • Monitor compliance metrics and identify performance gaps
  • Develop dashboards and reports to track outcomes
  • Lead process improvement initiatives
  • Ensure adherence to regulatory standards and best practices
Analytics & Reporting
  • Analyze operational and departmental performance metrics
  • Utilize case management systems to drive improvements
  • Present data-driven recommendations to leadership
Required Qualifications
  • Active Registered Nurse (RN) license (state-specific)
  • Bachelor of Science in Nursing (BSN) required
  • Minimum 3 years of recent acute care clinical experience
  • Minimum 5 years of Case Management experience in an acute care setting
  • Minimum 2 years of process improvement experience
  • Working knowledge of utilization review systems (e.g., InterQual or equivalent)
  • Knowledge of healthcare regulations and reimbursement processes (e.g., CMS)
  • Experience developing and delivering education programs
  • Strong computer skills (Windows-based applications)
  • Excellent organizational, analytical, and communication skills
Preferred Qualifications
  • Master's degree in Nursing or related field
  • Certification in Case Management (CCM) and/or Clinical Documentation Integrity (CDI)
  • Prior management or supervisory experience
  • Experience leading multidisciplinary healthcare teams
Work Environment
  • Acute care hospital setting
  • Leadership role requiring collaboration across departments
  • Focus on patient-centered care, compliance, and operational efficiency
Additional Notes
  • Candidates must be flexible for on-call responsibilities
  • Strong emphasis on leadership, quality improvement, and team development

For more details reach at Aditi.sharma@navitashealth.com or Call / Text at 516-587-6677.

About Navitas Healthcare, LLC: It is a Joint Commission 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