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Utilization Review Rn information

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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.
Psychiatric Registered Nurse (Psych RN)

Psychiatric Registered Nurse (Psych RN)

Yale New Haven Health

Providence, RI

$1K - $2K/wk

Other

Posted 27 days ago

Yale New Haven Health rating

7.3

Company rating: 7.3 out of 10

Based on 226 frontline employees who took The Breakroom Quiz

294th of 872 rated healthcare providers

Job description

Overview
To be part of our organization, every employee is expected to understand and embrace the YNHHS Vision, support our Mission, and live our Values: integrity, patient-centered care, respect, accountability, and compassion. These principles guide our actions and define our commitment to delivering exceptional care every day.
Under the supervision of the Nurse Manager or Clinical Coordinator, the Registered Nurse (RN) provides comprehensive, patient-centered care across a diverse behavioral health population, we have open roles, and various shifts open in Adolescent Psychiatry, General Adult, Geriatric Psychiatry, Mood Disorders, and Transitional Youth.
The RN is responsible for assessing, planning, implementing, and evaluating individualized care in accordance with unit policies and procedures. This role includes supervising non-RN staff, coordinating patient care activities, and serving in a charge nurse capacity when assigned, including delegation and oversight of unit operations.
The RN may be required to support multiple behavioral health units based on patient needs and staffing priorities, ensuring continuity and quality of care. Additional responsibilities may be assigned to maintain a high standard of service and patient outcomes.
EEO/AA/Disability/Veteran
Responsibilities
  1. Assesses The Patient's Physical And Psychosocial Condition On An Ongoing Basis Throughout The Continuum Of Care.
  2. Develops, Communicates And Documents A Plan Of Care Reflecting Individualized Patient Problems And Interventions To Achieve Desired Outcomes, Involving The Patient, Family And Healthcare Team In This Process.
  3. Implements And Coordinates This Plan Of Care In Collaboration With The Healthcare Team.
  4. Evaluates The Effectiveness Of The Plan Of Care, Patient?S Response To Care, And Readiness For Discharge. Revises The Plan Of Care As Needed And Makes Referrals Where Indicated.
  5. Plans For Education After Assessing The Individual Learning Needs And Readiness Of The Patient And Family. Provides Educational Opportunities And Documents Outcomes.
  6. Functions As A Preceptor To New Staff.
  7. Functions As A Charge Nurse.
  8. Meets Performance Expectations For Customer Service, Teamwork, Resource Utilization, And Staff And Self Development As Outlined In Performance Review.
  9. Performs Other Duties As Assigned Or Directed To Ensure Smooth Operation Of The Department/Unit.
  10. Demonstrates Competency In The Care Of The Neuro Patient
  11. Demonstrates Skill And Knowledge In Neuro Assessment
  12. Demonstrates Skill And Knowledge In The Airway Management Of The Neuro Patient
  13. Demonstrates Skill And Understanding In Caring For A Trached Patient
  14. Demonstrates Skill And Understanding In Assisting The Physician And Caring For The Patient During Special Neuro Procedures
  15. Demonstrates Knowledge And Understanding Of Our 'Tia' Teaching Program
  16. Performs Pharynaeal, Endotracheal, Tracheostomy Suctioning According To Established Policy And Procedure: Pharynaeal, Endotracheal, Tracheastomy
  17. Demonstrates Skill And Understanding In The Use Of Equipment And Care Of Patient In A Halo Brace
  18. Demonstrates Skill And Understanding Of Nursing Responsibilities And Interventions For The Patient On A Ventilator

Qualifications
EDUCATION
Graduate Of An Accredited School Of Nursing; BSN Preferred. Proficient In Use Of Computer Software To Include Electronic Patient Records. Must Have Ability To Use Internet For Literature Searches Regarding Care For Patients.
EXPERIENCE
N/A
LICENSURE
Valid State Of Connecticut Registered Nurse License
SPECIAL SKILLS
BLS Required

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