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Utilization Review Rn Jobs (NOW HIRING)

Memorial Health

Utilization Review RN

Springfield, IL

$32.95 - $52.73/hr

... RN licensure in the State of Illinois required Experience: Minimum of 3- 5 years of recent acute care and/or home health nursing or case management experience required. Previous utilization review ...

Memorial Health

Utilization Review RN

Springfield, IL

$32.95 - $52.73/hr

... RN licensure in the State of Illinois required Experience: Minimum of 3- 5 years of recent acute care and/or home health nursing or case management experience required. Previous utilization review ...

Houston Methodist

Utilization Review RN

Cypress, CA

At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent medical record review for medical ...

Memorial Health

Utilization Review RN

Springfield, IL · On-site

$32.95 - $52.73/hr

... RN licensure in the State of Illinois required Experience: Minimum of 3- 5 years of recent acute care and/or home health nursing or case management experience required. Previous utilization review ...

Care Career

Travel Utilization Review RN

Hanover, MD · On-site

Care Career is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Hanover, Maryland. & Requirements * Specialty: Utilization Review * Discipline: RN * Start Date ...

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How much do utilization review rn jobs pay per hour?

As of Jun 28, 2026, the average hourly pay for utilization review rn in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 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.
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Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in the United States as of June 2026, with employment types broken down into 2% As Needed, 58% Full Time, 3% Part Time, 1% Temporary, 35% Contract, and 1% Nights. Highlights an 90% Physical, 2% Hybrid, and 8% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Registered Nurse - Utilization Review - RNUR 0615 AR#01

NavitasPartners

Yonkers, NY • On-site

$2.5K - $2.8K/wk

Other

Posted 14 days ago

Job description

Job Title: Registered Nurse - Utilization Review (RN-UR)

Location: Syracuse, NY 13210
Schedule: Day Shift
Duration: 14 Weeks

Compensation
  • Local Candidates: $2,000 - $2,300 per week
  • Traveler Candidates: $2,500 - $2,800 per week
Position Overview

We are seeking an experienced Utilization Review Registered Nurse (RN) to support a fast-paced healthcare setting. This role involves reviewing patient cases across multiple levels of care to ensure medical necessity, appropriate resource utilization, and compliance with payer requirements.

Key Responsibilities
  • Perform a combination of Admission, Continued Stay, and Discharge reviews with a minimum productivity of 25 reviews per day
  • Review cases across Medical, Surgical, and Behavioral Health populations (pediatric through adult)
  • Evaluate patient care levels including:
    • Inpatient
    • Outpatient
    • Observation
    • Emergency
  • Work with multiple payer types, including:
    • Medicare & Managed Medicare
    • Medicaid & Managed Medicaid
    • Commercial Insurance
    • Workers' Compensation & No-Fault
  • Ensure accurate order and class alignment within the Epic EHR system throughout the patient stay
  • Apply InterQual criteria for medical necessity and level-of-care determinations
  • Utilize payer portals for authorization and review processes
Required Qualifications
  • Active, unrestricted New York State Registered Nurse (RN) license
  • BLS certification (AHA required)
  • Minimum 1.5 years of recent clinical experience
  • Prior experience in acute care or hospital-based Utilization Review
Preferred Skills & Experience
  • Hands-on experience with Epic Electronic Health Record (EHR)
  • Familiarity with InterQual first-level screening
  • Experience navigating and working with payer portals
  • Strong analytical, documentation, and communication skills

For more details reach at jknox@navitashealth.com or Call / Text at 732-791-4827.

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