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Utilization Review Rn Jobs (NOW HIRING)

CommonSpirit Health

Utilization Review RN

Omaha, NE · On-site

Conducts admission and continued stay reviews per the Care Coordination Utilization Review ... review outcomes. Collaborates with facility RN Care Coordinators to ensure progression of care.

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 ...

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 ...

Schneck Medical Center

UTILIZATION REVIEW RN

Seymour, IN · On-site

$30.72/hr

Bachelors Degree in Nursing with case management certification LICENSE/CERTIFICATION Licensed RN in ... DUTIES 1. Utilization Review and Medical Necessity 2. Concurrent Review and Length of Stay ...

Bestica Healthcare

RN - Utilization Review

Lansing, MI · On-site

Utilization Review Rn Travel Position We at Bestica believe our success is a direct result of hard work and outstanding employee dedication. Our environment is dynamic, friendly, and collaborative.

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 ...

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How much do utilization review rn jobs pay per hour?

As of Jun 5, 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.

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.

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 May 2026, with employment types broken down into 2% As Needed, 57% Full Time, 4% Part Time, 1% Temporary, and 36% Contract. Highlights an 98% Physical, and 2% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
Utilization Review RN

Utilization Review RN

CommonSpirit Health

Omaha, NE • On-site

Full-time

Posted 23 days ago

CommonSpirit Health rating

7.1

Company rating: 7.1 out of 10

Based on 502 frontline employees who took The Breakroom Quiz

370th of 865 rated healthcare providers

Job description

CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S., from clinics and hospitals to home-based care and virtual care services, CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources, CommonSpirit is committed to building healthy communities, advocating for those who are poor and vulnerable, and innovating how and where healing can happen, both inside our hospitals and out in the community.


Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted based on established criteria and critical thinking.  Reviews include admission, concurrent and post discharge for appropriate status determination.

Ensures compliance with principles of utilization review, hospital policies and external regulatory agencies, Peer Review Organization (PRO), Joint Commission, and payer defined criteria for eligibility.


Reviews the records for the presence of accurate patient status orders and addresses deficiencies with providers.


Ensures timely communication and follow up with physicians, payers, Care Coordinators and other stakeholders
regarding review outcomes.


Collaborates with facility RN Care Coordinators to ensure progression of care.


Engages the second level physician reviewer, internal or external, as indicated to support the appropriate status.


Communicates the need for proper notifications and education in alignment with status changes.


Graduate of an accredited school of nursing

RN license

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