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Utilization Review Rn Jobs (NOW HIRING)

St. Luke's Health

Utilization Review RN

Houston, TX · On-site

$41.14 - $61.20/hr

Job Summary and Responsibilities As our Utilization Management Professional, you will be a critical ... review outcomes. * Collaborates with facility RN Care Coordinators to ensure progression of care.

St Luke's Health

Utilization Review RN

Houston, TX

$41.14 - $61.20/hr

Job Summary and Responsibilities As our Utilization Management Professional, you will be a critical ... review outcomes. * Collaborates with facility RN Care Coordinators to ensure progression of care.

Prime Healthcare

Utilization Review RN

Ontario, CA

$71K - $104K/yr

Minimum 3 years RN Utilization Manager working for a Health Plan. * At least 3 years of experience in utilization review, referrals, authorizations, denials and appeals. * Current BCLS (AHA ...

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How much do utilization review rn jobs pay per hour?

As of Aug 1, 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 to get into utilization review as a nurse?

To become a utilization review RN, candidates typically need a valid nursing license and experience in clinical settings. Additional certifications such as Certified Professional in Healthcare Quality (CPHQ) or case management credentials can enhance prospects, and familiarity with electronic health records and insurance policies is beneficial.

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.

How to make $300,000 as a nurse?

A Utilization Review RN can earn $300,000 by gaining extensive experience, obtaining certifications such as Certified Review Officer (CRO), working in high-paying settings like insurance companies or managed care organizations, and taking on leadership or specialized roles that offer higher compensation. Advanced skills in clinical assessment, documentation, and understanding of healthcare policies can also contribute to higher earnings.

What does an RN utilization review do?

An RN utilization review evaluates medical records and treatment plans to determine the necessity, appropriateness, 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.

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 Certified Review Officer (CRO), working in high-demand settings, and possibly taking on leadership or specialized roles. Increasing your workload, working overtime, or pursuing advanced education can also contribute to higher earnings within this field.

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 July 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 1% Temporary, and 3% Contract. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review RN

Integrated Resources INC

Watertown, NY • On-site

Full-time

Re-posted yesterday

Job description

Company Description

Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.

Job Description

Job Description:
We are seeking a UR RN to work full time, M-F 8-5pm.
This is a direct placement opportunity. Job purpose:
RN is responsible to provide Utilization Review and approval during the admission process and to provide clinical information as required to Insurance Companies at admission and during stay. This position will work closely with Revenue Cycle staff and Discharge Planning to assist in the review and acceptance into the sub-acute rehab program. RN will coordinate the Quality Improvement monthly meetings and subsequent reports. RN will also coordinate the Risk Management process.

Qualifications

Qualifications
Registered Nurse with current NYS License
Preferred experience with QI/Risk Management/Utilization Review/Infection Control
BSN Preferred
Familiar with agency support availability
PRI certification or within six months of employment
Position Urgency: Quick Start
Shifts: Working Mon-Fri, 8a-5p. No wends, no call

Additional Information

Regards,

Riya Khem

Life Science Recruiter

Integrated Resources, Inc.

IT Life Sciences Allied Healthcare CRO

(Direct) 732-844-8721 | (W) 732-549-2030 x 311 | (F) 732-549-5549

"INC 5000's FASTEST GROWING, PRIVATELY HELD COMPANIES" (8th Year in a Row)




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About Integrated Resources

Sourced by ZipRecruiter

Integrated Resources Inc (IRI), based in Edison, NJ, US, is an esteemed player in the staffing solutions industry with a credible presence on their official website irionline.com. Notably, IRI provides a range of professional staffing services including contract, contract-to-hire, and direct hire solutions to a wide spectrum of industries such as healthcare, life sciences, manufacturing, financial, insurance, and others. Since its inception, IRI has been committed to delivering top-talent and optimum solutions to meet its clients' diverse needs.

Industry

Recruiting and staffing services

Company size

51 - 200 Employees

Headquarters location

Edison, NJ, US

Year founded

1996

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