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Utilization Review Rn Jobs (NOW HIRING)

KYYBA

Remote Utilization Review RN

Detroit, MI · Remote

$35 - $39/hr

Utilization Review RN Contract Duration: 12+ months Job Location: 100% REMOTE License Requirements: MI Registered Nurse License Mandatory Requirements to Apply * Active, unrestricted Michigan ...

LeaderStat

Travel Utilization Review RN

Torrance, CA · On-site

Utilization Review * Discipline: RN * Start Date: 09/21/2026 * Duration: 13 weeks * 40 hours per week * Shift: 8 hours, days * Employment Type: Travel Estimated Pay Package : Up to $ 2063.47 per week

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How much do utilization review rn jobs pay per hour?

As of Sep 3, 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.

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.

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.

How to get into utilization review as a registered nurse?

To become a utilization review RN, you typically need a valid registered nurse license and experience in clinical settings. Additional certifications such as the Certified Professional in Healthcare Quality (CPHQ) or case management certification can enhance job prospects, and familiarity with electronic health records (EHR) systems is often required.
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Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 3% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Remote Utilization Review RN

KYYBA

Detroit, MI • Remote

$35 - $39/hr

Contractor

Medical, Dental, Vision, PTO

Posted 24 days ago

Job description

Job Title: Utilization Review RN
Contract Duration: 12+ months
Job Location: 100% REMOTE
License Requirements: MI Registered Nurse License

Mandatory Requirements to Apply

  • Active, unrestricted Michigan Registered Nurse (RN) license required.
  • Nursing Diploma or Associate Degree in Nursing required; BSN preferred.
  • Minimum 5 years of healthcare experience.
  • 3–5 years of Utilization Management experience required.
  • Experience with InterQual and/or MCG criteria.
  • Knowledge of CMS, NCQA, HIPAA, PA60, utilization management, and clinical documentation.
  • Working knowledge of ICD-10 and CPT coding.

Roles & Responsibilities

  • Deliver clinical education and training for Care Management and Utilization Management staff, including onboarding, mentoring, and ongoing professional development.
  • Conduct quality reviews, internal and external audits, and analyze performance to support accreditation and continuous quality improvement initiatives.
  • Develop, maintain, and update training materials, manuals, and educational resources reflecting system updates, InterQual criteria, and departmental processes.
  • Collaborate with leadership and subject matter experts to implement new programs, systems, and process improvements while supporting change management initiatives.
  • Coordinate training operations, including scheduling, class administration, new hire system access, attendance tracking, and communication with internal teams and external provider facilities.

Salary & Benefits

  • Pay: $35–$39 per hour
  • Health Insurance (Medical, Dental and Vision)
  • 9 Days of Paid Time Off
  • All equipment provided by the client

Company Description

Founded in 1998 and headquartered in Farmington Hills, MI, Kyyba has a global presence delivering high-quality resources and top-notch recruiting services, enabling businesses to effectively respond to organizational changes and technological advances.

At Kyyba, the overall well-being of our employees and their families is important to us. We are proud of our work culture which embodies our core values; incorporating value, passion, excellence, empowerment, and happiness, creates a vibrant and productive atmosphere. We empower our employees with the resources, incentives, and flexibility that they need to support a healthy, balanced, and fulfilling career by providing many valuable benefits and a balanced compensation structure combined with career development.

Kyyba is an Equal Opportunity Employer.

Kyyba does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other b

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About KYYBA

Sourced by ZipRecruiter

About Kyyba: Founded in 1998 and headquartered in Farmington Hills, MI, Kyyba has a global presence delivering high-quality resources and top-notch recruiting services, enabling businesses to effectively respond to organizational changes and technological advances. At Kyyba, the overall well-being of our employees and their families is important to us. We are proud of our work culture which embodies our core values; incorporating value, passion, excellence, empowerment, and happiness, creates a vibrant and productive atmosphere. We empower our employees with the resources, incentives, and flexibility that they need to support a healthy, balanced, and fulfilling career by providing many valuable benefits and a balanced compensation structure combined with career development.

Industry

Recruiting and staffing services

Company size

501 - 1,000 Employees

Headquarters location

Farmington Hills, MI, US

Year founded

1998

Social media

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