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Utilization Review Rn Jobs (NOW HIRING)

Oregon Health & Science University

They conduct robust utilization review. Utilization Management Nurses use established criteria to ... Current, unencumbered Oregon State Registered Nurse License * BLS from AHA required. New hires will ...

Oregon Health & Science University

They conduct robust utilization review. Utilization Management Nurses use established criteria to ... Current, unencumbered Oregon State Registered Nurse License * BLS from AHA required. New hires will ...

Oregon Health & Science University

They conduct robust utilization review. Utilization Management Nurses use established criteria to ... Current, unencumbered Oregon State Registered Nurse License * BLS from AHA required. New hires will ...

CareConnect

Utilization Review RN

Greenvale, NY · On-site

Reviews and coordinates prospective, concurrent and retrospective activities related to utilization ... Bachelor's Degree in Nursing, preferred. Must be enrolled in an accredited program within 24 months ...

CareConnect

Utilization Review RN

Greenvale, NY

Reviews and coordinates prospective, concurrent and retrospective activities related to utilization ... Bachelor's Degree in Nursing, preferred. Must be enrolled in an accredited program within 24 months ...

GLC On-The-Go

Travel Utilization Review Nurse

Kinston, NC · On-site

$2.1K - $2.3K/wk

GLC On-The-Go is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Kinston, North Carolina. & Requirements * Specialty: Utilization Review * Discipline: RN * ...

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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.

Utilization Review RN - Per Diem*

CARSON VALLEY HEALTH

Gardnerville, NV • On-site

Other

Posted yesterday

Carson Valley Health rating

8.4

Company rating: 8.4 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

Job description

Utilization Review RN - Per Diem*

*IMPORTANT NOTE: In lieu of benefits due to "per diem" status, 15% will be added to the hourly rate. Per diem employees are offered work on an "as-needed" basis.

POSITION SUMMARY:

Performs clinically orientated medical chart reviews and other administrative tasks to meet the requirements of the medical center's utilization review plan, state and federal regulations, insurance company requirements for reimbursement.


POSITION REQUIREMENTS:

Minimum Education

  • A Bachelor's Degree in Nursing preferred; three (3) years of clinical care or nursing experience; OR an equivalent combination of education and experience AND (2) two years’ experience Utilization Review.

Certificate Preferred

  • CCM (certification in case management) is preferred.

License Required

  • Must be licensed as a Registered Nurse by the State of Nevada, and remain active with all annual licensing requirements.

Minimum Work Experience

  • Minimum of 1 year of case management or utilization management experience.
  • Knowledge of InterQual or McKesson criteria preferred.
  • Knowledge in conducting a medical record review for medical necessity.
  • Knowledge of basic ICD-10, CPT coding knowledge preferred.
  • Basic knowledge of regulations as set forth by The Centers for Medicare Medicaid Services.
  • Skill in operating a personal computer utilizing a variety of software applications.
  • Strong written and oral communication skills
  • Skill and ability to work independently

POSITION ESSENTIAL FUNCTIONS:

Chart Review

  • Conducts chart review to determine that InterQual-based care criteria is met.
  • Assist in determining if patients are in the correct hospital setting
  • Review elective surgery schedule
  • Review outpatient charts (observation)
  • Obtains appropriate patient records as required by payor agencies and initiates the UR Medical Director as necessary for unwarranted admissions

Hospital Reimbursements

  • Understand and demonstrates the requirements needed to maximize reimbursement to the hospital
  • Assist in obtaining authorizations as needed; including follow-up
  • Respond to insurance providers in a timely and thorough manner
  • Communicates with various hospital departments in a meaningful manner
  • Assists in ensuring appropriate room charges, patient status, discharge disposition, etc.
  • Reviews denials and collaborates on appeals of denials
  • Communicates with HIM staff and resolves discrepancies

Knowledge

  • Condition 44 documentation and requirement; HINN notification letters, ABN-advance beneficiary notice, Important Letter from Medicare, etc
  • Maintains practices consistent with the hospital's utilization review (UR) plan
  • Reviews the plans components and is a member of the utilization review committee
  • Obtains data and statistics addressed in the hospital's UR plan and presents information as needed
  • Ensures appropriate and cost-effective healthcare services to patients

Documentation

  • Demonstrates understanding and supports clinical documentation improvement strategies
  • Ability to efficiently locate priority clinical information in a medical record, and to critically interpret that information as part of a treatment plan.
  • Analyze clinical information to identify areas with potential for documentation improvement
  • Demonstrates collaborative work relationship with coding staff to assure documentation of discharge diagnosis and co-morbidities are complete and accurately reflect the patient’s clinical status and care.
  • Demonstrates collaborative work relationship with coding staff to assure documentation of discharge diagnosis and co-morbidities are complete and accurately reflect the patient's clinical status and care.
  • Reviews medical records concurrently, recognizes opportunities for documentation improvement, and follows up with appropriate staff.
  • Facilitates modifications to clinical documentation through collaborative interactions with physicians, nurses, and ancillary staff.


CARSON VALLEY HEALTH IS PROUD TO BE RECOGNIZED AS A FINALIST IN THE

"BEST PLACES TO WORK" - NORTHERN NEVADA, 2021, 2022, 2024, 2025 & 2026!

WE LOOK FORWARD TO WELCOMING YOU TO OUR TEAM!!


Per Diem positions have no guaranteed hours or set schedule. The position will fill in for individuals who take unplanned and/or planned time off.