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Utilization Review Rn Jobs (NOW HIRING)

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 ...

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Utilization Review Rn information

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How much do utilization review rn jobs pay per hour?

As of Jul 25, 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- Care Coordination- Full Time

Utilization Review RN- Care Coordination- Full Time

SolutionHealth

Manchester, NH • On-site

Full-time

Medical, Dental, Vision, Life, Retirement

Posted 9 days ago

Job description

Come work at the best place to give and receive care!
Job Description:
RN Utilization Review
Who We Are:
Elliot Health System's Care Coordination Department, located in Manchester, NH, plays a vital role in ensuring seamless, patient-centered care across the healthcare continuum. Our team is dedicated to care management, discharge planning, and patient advocacy, working closely with providers, social workers, and community resources to enhance patient outcomes. By developing individualized care plans, facilitating smooth transitions between care settings, and offering proactive support, we help patients navigate complex healthcare needs while improving overall access to high-quality, coordinated care.
About the Job:
Under the direction of the Director of Care Coordination, the Utilization Review RN (UR RN) is responsible for ensuring the effective and efficient use of hospital services in alignment with the hospital's utilization review plan.
What You'll Do:
  • Complete admission reviews to determine the appropriate level of care.
  • Document continued stay reviews to assess the necessity of inpatient care, procedures, and estimated length of stay.
  • Communicate and collaborate with payer care managers to prevent denials by ensuring timely clinical reviews.
  • Address potential denials proactively, working with physicians and payer representatives to minimize retrospective denials.
  • Screen all patients upon admission or the next business day to determine appropriate level of care using medical necessity tools, Medicare Inpatient Only List, and payer requirements.
  • Monitor observation status patients to ensure appropriate utilization, and collaborate with admitting physicians if documentation does not support the current level of care.
  • Perform concurrent reviews to justify extended stays, working with attending physicians to ensure accurate documentation of medical necessity.
  • Refer cases that do not meet admission or continued stay guidelines to the Utilization Review Physician Advisor after discussions with attending physicians.

Who You Are:
  • Graduate of an accredited nursing program (Bachelor's degree in Nursing required for nurses hired after May 2015 or commitment to obtain within a specified timeframe).
  • Minimum of three (3) years of experience in hospital case management or utilization management.
  • Active New Hampshire or Compact State RN license required.
  • CCM or ACM certification preferred.

Why You'll Love Us:
  • Health, dental, prescription, and vision coverage for full-time & part-time employees
  • Short-term, long-term disability, life & pet insurance
  • Tuition reimbursement
  • 403(b) Retirement savings plans
  • Continuous earned time accrual

Work Shift:
8:00-4:30
SolutionHealth is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, disability status, veteran status, or any other characteristic protected by law.

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