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Utilization Review Jobs in Tennessee (NOW HIRING)

UHS

Full-time - UR Coordinator

Memphis, TN · On-site

Oversees utilization review activities with other departments to ensure reimbursement for services provided by the hospital. The UM Coordinator facilitates physician weekly staffing meetings and ...

UHS

Full-time - UR Coordinator

Memphis, TN · On-site

Oversees utilization review activities with other departments to ensure reimbursement for services provided by the hospital . The UM Coordinator facilitates physician weekly staffing meetings and ...

UHS

UM Coordinator - Full-time days

Memphis, TN

Oversees utilization review activities with other departments to ensure reimbursement for services provided by the hospital. The UM Coordinator facilitates physician weekly staffing meetings and ...

genex

Onsite Telephonic Case Manager (RN)

Memphis, TN · On-site

Responsible for the performance of Utilization Review services, including pre-admission certification, second surgical opinion, concurrent utilization review, DRG validation, as well as assessment ...

genex

Onsite Telephonic Case Manager (RN)

Memphis, TN · On-site

Responsible for the performance of Utilization Review services, including pre-admission certification, second surgical opinion, concurrent utilization review, DRG validation, as well as assessment ...

Genex

Onsite Telephonic Case Manager (RN)

Memphis, TN · On-site

Responsible for the performance of Utilization Review services, including pre-admission certification, second surgical opinion, concurrent utilization review, DRG validation, as well as assessment ...

Vertek Staffing

CDI Specialist

Franklin, TN · Remote

$33.50 - $45/hr

The CDI Specialist will work collaboratively with HIM, Coding, Case Management, Utilization Review, Physician Advisors, and providers to support accurate and complete clinical documentation. Key ...

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Utilization Review information

See Tennessee salary details

$19

$38

$62

How much do utilization review jobs pay per hour?

As of Sep 12, 2026, the average hourly pay for utilization review in Tennessee is $38.38, according to ZipRecruiter salary data. Most workers in this role earn between $30.34 and $44.09 per hour, depending on experience, location, and employer.

What is a utilization review?

A Utilization Review (UR) job involves assessing the medical necessity, efficiency, and appropriateness of healthcare services. UR professionals, often nurses or healthcare specialists, review patient records, insurance claims, and treatment plans to ensure they meet industry standards and payer requirements. They work with healthcare providers, insurance companies, and regulatory agencies to optimize care while controlling costs. Their goal is to balance quality patient care with cost-effective resource utilization.

What does a utilization review do?

A typical day in Utilization Review involves reviewing patient medical records, evaluating the necessity and appropriateness of proposed treatments or services, and documenting recommendations based on clinical criteria and insurance policies. Utilization Review specialists often collaborate closely with physicians, nurses, and insurance representatives to gather additional information and clarify cases. While much of the role is desk-based and may include remote work options, it requires regular communication with both clinical and administrative teams. This position offers variety and challenge, as no two cases are exactly alike, and there are often opportunities to advance into supervisory or quality improvement roles within the department.

What are the key skills and qualifications needed to thrive in utilization review?

To thrive in Utilization Review, professionals typically need a background in nursing or healthcare, strong clinical assessment capabilities, and a thorough understanding of medical guidelines and insurance regulations. Familiarity with electronic medical records (EMR) systems and utilization management software, and often certification such as Certified Utilization Review Specialist (CURN), are important. Excellent critical thinking, attention to detail, and strong communication skills enable effective case evaluation and collaboration with healthcare teams. These skills and qualifications ensure objective, accurate decisions that support cost-effective, quality patient care within compliance standards.

How do I get into a utilization review?

To become a utilization review specialist, typically a healthcare or related degree such as nursing, health administration, or social work is required. Certification in case management or utilization review, like the Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects, and strong analytical and communication skills are essential for success in the role.

Is utilization review a stressful job?

Utilization review is a healthcare role that involves evaluating medical necessity and appropriateness of services, often under strict deadlines and documentation requirements. The job can be stressful due to high workload, the need for accuracy, and managing complex cases, but stress levels vary based on work environment and individual coping skills.

What are the most commonly searched types of Utilization Review jobs in Tennessee?

The most popular types of Utilization Review jobs in Tennessee are:

What are popular job titles related to Utilization Review jobs in Tennessee?

For Utilization Review jobs in Tennessee, the most frequently searched job titles are:

What job categories do people searching Utilization Review jobs in Tennessee look for?

The top searched job categories for Utilization Review jobs in Tennessee are:

What cities in Tennessee are hiring for Utilization Review jobs?

Cities in Tennessee with the most Utilization Review job openings:

Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Tennessee as of September 2026, with employment types broken down into 1% As Needed, 80% Full Time, 16% Part Time, 1% Temporary, and 2% Contract. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $79,822 per year, or $38.4 per hour.

Utilization Management Nurse RN

Nashville, TN • On-site

Signature HealthCARE
See more jobs at Signature HealthCAREexternal

$75K - $80K/yr

Other

Medical, Dental, Vision, Life, Retirement, PTO

Posted 20 days ago

Signature Healthcare rating

5.3

Company rating: 5.3 out of 10

Based on 173 frontline employees who took The Breakroom Quiz

Job description

Signature HealthCARE is a family-based healthcare company offering integrated services across multiple states. Our continuum of care includes skilled nursing, rehabilitation, assisted and memory care, and home-based services supported by innovative technologies like telehealth and Care.ai-enabled solutions.

We are committed to advancing person-directed care and quality outcomes. Many of our facilities continue to receive high performance ratings and accreditations. As an award-winning organization recognized over the years by national outlets such as U.S. News & World Report, we take pride in fostering compassionate care environments and being an employer of choice in the healthcare industry.

Overview

Collaboration with Managed Care Organizations (MCO) and care providers is vital to ensure care is being delivered in the right setting at the right time.

How you Will make a difference

  • Collaborate regularly and maintain open communication with leadership, patients, families, internal care givers, and external Utilization Management Nurses.

  • Coordinate internal and external health care team activities related to resident care, transitions and discharge planning with agencies, and other healthcare organizations.

  • Conduct initial baseline assessment of resident care needs and communicate that effectively to the Managed Care Organization (MCO) ensuring all aspects of care services are communicated accurately.

  • Verify all care needs and the authorization for services and outliers.

  • Communicate/collaborate with the Managed Care Organization (MCO) at required intervals as determined by the MCO

  • Negotiate appropriate levels based on services provided and contractual arrangements with the facility and the MCO.

  • Document all authorizations and continued stay activity in Case Management software to ensure appropriate reporting and billing

  • Prepare all Managed Care documentation to facility accurate billing.

What you Need to make a Difference

  • Registered Nurse (RN) in good standing with required current state license.

  • Associates degree required, but Bachelor’s degree preferred.

  • Basic knowledge of medical necessity criteria such as Milliman Care Guidelines or Interqual.

  • Minimum of three (3) years related case management experience.

  • Minimum of three (3) years of hospital, SNF or Acute Rehab clinical experience

  • Certified in Case Management through ACMA, CCMC or other credentialed agencies, preferred or willing to obtain after one year of employment.

  • Knowledge of Medicare payment methodology and the MDS RUG system. Previous experience with MDS and assessment preferred

Our exceptional Benefits Package and Signature Perks include the following and more!

  • Medical, Dental and Vision – Voluntary Life/Disability

  • Free Telemedicine with Medical Plan

  • 401(K) and Roth 401(K)

  • Tuition Forgiveness/Education Reimbursement

  • A variety of additional specialized Insurances

  • Pay Advance and Next Day Pay!

  • Paid Time Off (PTO)

  • Partner Perks and Discounts!

  • Reward & Recognition Program (HEART)

  • Vital Links

At Signature HealthCARE, our team members are permitted – no, encouraged – to employ their talents and abilities to solve problems. Our culture is built on three distinct pillars: Learning, Spirituality and Intra-preneurship. Each pillar has its own staff and initiatives, ensuring that our unique culture permeates the entire organization. Come see what the revolution is all about!

Signature HealthCARE is an Equal Opportunity-Affirmative Action Employer – Minority / Female / Disability / Veteran and other protected categories

Salary Range

USD $75,000.00 - USD $80,000.00 /Yr.

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