Healthfirst

60 Healthfirst Utilization Review Nurse Jobs Hiring Near You

Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in Acute Care. Overview Seeking an experienced Utilization Review Nurse (RN) to review patient admissions ...

About the job Utilization Review Nurse Sign on bonus may apply up to $15,000 Position Summary: Reviews patient admissions for appropriateness, efficiency of resource utilization and compliance with ...

Utilization Review Nurse

Atlanta, GA · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You will perform frequent case reviews, check medical records and speak with care providers regarding ...

The Utilization Review Nurse will provide utilization review for authorization, concurrent review and discharge review services using InterQual criteria guidelines to validate medical necessity and ...

New

Utilization Review Nurse

Dallas, TX · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You will perform frequent case reviews, check medical records and speak with care providers regarding ...

Utilization Review Nurse

Miami, FL · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You will perform frequent case reviews, check medical records and speak with care providers regarding ...

Utilization Review Nurse Responsible for utilization review work for emergency admissions and continued stay reviews. Responsibilities include: * Review and evaluate electronic medical records of ...

New

Utilization Review Nurse

Canton, MA · On-site

$55 - $60/hr

... Nurse to support outpatient utilization review and prior authorization activities for a leading healthcare organization. The ideal candidate will have a strong background in managed care, utilization ...

The Utilization Review Nurse ensures appropriate utilization of health services by performing initial, concurrent and retrospective clinical case reviews. This role collaborates and communicates with ...

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Healthfirst Jobs Information

Infographic showing various Utilization Review Nurse job openings at Healthfirst in the United States as of August 2026, with employment types broken down into 100% Full Time. Highlights an 80% Physical, 16% Hybrid, and 4% Remote job distribution.

Utilization Review Nurse

Fusion HCR

Las Vegas, NV • On-site

Other

Re-posted 7 days ago


Job description

Fusion HCR is hiring!Direct Hire - Utilization Review Nurse, this is an onsite position, working with our client in Acute Care.
Overview
Seeking an experienced Utilization Review Nurse (RN) to review patient admissions for medical necessity, appropriate level of care, and compliance with payer guidelines. This role works closely with clinical teams to ensure efficient resource utilization and quality patient outcomes.
Responsibilities
  • Review admissions using InterQual and/or Milliman criteria
  • Evaluate medical necessity, level of care, and documentation accuracy
  • Ensure compliance with Medicare, Medicaid, and regulatory guidelines
  • Collaborate with physicians, case management, and care teams
  • Support discharge planning and care coordination
  • Document findings and communicate recommendations

Requirements
  • Active RN license (Nevada)
  • 5+ years acute care nursing experience
  • 3+ years Utilization Review experience
  • 3+ years discharge planning experience (acute care)
  • Experience with InterQual (must be able to pass exam)
  • Experience with Milliman guidelines

Preferred
  • Background in Case Management or CDI
  • Strong knowledge of Joint Commission and CMS guidelines

Why Apply
  • Competitive pay
  • Stable, high-demand role
  • Collaborative healthcare environment

Apply Now
If you have strong Utilization Review, InterQual, and acute care experience, we want to hear from you!