Utilization Review Nurse
Protouch Staffing
Utilization Management Nurse
Review patient medical records to determine the medical necessity and appropriateness of admissions, continued stays, and services.
Perform concurrent and retrospective utilization reviews in accordance with established clinical guidelines.
Collaborate with physicians, case managers, and interdisciplinary teams to optimize patient outcomes and ensure efficient resource utilization.
Document review findings accurately using Epic and Dragonfly utilization management software.
Ensure compliance with payer requirements, regulatory standards, and organizational policies.
Identify potential barriers to discharge and communicate recommendations to the care team.
Maintain accurate documentation and participate in quality improvement initiatives.
Active Registered Nurse (RN) license.
Minimum 2 years of Utilization Management/Utilization Review experience required.
BLS Certification required.
CCM (Certified Case Manager) or CMCN (Certified Managed Care Nurse) certification required.
Experience with Epic EMR and Dragonfly utilization management tool preferred.
Prior travel nursing experience highly preferred.
Comfortable working independently in a remote environment and proficient with computer systems.
Candidate must provide their own computer/workstation (equipment is not supplied).
Degree accreditation verification required, or 5 years of relevant experience in lieu of degree verification.
Must successfully complete the HWL prescreen interview followed by the facility manager interview.
100% Remote opportunity-work from the comfort of your home.
Consistent Monday-Friday day shift schedule with excellent work-life balance.
Join a collaborative team using industry-leading technology like Epic and Dragonfly.
Gain valuable experience in Utilization Management with a respected healthcare organization.
Streamlined hiring process with prescreening, manager interview, and quick offers for qualified candidates.
Excellent opportunity for experienced UR/Case Management nurses seeking long-term remote career growth.
$40.12 - $62.19 per hour
...Utilization Review Nurse RN ~Baltimore, MD ~SINAI HOSPITAL ~UTILIZATION REVIEW ~Full-time w/Weekend Commitment - Day shift - 8:00am-4:30pm ~RN OTHER ~96812 ~$40.12-$62.19 Experience based ~Posted: July 2, 2026 Apply Now Save...SuggestedFull timeShift workWeekend workDay shift- ...Description Summary: The Utilization Review Nurse is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services. This nurse is responsible for performing a variety of pre-admission...SuggestedFull time
Christus Health
Irving, TX2 hours ago $15k
...Job Description Job Description The Utilization Review Nurse plays a critical role in assessing patient admissions to ensure appropriate care, resource efficiency, and adherence to third-party payer requirements. This position involves detailed analysis of medical...SuggestedRelocation packageLancesoft INC
Las Vegas, NVmore than 2 months ago$40.12 - $62.19 per hour
...Utilization Review Nurse RN - NE ~Randallstown, MD ~NORTHWEST HOSPITAL ~NW CARE MANAGEMENT ~Part-time - Weekends - Weekend shifts - 8:00am-4:30pm ~RN OTHER ~95496 ~$40.12-$62.19 Experience based ~Posted: Yesterday Apply Now Save...SuggestedPart timeShift workWeekend work$43 - $63 per hour
...Job Description Job Description The Utilization Review Nurse plays a key role in evaluating patient admissions to ensure appropriate levels of care, efficient resource utilization, and compliance with third-party payer requirements. This position involves reviewing...SuggestedRelocation packageLancesoft INC
Las Vegas, NVa month ago$63 per hour
...Job Description Job Description Title: Utilization Review Nurse (RN) Department: Case Management Job Type: Full-Time Facility Details Academic Medical Center Nevada’s: Level I Trauma Center Verified Burn Center Transplant Center First...Hourly payFull timeLancesoft INC
Las Vegas, NVa month ago$42 - $65 per hour
...Job Description Job Description Utilization Review Nurse Location: Las Vegas, NV Job Type: Full-Time Pay: $42–$65/hr + Sign-On Bonus Job Summary Review patient admissions and continued stays to ensure medical necessity, appropriate resource utilization...Full timeRelocation packageLancesoft INC
Las Vegas, NV18 days ago- ...Job Description Job Description Job Description – Utilization Review Nurse Position Summary The Utilization Review Nurse is responsible for reviewing patient admissions and ongoing hospital stays to ensure the delivery of medically necessary, appropriate, and...Full timeCasual workWork at officeShift work
Lancesoft INC
Las Vegas, NV18 days ago $1,600 - $1,800 per week
...Now Hiring: Registered Nurse – Utilization Management Location: Buckley AFB & Peterson AFB, Colorado Military Health System Compensation... ...2 consecutive months in Utilization Management, Utilization Review, or Case Management Preferred Certifications: Not required...Contract workImmediate startRemote workMonday to FridayJ Edward Staffing LLC
Aurora, CO3 days ago- ...Job Description A facility located near Lexington, Nebraska is seeking a Utilization Review Registered Nurse to join their team! Utilization Review Registered Nurse Opportunity: Full-time, permanent position Schedule: Monday-Friday, 9: 00AM-5: 00...Permanent employmentFull timeMonday to Friday
Ironside HR
Kearney, NE2 days ago - ...Overview Title: Clinical Review Nurse – Prior Authorization Review Location: Fully Remote (PST Time Zone - WA/OR Resident)... ...Clinical Review Nurse for Prior Authorization Review to join our Utilization Management team. In this role, you will conduct concurrent...Contract workRemote work
SPECTRAFORCE
Washington DC2 days ago - ...lives and building a stronger, healthier community together. Join us in making a difference at Umpqua Health. Position Title Utilization Review Nurse Department Umpqua Health Job Status Full Time, Exempt position Schedule Monday – Friday 8:00am – 5:00pm (Pacific Standard...Full timeWork at officeLocal areaRemote workMonday to FridayFlexible hours
Umpqua Health
Roseburg, OR4 days ago - ...Job Summary: The Utilization Review RN is responsible for utilization review, discharge planning and transitions in care, in collaboration... ...work state(s) are required post hire. ~ Registered Nurse License (Virginia) within 6 months of hire AND Registered...Work from home
Kaiser Permanente
Halethorpe, MD4 days ago - ...staff (commercial, behavioral health, inpatient, etc). Requirements: ~2 years of staff nurse experience performing care for hospitalized patients. ~2 years of utilization review (UR) experience reviewing hospital admissions for medical necessity. ~ Must live...ReliefLocal areaRemote workWork from homeMonday to FridayFlexible hoursShift work
BJC HealthCare
Saint Louis, MO4 days ago - ...advancement. Responsibilities Apply approved utilization criteria to monitor appropriateness of... ..., levels of care, and ongoing stay review. Communicate with third‑party payers for... ...clinical reviews with payers as determined by nursing judgment and contractual obligations....Work at officeRelocationShift workNight shiftRotating shift
University of Utah Health
Salt Lake City, UT3 days ago $34.73 - $45.15 per hour
...Position Summary Performs medical record review for severity of illness and intensity of service... ...licensure. BSN preferred. 2–5 years previous Utilization Review experience preferred. Current CPR. Relevant hospital nursing; hospital case management; insurance case management...Full timePart timeWork experience placementFlexible hoursShift workWeekend work01 Silver Cross Hospital and Medical Centers
New Lenox, IL1 day ago- ...Registered Nurse - Utilization Review (Nursing) Location: Aurora, CO. Location: Colorado Military Health System – Buckley AFB and Peterson AFB. Labor Category: Registered Nurse – Utilization Management. Current POP ends 11/30/25. TO POP ends 11/30/27. This assignment...Contract workRemote workWork from homeMonday to FridayNight shift
Software Technology Inc
Aurora, CO3 days ago $88.85k
...income communities and residents and to support the safety net required to achieve that purpose. Job Summary The Utilization Management (UM) Claims Review Nurse RN II is responsible for conducting clinical review of medical claims to ensure services were medically...Full timeL.A. Care Health Plan
Lancaster, CA2 days ago$40.12 - $62.19 per hour
...Utilization Review Nurse RN ~Sign On Bonus Potential: 6,000 ~Randallstown, MD ~NORTHWEST HOSPITAL ~NW CARE MANAGEMENT ~Part-time w/Weekend Commitment - Day/Night rotation - Rotating-7am-730pm/7pm-730am ~RN OTHER ~96531 ~$...Part timeRelocation packageShift workNight shiftWeekend workLifeBridge Health
Randallstown, MD3 days ago- ...yourcommission in Bellaire, Texas is seeking a Utilization Management Review Nurse (UMRN) to evaluate medical services and ensure appropriate care levels. Candidates must have a Bachelor’s degree in Nursing and be a Registered Nurse licensed in Texas. This role involves...Remote workFlexible hours
yourcommission
Bellaire, TX5 days ago - A Director for Cyber Security position is now available through Adecco Healthcare and Life Science. In this position, you will be responsible for reporting reports to the Chief Information Security Officer (CISO) and oversees cybersecurity operations and strategy. This...Temporary workWork experience placementFor subcontractorWork at officeLocal areaRelocation package
Adecco USA
Knoxville, TN5 days ago - ...of avoidable days. Enter Ancillary notes utilizing the templates for care facilitation. Proactively... ...to develop patient care plans and review medical needs for continued hospital services... ...consumption. Utilize case manager nurse-driven protocols to facilitate care and request...Full time
University of Miami
Doral, FL5 days ago - ...Utilization Review Nurse (RN) A Few Words About Us - Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its...Work experience placement
Careers Integrated Resources Inc
Raleigh, NC1 day ago $28.85 - $31.25 per hour
...care and long-term care needs for medical necessity Perform case reviews and complete all required documentation in appropriate... ...72-hours for weekend) Provide outpatient or pharmacy services utilization review Qualifications 3+ years in recent medical/surgical or critical...Private practiceWeekend workWeekday workHealthCare Support
Fort Lauderdale, FL3 days ago- ...Case Management Society of America (CMSA) ® is seeking a Utilization Management Review Nurse (UMRN) in Bellaire, Texas. The role involves evaluating the appropriateness of medical services while collaborating with healthcare professionals to enhance patient outcomes. The...Remote workFlexible hours
Case Management Society of America Inc
Bellaire, TX5 days ago - A healthcare provider is seeking a Utilization Review Nurse to coordinate resources and ensure efficient delivery of home health care. This role involves monitoring patient admissions and ongoing care while ensuring adherence to guidelines. The ideal candidate will have...Contract workRemote work
IntePros
Phoenix, AZ4 days ago - ...Utilization Review Registered Nurse Job Summary Join our team and be a part of our mission to deliver accessible, high-quality, affordable, and compassionate healthcare. Prairie Lakes Healthcare System is a non-profit healthcare system serving 10 counties in...Full timePart timeWork from homeMonday to FridayFlexible hoursWeekend work
Prairie Lakes Healthcare System
Watertown, SD4 days ago - ...position is responsible for performing accurate and timely medical review of claims suspended for medical necessity, contract... ...Organizational skills and prioritization skills. ~ Registered Nurse (RN) with unrestricted license in state . ~3 years clinical experience...Full timeContract workRemote work
Innovative Systems Group
Richardson, TX4 days ago - 40 hours per week Position: Utilization Review (UR) Nurse Company Overview Telenett is a leading healthcare company based in Honolulu, HI. We provide innovative and high-quality healthcare services to our clients, including insurance companies, hospitals, and healthcare...Relocation package
Telenett
Honolulu, HI4 days ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Utilization Review Nurse. Be the first to apply!
- utilization review nurse United States
- utilization review registered nurse United States
- remote utilization review nurse part time United States
- utilization review nurse part time United States
- utilization review nurse work from home United States
- remote utilization review nurse United States
- utilization review nurse
- utilization review registered nurse
- remote utilization review nurse part time
- utilization review nurse part time