Utilization Review Nurse Jobs
Utilization Review Nurse jobs are open across health insurance, managed care, hospital systems, and third-party administrators, from staff to senior and supervisory levels, with specializations in acute care, behavioral health, and case management. Find a role that fits from the openings below and apply directly.
Find Utilization Review Nurse JobsLooking for remote work? View remote utilization review nurse jobs →Overview
Showing 5 of 151+ Utilization Review Nurse jobs
Part time
Shift:
Day Shift
Description:
Reporting to the Manager Social Services, Social Services, this position coordinates utilization review service for defined patient populations across the acute care continuum. This includes discharge planning, utilization management, care coordination collaboration, and support for resource utilization. This position works collaboratively with an interdisciplinary team to improve patient care through the effective utilization of the facility's resources.
Requirements
1. Current licensure as a Registered Nurse (RN) in the state of California is required.
2. Current American Heart Association (AHA) Healthcare Provider CPR card is preferred.
3. Degree from an accredited baccalaureate nursing program (BSN) is preferred.
4. Certified Case Manager (CCM) national certification is preferred.
5. InterQual training must be obtained within six (6) months of hire into position.
6. Previous experience in at least two (2) areas of clinical specialty in an acute care setting is required.
7. Excellent communication skills, critical thinking, creative problem-solving skills, and competent organizational and planning skills are required.
8. The incumbent must be self-directed and able to tolerate frequent interruptions with a demanding workload.
9. Knowledge regarding hospital protocol and procedures, clinical standards and outcomes, funding options, familiarity with community resources and outside professional agencies, familiarity with federal and state regulations governing hospital and home care, as well as understanding of the financial structure of health plan and delivery system is preferred.
Pay Range
$49.47 - $71.74
Our Commitment
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.
Part time
Shift:
Day Shift
Description:
Reporting to the Manager Social Services, Social Services, this position coordinates utilization review service for defined patient populations across the acute care continuum. This includes discharge planning, utilization management, care coordination collaboration, and support for resource utilization. This position works collaboratively with an interdisciplinary team to improve patient care through the effective utilization of the facility's resources.
Requirements
1. Current licensure as a Registered Nurse (RN) in the state of California is required.
2. Current American Heart Association (AHA) Healthcare Provider CPR card is preferred.
3. Degree from an accredited baccalaureate nursing program (BSN) is preferred.
4. Certified Case Manager (CCM) national certification is preferred.
5. InterQual training must be obtained within six (6) months of hire into position.
6. Previous experience in at least two (2) areas of clinical specialty in an acute care setting is required.
7. Excellent communication skills, critical thinking, creative problem-solving skills, and competent organizational and planning skills are required.
8. The incumbent must be self-directed and able to tolerate frequent interruptions with a demanding workload.
9. Knowledge regarding hospital protocol and procedures, clinical standards and outcomes, funding options, familiarity with community resources and outside professional agencies, familiarity with federal and state regulations governing hospital and home care, as well as understanding of the financial structure of health plan and delivery system is preferred.
Pay Range
$49.47 - $71.74
Our Commitment
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.
Utilization Review Nurse Jobs by Experience Level
See All 151+ Utilization Review Nurse Jobs
Find roles that match your experience and apply in just a few clicks.
Find Utilization Review Nurse JobsUtilization Review Nurse Job Market
Who's Hiring
Top Industries Hiring
- Healthcare & Medical Services25
- Insurance4
- Non-Profit & Social Services3
- Education2
- Consulting & Professional Services2
What Employers Look For
The qualifications that appear most often in utilization review nurse jobs.
- Active registered nurse license with at least two years of acute care clinical experience
- Working knowledge of InterQual or Milliman evidence-based clinical criteria sets
- Experience with prior authorization, concurrent review, or discharge planning processes
- Proficiency with electronic health records and payer portal documentation systems
- Certified Case Manager (CCM) credential or willingness to obtain within a defined timeframe
- Strong written communication skills for denial letters and clinical documentation in compliance with regulatory standards
Tips for Your Utilization Review Nurse Job Search
Tailor your resume to UR criteria
Highlight your clinical decision-making experience alongside specific criteria sets you've used, such as InterQual or Milliman. Employers want to see that you can apply evidence-based guidelines, not just that you have bedside nursing hours.
Lead with your certifications upfront
Certified Case Manager or Registered Health Information Administrator credentials often appear as preferred qualifications in utilization review nurse postings. List them immediately after your name so reviewers spot them before reading your experience section.
Filter openings by payer versus provider side
Roles at insurance companies focus on prior authorization and denial management, while hospital-based positions lean toward concurrent review and discharge planning. Knowing which side fits your background helps you target the right listings and write sharper cover letters.
Apply early to roles that fit
Migrate Mate lists utilization review nurse openings from across the United States in one place, so you can find roles that match and apply directly to each listing.
Prepare for competency-based interview questions
Interviewers frequently ask how you handled a denial that conflicted with a physician's recommendation. Prepare two or three specific examples where you applied clinical criteria, communicated a decision clearly, and documented the outcome in compliance with payer requirements.
Negotiate remote or hybrid terms strategically
Many utilization review nurse roles are performed entirely by phone and electronic health record, making remote arrangements common. Ask about equipment provisions, productivity metrics, and audit processes during the offer stage so expectations are documented before you accept.
Utilization Review Nurse Jobs: Frequently Asked Questions
Which companies are hiring the most utilization review nurses?
The companies hiring the most utilization review nurses right now include Providence, Kaiser Permanente, and Kern Medical, with the largest share of openings in California, Texas, and Florida, based on current listings on Migrate Mate as of August 2026. Managed care organizations and large hospital systems consistently account for the highest volume of postings.
How many utilization review nurse jobs are remote?
About 66% of utilization review nurse openings are fully remote or hybrid as of August 2026, reflecting how much of the work happens over phone and electronic health record systems rather than at the bedside. Prior authorization and telephonic case management sub-specialties tend to have the highest concentration of remote-eligible postings.
How do you become a utilization review nurse?
You become a utilization review nurse by first earning your registered nurse license and gaining clinical experience, typically in a hospital or acute care setting. From there, you build familiarity with payer criteria sets like InterQual or Milliman, pursue a Certified Case Manager credential if possible, and apply to roles in insurance companies, managed care organizations, or hospital utilization management departments.
Can you get a utilization review nurse job with limited UR experience?
Yes, employers routinely hire registered nurses with strong acute care backgrounds into entry-level utilization review roles and provide on-the-job training on criteria application and payer processes. Emphasizing experience with discharge planning, care coordination, or insurance verification strengthens your application, and roles labeled 'utilization management nurse' or 'clinical reviewer' often have more flexible experience requirements.
What does the utilization review nurse interview process look like?
The process typically begins with a phone screen from a recruiter or nurse manager covering your clinical background and familiarity with criteria sets. A second round usually involves a panel or one-on-one interview with scenario-based questions about denial decisions and physician communication. Some employers also include a brief written exercise where you review a clinical scenario and document a coverage recommendation.
Where can I find and apply to utilization review nurse jobs?
You can find and apply to utilization review nurse jobs on Migrate Mate, which lists current openings from across the United States. Find the roles that match your clinical background and the care setting you prefer, then apply directly to each listing. No separate sign-up step is needed before you apply.
See All 151+ Utilization Review Nurse Jobs
Find roles that match your experience and apply in just a few clicks.
Find Utilization Review Nurse Jobs