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.
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Showing 5 of 152+ Utilization Review Nurse jobs
Ready to lead the clinical team that keeps care moving when it matters most?
Why This Role Matters
Schedule: Monday–Friday, 8:00 AM–5:00 PM Pacific Time, with rotating Saturday coverage as required.
What You'll Actually Do
- Set daily direction for your UM team: Establish priorities, reinforce expectations, and build a culture where clinical quality and accountability are the norm, not the exception.
- Coach reviewers on criteria application: Guide consistent use of medical-necessity criteria, medical policy, and benefit language, and step in with real-time answers when interpretations vary.
- Monitor workflow health daily: Track intake volume, aging cases, and turnaround risk; flag barriers to the UM Manager with a recommendation attached, not just a problem.
- Audit for documentation quality: Review reviewer work for completeness and audit readiness, then coach for sharper clinical rationale and tighter regulatory timeliness.
- Build reviewer capability: Run shadowing plans, job aids, and competency check-ins for new and existing staff; identify training gaps and propose solutions before they become bigger problems.
- Resolve cross-team barriers: Partner with providers, facilities, Case Management, Appeals, and Provider Relations to clear roadblocks and keep determinations moving.
- Protect member and company data: Maintain HIPAA compliance and company privacy standards, and model the ethical decision-making you expect from your team.
- Drive training completion: Complete required training and attestations on time, and keep your team on track to do the same.
Qualifications:
What You Bring to Our Team
- Active RN license
- Experience in utilization management, clinical review, or case management
- Background applying medical-necessity criteria and benefit plan interpretation in a healthcare payer or clinical review setting
- Proficiency with UM platforms and standard office/productivity tools
- Working knowledge of medical terminology and coding concepts (ICD-10, CPT, HCPCS) sufficient to support accurate UM documentation
- Familiarity with remote collaboration tools for team visibility and responsiveness
Benefits
The Highlights:
- Competitive base salary and benefits effective day one
- Comprehensive medical and dental through our own health solutions (yes, we use what we build)
- Paid Time Off—rest and recharge time is non-negotiable
- Mental health support, retirement planning, and financial protection
- Professional development with clear career progression and learning budgets
- Mission-driven culture where diverse perspectives drive real impact on people's health
Our Commitment: Personify Health is an equal opportunity employer committed to diversity, equity, inclusion, and belonging. We cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive—because diversity is core to who we are and critical to our work in health and wellbeing.
Stay Safe: Personify Health will never ask for payment or sensitive personal information like social security numbers during hiring. All official communication comes from verified company email addresses and or our secure applicant tracking system. Suspicious requests? Report them to talent@personifyhealth.com. View all legitimate openings at personifyhealth.com/careers.
Ready to lead the clinical team that keeps care moving when it matters most?
Why This Role Matters
Schedule: Monday–Friday, 8:00 AM–5:00 PM Pacific Time, with rotating Saturday coverage as required.
What You'll Actually Do
- Set daily direction for your UM team: Establish priorities, reinforce expectations, and build a culture where clinical quality and accountability are the norm, not the exception.
- Coach reviewers on criteria application: Guide consistent use of medical-necessity criteria, medical policy, and benefit language, and step in with real-time answers when interpretations vary.
- Monitor workflow health daily: Track intake volume, aging cases, and turnaround risk; flag barriers to the UM Manager with a recommendation attached, not just a problem.
- Audit for documentation quality: Review reviewer work for completeness and audit readiness, then coach for sharper clinical rationale and tighter regulatory timeliness.
- Build reviewer capability: Run shadowing plans, job aids, and competency check-ins for new and existing staff; identify training gaps and propose solutions before they become bigger problems.
- Resolve cross-team barriers: Partner with providers, facilities, Case Management, Appeals, and Provider Relations to clear roadblocks and keep determinations moving.
- Protect member and company data: Maintain HIPAA compliance and company privacy standards, and model the ethical decision-making you expect from your team.
- Drive training completion: Complete required training and attestations on time, and keep your team on track to do the same.
Qualifications:
What You Bring to Our Team
- Active RN license
- Experience in utilization management, clinical review, or case management
- Background applying medical-necessity criteria and benefit plan interpretation in a healthcare payer or clinical review setting
- Proficiency with UM platforms and standard office/productivity tools
- Working knowledge of medical terminology and coding concepts (ICD-10, CPT, HCPCS) sufficient to support accurate UM documentation
- Familiarity with remote collaboration tools for team visibility and responsiveness
Benefits
The Highlights:
- Competitive base salary and benefits effective day one
- Comprehensive medical and dental through our own health solutions (yes, we use what we build)
- Paid Time Off—rest and recharge time is non-negotiable
- Mental health support, retirement planning, and financial protection
- Professional development with clear career progression and learning budgets
- Mission-driven culture where diverse perspectives drive real impact on people's health
Our Commitment: Personify Health is an equal opportunity employer committed to diversity, equity, inclusion, and belonging. We cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive—because diversity is core to who we are and critical to our work in health and wellbeing.
Stay Safe: Personify Health will never ask for payment or sensitive personal information like social security numbers during hiring. All official communication comes from verified company email addresses and or our secure applicant tracking system. Suspicious requests? Report them to talent@personifyhealth.com. View all legitimate openings at personifyhealth.com/careers.
Utilization Review Nurse Jobs by Experience Level
See All 152+ 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
- Centene11
- LCMC Health3
- Voyage Health3V
- American Traveler3
- Lifebridge Health3
Top Industries Hiring
- Healthcare & Medical Services13
- Insurance5
- Consulting & Professional Services2
- Staffing & Recruiting1
- Government & Public Sector1
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 Centene, LCMC Health, and Voyage Health, with the largest share of openings in California, Texas, and Florida, based on current listings on Migrate Mate as of September 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 76% of utilization review nurse openings are fully remote or hybrid as of September 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 152+ Utilization Review Nurse Jobs
Find roles that match your experience and apply in just a few clicks.
Find Utilization Review Nurse Jobs