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 JobsOverview
Showing 5 of 40+ Utilization Review Nurse jobs
Major Responsibilities:
- Documents utilization review activity per department and medical center standards in a timely manner. Performs and documents accurate and timely concurrent and retrospective reviews based on approved established criteria.
- Communicates effectively with the healthcare team. Works closely with medical staff, hospital departments and ancillary services as part of Outcome Facilitation Team/Multidisciplinary Team in expediting care delivery to avoid delays in timely service provision and implementing and reporting utilization management (UM) activities, as applicable.
- Collaborates with managers, physicians, medical directors, advisory groups and treatment teams for issues related to physician practices and best practices for the patient’s plan of care. Refers cases to physician advisor as needed to ensure accurate status and compliance with regulatory guidelines.
- Remains knowledgeable in issues of healthcare regulations, reimbursement issues, impact on length of stay and community resources. Provides clinical updates to payers and/or external review organizations, collects data, coordinates denial activity, supports UM activity, and manages avoidable delays.
- Develops and maintains productive relationships with community-based agencies and networks by representing Aurora Health Care in a positive manner working collaboratively, internally and externally, to meet patient/family needs.
- Serves as an educator and expert resource to medical and hospital staff regarding admission status and acute care criteria, utilization management issues, and relevant regulatory requirements.
- Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served. Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify each patient's requirements relative to his/her age-specific needs, and to provide the care needed as described in the department's policies and procedures. Age-specific information is developed further in the departmental job standards.
Licensure, Registration, and/or Certification Required:
Registered Nurse license issued by the state in which the team member practices.
Education Required:
Bachelor's Degree (or equivalent knowledge) in Nursing.
Experience Required:
Typically requires 3 years of experience in clinical nursing, utilization and/or quality management.
Knowledge, Skills & Abilities Required:
- Must have working knowledge in the use of Microsoft Office (Excel, Outlook, PowerPoint and Word) or similar products.
- Knowledge of the components of quality and acute care patient care needs specifically related to the area/function in which care management will be performed.
- Demonstrates working knowledge of Utilization Review criteria as demonstrated by achieving 80% or greater on the annual InterRater Reliability (IRR) competency exam.
- Utilizes critical thinking skills to analyze and synthesize clinical scenarios as it relates to application of medical necessity criteria.
- Excellent analytical and interpersonal communication skills necessary to interact with families, patients, physicians, and third party payers.
- Ability to manage conflict appropriately, seeking a win-win outcome by communicating issues in accordance with the Aurora Service commitments.
- Promotes effective professional relationships with physicians and other professionals in a direct and positive manner.
- Takes responsibility for self-development by seeking out opportunities for professional growth and development and being an active participant in department, hospital, and system initiatives.
Physical Requirements and Working Conditions:
- Must be able to sit for approximately 50 percent of the workday; stand and walk for the equivalent of several blocks at a time.
- Must lift up to 10lbs. continuously and up to 20 lbs. frequently.
- Manual dexterity required for operation of computer and calculator.
- Visual acuity required for facilitating review of written documents/computer screens, medical records, and to record information accurately.
- Clear verbal communications and hearing acuity required for receiving instructions and converse on standard telephone.
- Functional speech and hearing to allow for effective communication of instructions and conversation over the telephone.
- Exposed to normal office environment; including usual hazards related to operating electrical equipment.
- Operates all equipment necessary to perform the job.
- May be exposed to mechanical, electrical, chemical, and radiation hazards as well as blood and body fluids; therefore, personal protective equipment must be worn as necessary.
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
Major Responsibilities:
- Documents utilization review activity per department and medical center standards in a timely manner. Performs and documents accurate and timely concurrent and retrospective reviews based on approved established criteria.
- Communicates effectively with the healthcare team. Works closely with medical staff, hospital departments and ancillary services as part of Outcome Facilitation Team/Multidisciplinary Team in expediting care delivery to avoid delays in timely service provision and implementing and reporting utilization management (UM) activities, as applicable.
- Collaborates with managers, physicians, medical directors, advisory groups and treatment teams for issues related to physician practices and best practices for the patient’s plan of care. Refers cases to physician advisor as needed to ensure accurate status and compliance with regulatory guidelines.
- Remains knowledgeable in issues of healthcare regulations, reimbursement issues, impact on length of stay and community resources. Provides clinical updates to payers and/or external review organizations, collects data, coordinates denial activity, supports UM activity, and manages avoidable delays.
- Develops and maintains productive relationships with community-based agencies and networks by representing Aurora Health Care in a positive manner working collaboratively, internally and externally, to meet patient/family needs.
- Serves as an educator and expert resource to medical and hospital staff regarding admission status and acute care criteria, utilization management issues, and relevant regulatory requirements.
- Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served. Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify each patient's requirements relative to his/her age-specific needs, and to provide the care needed as described in the department's policies and procedures. Age-specific information is developed further in the departmental job standards.
Licensure, Registration, and/or Certification Required:
Registered Nurse license issued by the state in which the team member practices.
Education Required:
Bachelor's Degree (or equivalent knowledge) in Nursing.
Experience Required:
Typically requires 3 years of experience in clinical nursing, utilization and/or quality management.
Knowledge, Skills & Abilities Required:
- Must have working knowledge in the use of Microsoft Office (Excel, Outlook, PowerPoint and Word) or similar products.
- Knowledge of the components of quality and acute care patient care needs specifically related to the area/function in which care management will be performed.
- Demonstrates working knowledge of Utilization Review criteria as demonstrated by achieving 80% or greater on the annual InterRater Reliability (IRR) competency exam.
- Utilizes critical thinking skills to analyze and synthesize clinical scenarios as it relates to application of medical necessity criteria.
- Excellent analytical and interpersonal communication skills necessary to interact with families, patients, physicians, and third party payers.
- Ability to manage conflict appropriately, seeking a win-win outcome by communicating issues in accordance with the Aurora Service commitments.
- Promotes effective professional relationships with physicians and other professionals in a direct and positive manner.
- Takes responsibility for self-development by seeking out opportunities for professional growth and development and being an active participant in department, hospital, and system initiatives.
Physical Requirements and Working Conditions:
- Must be able to sit for approximately 50 percent of the workday; stand and walk for the equivalent of several blocks at a time.
- Must lift up to 10lbs. continuously and up to 20 lbs. frequently.
- Manual dexterity required for operation of computer and calculator.
- Visual acuity required for facilitating review of written documents/computer screens, medical records, and to record information accurately.
- Clear verbal communications and hearing acuity required for receiving instructions and converse on standard telephone.
- Functional speech and hearing to allow for effective communication of instructions and conversation over the telephone.
- Exposed to normal office environment; including usual hazards related to operating electrical equipment.
- Operates all equipment necessary to perform the job.
- May be exposed to mechanical, electrical, chemical, and radiation hazards as well as blood and body fluids; therefore, personal protective equipment must be worn as necessary.
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
See All 40+ Utilization Review Nurse Jobs
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Find Utilization Review Nurse JobsUtilization Review Nurse Job Market
A snapshot from current openings nationwide, updated as new roles post.
Who's Hiring
- Freeman Health System3
- Houston Methodist3
- CHRISTUS Health2
- Capital Health System2
- Lifebridge Health2
Top Industries Hiring
- Healthcare & Medical Services31
- Education5
- Insurance3
- Consulting & Professional Services1
- 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 Freeman Health System, Houston Methodist, and CHRISTUS Health, with the largest share of openings in Texas, Missouri, and Maryland, based on current listings on Migrate Mate as of June 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 23% of utilization review nurse openings are fully remote or hybrid as of June 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 40+ Utilization Review Nurse Jobs
Jump back to the full list of openings and apply to any utilization review nurse role that fits.
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