Utilization Review Nurse Career Guide

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A Utilization Review RN is a specialized healthcare professional responsible for evaluating the medical necessity and efficiency of patient care. They collaborate with healthcare teams, insurance companies and patients to ensure that medical treatments and services are appropriate and cost-effective.

Essential Job Functions:

Utilization Review RNs play a crucial role in assessing patient care plans, reviewing medical records and ensuring


To become a Utilization Review RN, aspiring individuals need to complete an Associate or Bachelor of Science in Nursing (ASN or BSN) degree from an accredited nursing program. After completing their education, they must pass the NCLEX-RN exam to become a licensed registered nurse.

A stethoscope held in one hand

Related certifications

Utilization Review RNs often have a background in medical-surgical nursing or case management. Experience in a clinical setting is valuable, and certification in case management (CCM) is beneficial for demonstrating expertise in this field.

State licenses process and requirements

All 50 states require state licensure to become a professional nurse. Review the step-by-step process to obtain or renew your RN license in each one.
A stethoscope held in one hand


Successful Staff or Travel Utilization Review RNs need strong critical thinking skills, attention to detail and the ability to analyze medical information and guidelines. Excellent communication and collaboration skills are essential for working with interdisciplinary teams, insurance companies and patients.

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Utilization Review RNs review medical records, collaborate with healthcare teams to assess treatment plans, communicate with insurance companies to obtain authorization for procedures, ensure compliance with regulations and provide guidance on appropriate care and resource utilization.

Salary Insights

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Utilization Review Nurse

The average salary for a Utilization Review Nurse is $2,452.12 per week.

Last updated on September 30, 2023. Based on active jobs on Vivian.com.

Pros & Cons

Becoming a Utilization Review RN offers several advantages. It allows nurses to work in a non-clinical setting, contribute to cost-effective and quality patient care and utilize their clinical knowledge in a unique way. It also offers opportunities for remote work and flexible schedules.

However, the role may involve challenging conversations with healthcare providers and patients about treatment plans, denials and coverage.

Utilization Review Nurse Jobs

View job details for Oakland, CATravel ContractOakland, CATravel Nurse RN - Case Manager, Utilization ReviewMedical Solutions$3,618/wkEstimated pay package
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Posted 3 days ago
View job details for Oakland, CATravel ContractOakland, CATravel Nurse RN - Case Manager, Utilization ReviewMedical Solutions$3,600/wkEstimated pay package
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Posted 4 days ago
View job details for Juneau, AKTravel ContractJuneau, AKTravel Nurse RN - Case Manager, Utilization ReviewMedical Solutions$3,364/wk
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View job details for Poway, CATravel ContractPoway, CATravel Nurse RN - Case Manager, Utilization ReviewMedical Solutions$3,097/wkEstimated pay package
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Posted 2 days ago

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