Utilization Review Nurse
WVU Medicine · United States · US
Utilization Review
Remote
Nurse
Demand78
Career growth68
Healthcare fit85
Remote potential35
5-year outlook
Stable demand for utilization review nurses, with pay varying by region, payer, and experience; RNs who add UM, InterQual/Milliman, and managed care expertise can progress into senior review, team lead, or manager roles.
Clinical license
Required
Applicant reach
moderate
Seniority
mid
Employment type
full-time
Date found
2026-10-03
Intelligence details
Flexible work details
- Engagement type
- Permanent
- Hours
- Full-time
- Eligible countries
- United States
- License jurisdiction
- US
- Profession fit
- Nurse
- Rate period
- Annual
Listing via Himalayas.
Eligibility, licensing, and location restrictions can change. Always confirm details on the source posting before applying.
Why this is worth applying to
A solid non-clinical pathway for nurses with clinical experience who want payer-side utilization management; however, it requires an active RN license and may be less accessible without prior UM or managed care exposure.
Who should apply
Registered nurses with at least three years of clinical experience, especially those interested in utilization management, care management, Medicare/Medicaid populations, or health plan medical management.
CV angle
Frame clinical experience around care coordination, discharge planning, application of evidence-based criteria, communication with multidisciplinary teams, and any exposure to prior authorization, utilization review, quality, or managed care; emphasize RN license and familiarity with InterQual/Milliman or NCQA if applicable.
Skills to highlight
- Utilization management
- Prior authorization
- Concurrent and retrospective review
- InterQual/Milliman Care Guidelines
- Care coordination
- Discharge planning
- NCQA/regulatory compliance
- Medicare/Medicaid managed care
- Clinical documentation review
- Multidisciplinary collaboration
Role summary
An RN utilization review position within a health plan's medical management team, responsible for prior authorization, concurrent and retrospective reviews, care variance reduction, timely discharge support, and collaboration with medical directors and care management staff.
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