Utilization Review RN
Sedgwick · United States · US
Utilization Review
Remote
physician
Nurse
Demand78
Career growth65
Healthcare fit88
Remote potential60
5-year outlook
Utilization review nursing roles are likely to remain stable as payers and insurers manage costs and quality. Compensation should stay competitive for experienced RNs, with growth into senior review, audit, quality, or utilization management leadership rather than explosive salary growth.
Clinical license
Required
Applicant reach
moderate
Seniority
mid
Employment type
full-time
Date found
2026-10-25
Intelligence details
Flexible work details
- Engagement type
- Permanent
- Hours
- Full-time
- Eligible countries
- United States
- License jurisdiction
- US
- Profession fit
- physician, 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
Worth considering for nurses seeking a non-bedside, insurance-based utilization review role with predictable work and transferable clinical assessment skills. The main barriers are the active RN license, experience requirement, and metric-driven audit/productivity environment.
Who should apply
RNs with recent clinical practice experience who want to move into utilization management, insurance review, or managed care; especially nurses comfortable with medical record review, evidence-based criteria, provider communication, and documentation.
CV angle
Frame bedside or clinical RN experience around medical record review, clinical assessment, evidence-based decision-making, provider communication, documentation quality, and ability to apply guidelines. Highlight any case management, insurance, claims, audit, quality, or utilization review exposure without overstating non-clinical experience.
Skills to highlight
- Clinical assessment and medical record review
- Evidence-based criteria application
- Utilization review and treatment plan evaluation
- Provider communication and negotiation
- Documentation and audit compliance
- Insurance/claims process awareness
- Productivity and quality metrics
- Interdisciplinary collaboration
Role summary
An RN utilization review role at Sedgwick reviewing treatment plan requests, analyzing medical records, applying evidence-based and jurisdictional criteria, documenting determinations, and coordinating with providers and claim examiners to support quality and cost-effective outcomes.
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