How much does a Registered Nurse (RN)- Utilization Review (UR) make in the United States?

Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Being a Utilization Review Coordinator reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Additionally, Utilization Review Coordinator consults with physicians as needed. May require a bachelor's degree. Typically reports to a supervisor. Typically requires Registered Nurse(RN). The Utilization Review Coordinator contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. To be a Utilization Review Coordinator typically requires 4 to 7 years of related experience. View Utilization Review Coordinator Salary

A Remote Utilization Review Nurse is responsible for reviewing and analyzing medical records to determine the appropriateness and necessity of healthcare services provided to patients. They work remotely to assess the utilization of healthcare resources, ensure compliance with insurance and regulatory requirements, and identify opportunities for cost savings and improved patient outcomes. They collaborate with healthcare providers, insurance companies, and other stakeholders to make recommendations for treatment plans, discharge planning, and care coordination. Additionally, they may provide education and support to healthcare professionals and patients regarding utilization management and best practices. This role requires strong clinical knowledge, critical thinking skills, and the ability to work independently in a remote setting. View Remote Utilization Review Nurse Salary

Medical Utilization Review Director directs the team responsible for evaluating proposed and/or delivered healthcare services to determine if the services meet established health plan coverage guidelines. Receives, reviews, and acts on pre-authorization requests from service providers for medical procedures, treatments, admissions, and medications. Being a Medical Utilization Review Director reviews patient and clinical information to ensure compliance with established utilization review guidelines. Refers more complex requests and those that need clinical review to a medical reviewer. Additionally, Medical Utilization Review Director requires a bachelor's degree. Typically reports to senior management. The Medical Utilization Review Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. To be a Medical Utilization Review Director typically requires 5+ years of managerial experience. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. View Medical Utilization Review Director Salary

Medical Utilization Review Supervisor supervises the team responsible for evaluating proposed and/or delivered healthcare services to determine if the services meet established health plan coverage guidelines. Receives, reviews, and acts on pre-authorization requests from service providers for medical procedures, treatments, admissions, and medications. Being a Medical Utilization Review Supervisor reviews patient and clinical information to ensure compliance with established utilization review guidelines. Refers more complex requests and those that need clinical review to a medical reviewer. Additionally, Medical Utilization Review Supervisor may require a bachelor's degree. Typically reports to a manager. The Medical Utilization Review Supervisor supervises a group of primarily para-professional level staffs. May also be a level above a supervisor within high volume administrative/production environments. Makes day-to-day decisions within or for a group/small department. Has some authority for personnel actions. To be a Medical Utilization Review Supervisor typically requires 3-5 years experience in the related area as an individual contributor. Thorough knowledge of functional area and department processes. View Medical Utilization Review Supervisor Salary