How to hire a utilization review nurse

How to hire a utilization review nurse, step by step

Here's a step-by-step utilization review nurse hiring guide:

• Step 1: Identify your hiring needs
• Step 2: Create an ideal candidate profile
• Step 3: Make a budget
• Step 4: Write a utilization review nurse job description
• Step 5: Post your job
• Step 6: Interview candidates
• Step 7: Send a job offer and onboard your new utilization review nurse
• Step 8: Go through the hiring process checklist

What does a utilization review nurse do?

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1. Identify your hiring needs

   Before you start hiring a utilization review nurse, identify what type of worker you actually need. Certain positions might call for a full-time employee, while others can be done by a part-time worker or contractor.

   Determine employee vs contractor status

   Is the person you're thinking of hiring a US citizen or green card holder?

   Yes

   No

   You should also consider the ideal background you'd like them a utilization review nurse to have before you start to hire. For example, what industry or field would you like them to have experience in, what level of seniority or education does the job require, and how much it'll cost to hire a utilization review nurse that fits the bill.

   The following list breaks down different types of utilization review nurses and their corresponding salaries.

   Type of Utilization Review Nurse	Description	Hourly rate
   Utilization Review Nurse	Registered nurses (RNs) provide and coordinate patient care, educate patients and the public about various health conditions, and provide advice and emotional support to patients and their family members.	$22-42
   Nurse Case Manager	A nurse case manager's role focuses on providing advice and medication to patients in an outpatient clinic or hospital. Typically, their responsibilities revolve around conducting extensive assessments, discussing essential matters to patients and families, devising efficient health care plans, coordinating with health care experts to share patients' progress, determining the needed care, and performing follow-up services... Show more	$23-46
   Nurse Coordinator	A nurse coordinator is primarily in charge of overseeing all nurses and their activities in a hospital or clinic. Their responsibilities include managing and rotating schedules, assessing nurse performance, organizing nursing programs, and developing strategies to optimize procedures... Show more	$29-49

   Show more

2. Create an ideal candidate profile

   Common skills:

   • Medical Necessity
   • Patients
   • Acute Care
   • Discharge Planning
   • Utilization Management
   • Utilization Review
   • Community Resources
   • Outpatient Services
   • Clinical Knowledge
   • Home Health
   • Patient Care
   • Appeals
   • CPT
   • Medical Directors

   Check all skills

   Responsibilities:

   • Monitor patients' status during surgery (circulate in operating room) and manage patients in PACU.
   • Case management for acute patients refer to LTC
   • Advise insurance carriers on recommend reimbursement for charges following automate bill audit utilizing ICD-9 and CPT codes.
   • Provide caregiver oversight relate to care, medication administration and emergency situations.
   • Identify inappropriate utilization of services/settings through the application of establish clinical criteria using InterQual and CMS guidelines for medical necessity.
   • Direct contact with IPA providers.

   More utilization review nurse duties

3. Make a budget

   Including a salary range in your utilization review nurse job description helps attract top candidates to the position. A utilization review nurse salary can be affected by several factors, such as geography, experience, seniority, certifications, and the prestige of the hiring company.

   For example, the average salary for a utilization review nurse in Alabama may be lower than in Rhode Island, and an entry-level utilization review nurse usually earns less than a senior-level utilization review nurse. Additionally, a utilization review nurse with certifications may command a higher salary, and working for a well-known company or start-up may also impact an employee's pay.

   Average utilization review nurse salary

   $65,425yearly

   $31.45 hourly rate

   ---

   Entry-level utilization review nurse salary

   $47,000 yearly salary

   Updated December 21, 2025

   Average utilization review nurse salary by state

   Rank	State	Avg. salary	Hourly rate
   1	California	$94,616	$45
   2	District of Columbia	$83,068	$40
   3	Oregon	$80,893	$39
   4	New Jersey	$78,566	$38
   5	Connecticut	$78,016	$38
   6	New York	$76,952	$37
   7	Nevada	$76,008	$37
   8	Pennsylvania	$75,975	$37
   9	Massachusetts	$75,482	$36
   10	Hawaii	$75,232	$36
   11	Washington	$73,869	$36
   12	Alaska	$70,496	$34
   13	Michigan	$69,438	$33
   14	Maryland	$68,259	$33
   15	Georgia	$67,705	$33
   16	Texas	$67,688	$33
   17	Ohio	$67,409	$32
   18	Minnesota	$67,070	$32
   19	Illinois	$66,207	$32
   20	Arizona	$65,020	$31

   Average utilization review nurse salary by company

   Company

   Rank	Company	Average salary	Hourly rate	Job openings
   1	Molina Healthcare	$84,644	$40.69	62
   2	Tenet Healthcare	$82,694	$39.76	17
   3	Berkshire Hathaway	$80,717	$38.81	9
   4	Emanate Health	$78,506	$37.74
   5	Hackensack Meridian Health	$77,707	$37.36	10
   6	Novant Health	$77,644	$37.33	4
   7	Presbyterian	$77,203	$37.12	2
   8	Capital Health	$76,635	$36.84	2
   9	Guidehouse	$75,665	$36.38	4
   10	University of Massachusetts Medical School	$75,274	$36.19	10
   11	Medstar Health	$74,338	$35.74
   12	Heartland Home Health Inc.	$74,143	$35.65	3
   13	Washington Regional Medical Center	$73,668	$35.42	1
   14	HCR Home Care	$72,907	$35.05
   15	Zurich	$72,601	$34.90	2
   16	The Travelers Companies	$72,522	$34.87
   17	Public Consulting Group	$72,462	$34.84
   18	Children's of Alabama	$72,199	$34.71	6
   19	Atlas Healthcare Partners	$71,917	$34.58
   20	CorVel	$71,902	$34.57	6

4. Writing a utilization review nurse job description

   A utilization review nurse job description should include a summary of the role, required skills, and a list of responsibilities. It's also good to include a salary range and the first name of the hiring manager. To help get you started, here's an example of a utilization review nurse job description:

   Utilization review nurse job description example

   You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
   
   Identify placement settings that offer the lowest level of restriction and greatest level of autonomy for the members based upon medical necessity.
   Monitor quality of care and collect and analyze utilization data
   
   Serve as a resource between the health plan, provider relations, and dental providers
   
   Review treatment plans and initial evaluations
   
   Comply with performance measures in regards to denials and concurrent review timeliness
   
   Develop and maintain collaborative relationships with providers and educate on levels of care
   
   Position Purpose: To function as a dental services liaison between the Delaware Medicaid authority and Delaware First Health plan. Act as a point of contact and resolution as required. Additional responsibilities to include utilization review of dental services provided in provider offices, community health centers, hospitals, and out-of-network settings based on medical necessity, eligibility, and in accordance with contract language.
   
   Experience: Graduate of accredited school of Dental Hygiene. 3+ years of utilization management or clinical experience in a dental office setting preferred. Previous experience documenting in Case Management or Utilization Management systems preferred.
   
   Licenses/Certifications: Possess an active and unrestricted license as a Licensed Dental Hygienist to practice as a health professional in a state or territory of the United States. The license has a scope of practice that is relevant to the clinical area(s) addressed in the initial clinical review.
   
   **Delaware only** : A dental services liaison who shall oversee and be responsible for all dental activities related to this Contract and serve as the main point of contact for DMMA regarding dental services.
   
   Location: Prospective employee must reside in the state of Delaware.
   
   Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
   
   Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
   
   **TITLE:** Utilization Management Reviewer - Dental
   
   **LOCATION:** Newark, Delaware
   
   **REQNUMBER:** 1371287

   Copy this example

   

5. Post your job

   There are various strategies that you can use to find the right utilization review nurse for your business:

   • Consider promoting from within or recruiting from your existing workforce.
   • Ask for referrals from friends, family members, and current employees.
   • Attend job fairs at local colleges to find candidates who meet your education requirements.
   • Use social media platforms like LinkedIn, Facebook, and Twitter to reach potential job candidates.

   Post your job online:

   • Post your utilization review nurse job on Zippia to find and recruit utilization review nurse candidates who meet your exact specifications.
   • Use field-specific websites.
   • Post a job on free websites.

6. Interview candidates

   To successfully recruit utilization review nurses, your first interview needs to engage with candidates to learn about their interest in the role and experience in the field. You can go into more detail about the company, the role, and the responsibilities during follow-up interviews.

   Remember to include a few questions that allow candidates to expand on their strengths in their own words. Asking about their unique skills might reveal things you'd miss otherwise. At this point, good candidates can move on to the technical interview.

   The right interview questions can help you assess a candidate's hard skills, behavioral intelligence, and soft skills.

7. Send a job offer and onboard your new utilization review nurse

   Once you've selected the best utilization review nurse candidate for the job, it's time to write an offer letter. In addition to salary, this letter should include details about the benefits and perks you offer the candidate. Ensuring that your offer is competitive is essential, as qualified candidates may be considering other job opportunities. The candidate may wish to negotiate the terms of the offer, and you should be open to discussion. After you reach an agreement, the final step is formalizing the agreement with a contract.

   It's equally important to follow up with applicants who don't get the job with an email letting them know that the position has been filled.

   To prepare for the new employee's start date, you can create an onboarding schedule and complete any necessary paperwork, such as employee action forms and onboarding documents like I-9 forms, benefits enrollment, and federal and state tax forms. Human Resources should also ensure that a new employee file is created.

8. Go through the hiring process checklist

   • Determine employee type (full-time, part-time, contractor, etc.)
   • Submit a job requisition form to the HR department
   • Define job responsibilities and requirements
   • Establish budget and timeline
   • Determine hiring decision makers for the role
   • Write job description
   • Post job on job boards, company website, etc.
   • Promote the job internally
   • Process applications through applicant tracking system
   • Review resumes and cover letters
   • Shortlist candidates for screening
   • Hold phone/virtual interview screening with first round of candidates
   • Conduct in-person interviews with top candidates from first round
   • Score candidates based on weighted criteria (e.g., experience, education, background, cultural fit, skill set, etc.)
   • Conduct background checks on top candidates
   • Check references of top candidates
   • Consult with HR and hiring decision makers on job offer specifics
   • Extend offer to top candidate(s)
   • Receive formal job offer acceptance and signed employment contract
   • Inform other candidates that the position has been filled
   • Set and communicate onboarding schedule to new hire(s)
   • Complete new hire paperwork (i9, benefits enrollment, tax forms, etc.)

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How much does it cost to hire a utilization review nurse?