Utilization Review Nurse
Rising Medical Solutions
Posted: 10/21/2026
EMT, PARA, LPN/LVN, RN
Grifols
Posted: 10/21/2026EMT, LPN/LVN
Grifols
Posted: 10/21/2026
Registered Nurse, Dialysis
Fresenius Medical Care
Posted: 10/21/2026
Registered Nurse
DaVita Kidney Care
Posted: 10/20/2026New Graduate Registered Nurse, RN
Fresenius Medical Care
Posted: 10/20/2026New Graduate Registered Nurse, RN
Fresenius Medical Care
Posted: 10/20/2026New Graduate Registered Nurse, RN
Fresenius Medical Care
Posted: 10/20/2026New Graduate Registered Nurse, RN
Fresenius Medical Care
Posted: 10/20/2026
Outpatient Review Nurse
All Care To You
Posted: 10/20/2026
Medical Office Nurse Coordinator, General Surgery/Urology
Olympic Medical Center
Posted: 10/20/2026
Nurse Aide
Monument Health
Posted: 10/20/2026
Clinical Nurse – OR
Dayton Children's Hospital
Posted: 10/20/2026
Triage Nurse
Vail Health
Posted: 10/20/2026
Nurse Liaison I – Utilization Management, Quality Review
Health Care Service Corporation
Posted: 10/20/2026
Travel Registered Nurse, RN – Med Surg Tele
Trinity Health
Posted: 10/20/2026Travel Registered Nurse, RN, Behavioral Health
Trinity Health
Posted: 10/20/2026Travel Registered Nurse, RN, Emergency Department
Trinity Health
Posted: 10/20/2026Travel Registered Nurse, RN, Labor & Delivery, L&D
Trinity Health
Posted: 10/20/2026Travel Registered Nurse, RN – Pediatrics
Trinity Health
Posted: 10/20/2026Utilization Review Nurse
Rising Medical SolutionsCore Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Utilization Review processes, including clinical judgment and evidence-based guidelines, while maintaining strong communication and organizational skills. Proficient in managing case documentation and collaborating with various stakeholders in a fast-paced environment.
Highest-signal resume keywords
Utilization Review ProcessActive RN LicenseClinical Practice ExperienceCPT and ICD-9/ICD-10 CodesMicrosoft Word, Excel, and Outlook
About the role
Key responsibilities & impact- Perform all aspects of the Utilization Review Process
- Review records and requests for utilization review received via mail, email, fax, or phone
- Use evidence-based guidelines to determine authorization or refer files for Peer or Physician Review
- Write nurse summaries on all utilization review files
- Document in Rising's and client databases and send determination letters
- Establish collaborative relationships with clients, patients, employers, providers, and attorneys
- Track utilization review activity to meet turnaround times
- Maintain organized files containing clinical documentation of claim interactions
- Apply clinical judgment, careful listening, critical thinking, and assessment skills
- Respond to written and telephone inquiries regarding case status
- Use a computer and multiple software programs simultaneously
Requirements
What you’ll need- An Associate's or Bachelor's degree in Nursing
- Hold an active and unencumbered RN license in one or more states
- 3 to 5 years of clinical practice experience or 2 years of case management and/or UR experience
- More than one state license (a plus)
- Experience with Workers' Compensation, short-term or long-term disability, or liability claims
- Ability to set priorities and work both autonomously and as a team member
- Well-developed time-management, organization, and prioritization skills
- Excellent analytical skills
- Superb oral and written communication
- Ability to gather data, compile information, and prepare summary reports
- Strong interpersonal and conflict resolution skills
- Experience in a fast-paced, multi-faceted environment
- Demonstrated persistence and attention to detail
- General understanding of CPT and ICD-9/ICD-10 codes and Medicare guidelines
- Working knowledge of Microsoft Word, Excel, and Outlook
- Ability to remain calm during stressful situations
- A customer-service mindset
Benefits
Comp & perks- Generous Flexible Time Off (take it when you need it!)
- Comprehensive benefit package including health/dental/vision insurance, profit sharing, and 401k matching
- Career Growth Opportunities - We often promote from within
- Professional Development Reimbursement Program (PDRP)
- Elevate program designed to recognize and reward employees for their hard work
- Top Workplace recognition in the healthcare industry for 2023
- Company culture and social media resources
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Utilization ReviewClinical JudgmentEvidence-Based GuidelinesData CompilationSummary Report Preparation
Soft Skills
Analytical SkillsOral and Written CommunicationInterpersonal SkillsConflict ResolutionTime Management
Tools & Technologies
Rising's DatabaseClient DatabasesMicrosoft WordMicrosoft ExcelMicrosoft Outlook
Certifications & Qualifications
Active RN License
Industry Keywords
Workers' CompensationDisability ClaimsLiability ClaimsPeer ReviewMedicare Guidelines