Registered Nurse (RN), Utilization Review (UR) Salary
Job Description for Registered Nurse (RN), Utilization Review (UR)
The primary responsibility of the utilization review nurse is to review medical records and prepare clinical appeals (when appropriate) on medical necessity, level of care, length of stay, and authorization denials for hospitalized patients. An understanding of the severity of an array illnesses, intensity of service, and care coordination needs are key, as the nurse must integrate clinical knowledge with billing knowledge to review, evaluate, and appeal clinical denials related to the care provided to the hospitalized patient. The utilization review nurse works with the multidisciplinary team to assess and improve the denial management, documentation, and appeals process of such findings.Read More...
The utilization review nurse manages all activities related to the monitoring, interpreting, and appealing of clinical denials received from third-party payers and ensures accuracy in patient billing. The position is integral to the organization, as successful appeals by the nurse result in the overturning of denied claims and recovered revenue for the health care provider. Those in the position also work in collaboration with physician advisers to support policy development, process improvement, and staff education related to clinical denial mitigation.
A bachelor's degree and state licensure in the relevant jurisdiction as a registered nurse is required. Strong candidates generally have three or more years' adult or pediatric clinical experience in a hospital setting, including at least one year as a utilization review nurse. Excellent written and oral communication skills are a must, as is the ability to work and meet deadlines in a fast-paced environment. Strong computer and customer service skills are required as well.
Registered Nurse (RN), Utilization Review (UR) Tasks
- Analyze information gathered by investigation, and report findings and recommendations.
- Modify patient treatment plans as indicated by patients' responses or case history.
- Audit and analyze patient records to ensure quality patient care and appropriateness of services.
- Interview or correspond with physicians to correct errors or omissions and to investigate questionable claims.
Common Career Paths for Registered Nurse (RN), Utilization Review (UR)
Many Utilization Review Registered Nurses move into an Utilization Management Registered Nurse role, which does not lead to a big boost in pay. Utilization Management Registered Nurses on average bring in a similar salary to Utilization Review Registered Nurses. A lot of Utilization Review Registered Nurses advance their careers by becoming Utilization Review Nurses and Utilization Management Case Managers. However, those positions offer $7K less and $4K less per year on average.
Registered Nurse (RN), Utilization Review (UR) Job Listings
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Popular Employer Salaries for Registered Nurse (RN), Utilization Review (UR)
Utilization Review Registered Nurses flock to UnitedHealth Group, United Healthcare Group, Aetna, Inc., Humana, Inc., and Centene Corporation, highly regarded companies that employ a generous number of people in this profession. Anthem attracts talent by shelling out the biggest paychecks in the area — the median in that office is $75K.
Popular Skills for Registered Nurse (RN), Utilization Review (UR)
Survey takers working as Utilization Review Registered Nurses report using a large range of professional skills. Most notably, skills in Intensive Care Unit, Hospice, Case Management, and Medicine / Surgery are correlated to pay that is above average. Skills that are correlated to lower pay, on the other hand, include Home Health/Home Care, Labor & Delivery, Birthing, and Psychiatric. Most people skilled in Case Management are similarly competent in Acute Care and Medicine / Surgery.
Pay by Experience Level for Registered Nurse (RN), Utilization Review (UR)
Median of all compensation (including tips, bonus, and overtime) by years of experience.
Utilization Review Registered Nurses with a lot of experience do not necessarily enjoy more money. Folks who are navigating the first five years of their careers have a median salary of approximately $62K in this position. Those who have been around for five to 10 years don't get much more, though; the median salary in that group is $64K. Utilization Review Registered Nurses bring in $68K after working for 10 to 20 years. In the end, the overall pattern seems to be that more experience generally corresponds to higher pay; an Utilization Review Registered Nurse with more than 20 years of experience can earn $72K on average.