Start a Fractional Utilization-Review Nurse Service for Behavioral Health (RN-Led)

1. 1

   Define the RN-led scope you own end to end

   As a licensed RN you can independently perform the full utilization-review workflow: concurrent review against InterQual and MCG criteria, prior-authorization submissions, continued-stay defense, appeal preparation, and peer-to-peer reviews. This is what lets you charge more than an administrative coordinator: a facility gets a clinician who can make and defend utilization decisions, not just track them.

2. 2

   Choose your delivery model

   Fractional utilization review is usually delivered remotely, reviewing cases in the facility's electronic health record and joining payer calls. Decide whether you cover a set caseload, a set number of hours per week, or all authorizations for a program. Most facilities want predictable coverage, which is why the retainer model fits better than pure hourly for ongoing work.

3. 3

   Set your pricing across three models

   Independent healthcare consultants command roughly $150 to $350 per hour, and senior utilization-review or revenue-cycle specialists sit in the $175 to $350 range. For ongoing coverage, a retainer of $3,000 to $8,000 per month is attractive to a facility losing $100,000 or more a year to denials. You can also price per case for authorizations and appeals. Frame every quote against the facility's revenue at risk, not your hourly rate.

4. 4

   Prove value with a short paid pilot

   Offer a defined starting engagement, such as taking over authorizations and continued-stay reviews for one program for 30 to 60 days, so the facility can see the effect on approvals before committing to a long retainer. A clean pilot that lifts authorization rates and clears a backlog of appeals is the strongest sales asset you will ever have.

5. 5

   Systematize so you can serve several facilities

   Your margin comes from covering multiple facilities without burning out. Build reusable criteria checklists, appeal templates, a peer-to-peer preparation script, and a tracking sheet for authorizations and deadlines. Standardized workflows let you take on more clients while keeping quality high, which is where a solo RN turns a job into a business.

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Best for: Experienced utilization-review RNs and case-management nurses who want to work for themselves and serve several behavioral health facilities at once

Not for: Nurses without genuine utilization-review depth, or anyone expecting to do this without an active RN license; independent clinical determinations and peer-to-peer calls require the credential and the experience.