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Anthem Utilization Review Jobs (NOW HIRING)

Harborview Thomasville

MDS Coordinator RN

Thomasville, GA · On-site

$30.25 - $36.50/hr

Conduct and participate in IDT meetings including: daily PDPM, weekly CMI, Utilization Review ... Health Insurance with Anthem Blue Cross or Cigna * Dental, Life, Vision, and Disability Insurance

Roselane Health Center by Harborview

RN MDS

Marietta, GA · On-site

$35.25 - $42.50/hr

Conduct and participate in IDT meetings including: daily PDPM, weekly CMI, Utilization Review ... Health Insurance with Anthem Blue Cross or Cigna * Dental, Life, Vision, and Disability Insurance

My Time Recovery

Case Manager

Fresno, CA · On-site

$21 - $27.25/hr

Complete Utilization Reviews as directed by supervisor * Drives clients as needed to appointments ... Anthem Blue Cross Anthem PPO Silver 45/40 1,750 Ded Anthem Blue Cross Anthem PPO Gold 30/20 500 Ded ...

Gulf Valor Rehabilitation

RN MDS

Pensacola, FL

$35 - $42.50/hr

Conduct and participate in IDT meetings including: daily PDPM, weekly CMI, Utilization Review ... Health Insurance with Anthem Blue Cross or Cigna * Dental, Life, Vision, and Disability Insurance

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Anthem Utilization Review information

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How much do anthem utilization review jobs pay per hour?

As of Jun 9, 2026, the average hourly pay for anthem utilization review in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

What is an Anthem Utilization Review job?

An Anthem Utilization Review job involves assessing medical services and treatments to ensure they are necessary, cost-effective, and aligned with insurance policies. Professionals in this role review patient records, apply clinical guidelines, and collaborate with healthcare providers to determine coverage eligibility. They help prevent unnecessary procedures while supporting quality patient care. This position typically requires a healthcare background, such as nursing or case management, along with knowledge of insurance regulations and medical necessity criteria.

What does a typical day look like for someone in an Anthem Utilization Review role?

A typical day in an Anthem Utilization Review position involves evaluating medical records and authorization requests to determine if healthcare services meet established criteria for coverage. You’ll collaborate frequently with healthcare providers, case managers, and internal teams to clarify clinical information and help guide appropriate care pathways. The job is largely desk-based and requires strong organizational skills to manage multiple concurrent cases and meet tight deadlines. Most professionals in this role work within a team structure, sharing best practices and supporting each other in making objective, evidence-based decisions. This dynamic environment offers exposure to a variety of healthcare scenarios and opportunities for ongoing learning in utilization management.

What are the key skills and qualifications needed to thrive in the Anthem Utilization Review position, and why are they important?

To thrive as an Anthem Utilization Review professional, you need a background in nursing or healthcare, strong analytical abilities, and familiarity with medical terminology and insurance guidelines. Experience with clinical documentation systems, review software, and URAC or NCQA certifications are commonly required. Excellent communication, critical thinking, and attention to detail are crucial soft skills in this position. These capabilities ensure accurate review of medical necessity, effective collaboration with providers, and regulatory compliance, which are vital for quality patient outcomes and cost management.

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What cities are hiring for Anthem Utilization Review jobs? Cities with the most Anthem Utilization Review job openings:
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Anthem Utilization Review jobs near you
Infographic showing various Anthem Utilization Review job openings in the United States as of May 2026, with employment types broken down into 94% Full Time, and 6% Part Time. Highlights an 82% In-person, and 18% Hybrid job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
Utilization Review RN

Utilization Review RN

Healthcare Support Staffing

Indianapolis, IN

$30 - $34/hr

Full-time

Medical, Dental, Vision

Posted 9 days ago

Job description

Company Description

Anthem, Inc. is working to transform health care with trusted and caring solutions. Our health plan companies deliver quality products and services that give their members access to the care they need. With more than 73 million people served by its affiliated companies including nearly 40 million enrolled in its family of health plans, Anthem is one of the nation's leading health benefits companies.

One in nine Americans receives coverage for their medical care through Anthem's affiliated plans.
We offer a broad range of medical and specialty products.

Job Description

These candidates will be working in the continued stay review department. They will be looking at emerging urgent inpatient admissions for medical necessity. Strong computer skills, positive attitude, and ability to hit high production goals is what the manager is looking for here. Expected to review 20 cases a day with a 95% accuracy rate.

Responsible for collaborating with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources

MAJOR JOB DUTIES AND RESPONSIBILITIES

  • Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs or community resources.
  • Applies clinical knowledge to work with facilities and providers for care coordination.
  • Works with medical directors in interpreting appropriateness of care and accurate claims payment.
  • May also manage appeals for services denied.
  • Conducts precertification, inpatient, retrospective, out of network and
    appropriateness of treatment setting reviews to ensure compliance
    with applicable criteria, medical policy, and member eligibility, benefits,
    and contracts.
  • Ensures member access to medical necessary, quality
    healthcare in a cost effective setting according to contract.
  • Consult with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process.
  • Collaborates with providers to assess member's needs for early identification of and proactive planning for discharge planning.
  • Facilitates member care transition through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required and does not issue non-certifications.
  • Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.
Qualifications


  • Must have clear and active RN license in the state of IN
  • 2 years of experience in a acute care clinical environment (The candidate should have a strong ER/Critical Care/Med-Surgical clinical background. )
  • Knowledge of Millman or Interqual criteria
  • Must have prior UM experience
  • Needs to be flexible to change
  • Experience with reviewing medical records
  • Proficient with computers and using MS applications
  • Strong written and verbal communication skills
Additional Information

Advantages of this Opportunity:


Competitive salary, negotiable based on relevant experience
Benefits offered, Medical, Dental, and Vision
Fun and positive work environment
$30 - $34 per hour
Monday - Thursday 8am-5pm EST Friday - 9am - 6pm EST Occasional Saturday rotation (8am-Noon) EST


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About Healthcare Support

Sourced by ZipRecruiter

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Maitland, FL, US

Year founded

2003

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