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Commission Anthem Utilization Review Jobs (NOW HIRING)

UHS

Utilization Review Manager

Grand Rapids, MI

We are licensed by the State of Michigan, fully accredited by The Joint Commission and we bring ... Utilization Review Manager. Position Description: The Utilization Manager is responsible for ...

UHS

Utilization Review Manager

Grand Rapids, MI · On-site

We are licensed by the State of Michigan, fully accredited by The Joint Commission and we bring ... Utilization Review Manager. Position Description: The Utilization Manager is responsible for ...

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All JobsCommission Anthem Utilization Review Jobs

Commission Anthem Utilization Review information

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How much do commission anthem utilization review jobs pay per hour?

As of Jun 16, 2026, the average hourly pay for commission 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 the difference between Commission Anthem Utilization Review vs Commission Anthem Claims Processor?

AspectCommission Anthem Utilization ReviewCommission Anthem Claims Processor
CertificationsTypically requires healthcare or insurance-related certificationsUsually requires claims processing or insurance administration certifications
Work EnvironmentHealthcare facilities, insurance companies, or remoteInsurance offices, call centers, or remote
Employer & Industry UsageUsed in healthcare and insurance sectors for review of medical necessityUsed in insurance companies for processing claims and payments

While both roles are part of the insurance industry, Commission Anthem Utilization Review focuses on evaluating the necessity of medical services, whereas Commission Anthem Claims Processor handles the processing and payment of insurance claims. Understanding these differences helps clarify job responsibilities and required skills in the insurance sector.

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What cities are hiring for Commission Anthem Utilization Review jobs? Cities with the most Commission Anthem Utilization Review job openings:
What are the most commonly searched types of Anthem Utilization Review jobs? The most popular types of Anthem Utilization Review jobs are:
What states have the most Commission Anthem Utilization Review jobs? States with the most job openings for Commission Anthem Utilization Review jobs include:
What job categories do people searching Commission Anthem Utilization Review jobs look for? The top searched job categories for Commission Anthem Utilization Review jobs are:
Commission Anthem Utilization Review jobs near you
Infographic showing various Commission Anthem Utilization Review job openings in the United States as of June 2026, with employment types broken down into 98% Full Time, and 2% Part Time. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Registered Nurse - Utilization Review - RNSC

NavitasPartners

Syracuse, NY • On-site

$60 - $65/hr

Full-time, Contractor

Posted 6 days ago

Job description

Registered Nurse (RN) - Utilization Review
Location: Syracuse, NY
Job Type: 14-Week Contract | Traveler or Local
Shift: Day Shift (Monday-Friday)
Hours: 8 Hours Per Day
Pay Rate: $60 - $65/hour
Position Overview
We are seeking an experienced Registered Nurse (RN) with Utilization Review and acute care experience to support medical necessity reviews, regulatory compliance, and care coordination activities. The RN will collaborate with physicians, case managers, insurance providers, and interdisciplinary teams to ensure appropriate utilization of healthcare services while promoting quality and cost-effective patient care.
Requirements
  • Active New York State Registered Nurse (RN) License required.
  • Current BLS Certification required or ability to recertify.
  • Minimum 1.5 years of recent acute care hospital experience required.
  • Utilization Review, Utilization Management, or Case Management experience strongly preferred.
  • Familiarity with InterQual and/or MCG criteria required or strongly preferred.
  • Knowledge of CMS regulations related to hospital admissions and inpatient criteria required.
  • Experience working with healthcare payers and regulatory agencies preferred.
  • EPIC EMR experience preferred.
  • Strong analytical, communication, and documentation skills.
  • Clean professional license history with no suspensions, investigations, or malpractice claims.
  • Must pass all required health, drug screening, and background check requirements.
Responsibilities
  • Conduct clinical reviews for inpatient admissions and continued stay authorization.
  • Apply InterQual, MCG, and evidence-based criteria for medical necessity determinations.
  • Review patient charts and clinical documentation for appropriateness of care.
  • Collaborate with physicians, case managers, and interdisciplinary teams.
  • Communicate with insurance companies, payers, and regulatory agencies regarding authorization decisions.
  • Support discharge planning and appropriate level-of-care transitions.
  • Ensure compliance with CMS regulations and hospital policies.
  • Document utilization review decisions accurately and timely in EMR systems.
Certification & Licensure
  • New York State Registered Nurse (RN) License
  • Basic Life Support (BLS)
Preferred Qualifications
  • Experience with InterQual and/or MCG Criteria
  • Prior Utilization Management or Case Management Experience
  • EPIC EMR Experience
  • Experience Working with Insurance Payers and Regulatory Agencies
Facility Highlights
  • Acute Care Hospital Environment
  • Collaborative Case Management and Utilization Review Department
  • Focus on Regulatory Compliance and Efficient Patient Flow
  • Strong Interdisciplinary Team Structure
For More Details
Email: hdavda@navitashealth.com
Call/Text: 516-862-1169
About Navitas Healthcare, LLC
It is a Joint Commission Certified / WBENC and one of the fastest-growing healthcare staffing firms in the US providing Medical, Clinical and Non-Clinical services to numerous hospitals. We offer the most competitive pay for every position we cater. We understand this is a partnership. You will not be blindsided and your salary will be discussed upfront.

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