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Contractual Insurance Utilization Review Jobs (NOW HIRING)

Integrated Resources INC

Care Review Nurse

Columbus, OH · On-site

Insurance Utilization Manager/Review and Millemen Experience (MCG). No case managers if that is their only experience. Must have Utilization Review or Management. Utilization Review (1 year +), Past ...

Seh

Summary The Utilization Review Nurse screens medical records in accordance with contractual agreement and regulatory requirements for medical necessity on admission and continued stay in the acute ...

Southeast Health

Utilization Review Nurse

Dothan, AL · On-site

Summary The Utilization Review Nurse screens medical records in accordance with contractual agreement and regulatory requirements for medical necessity on admission and continued stay in the acute ...

ICBD

Utilization Review Specialist

Lauderdale Lakes, FL · On-site

$55K - $70K/yr

Utilization Review Specialist - Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No ... This position collaborates closely with clinical teams, insurance providers, and other healthcare ...

ICBD

Utilization Review Specialist

Lauderdale Lakes, FL · On-site

$55K - $70K/yr

Utilization Review Specialist - Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No ... This position collaborates closely with clinical teams, insurance providers, and other healthcare ...

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Contractual Insurance Utilization Review information

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How much do contractual insurance utilization review jobs pay per hour?

As of Jun 20, 2026, the average hourly pay for contractual insurance 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 Contractual Insurance Utilization Review vs Insurance Claims Adjuster?

AspectContractual Insurance Utilization ReviewInsurance Claims Adjuster
CredentialsCertifications in healthcare or insurance review, such as URAC or AAPCAdjuster licenses, certifications like AIC or CPCU
Work EnvironmentHealthcare facilities, insurance companies, or third-party review organizationsInsurance companies, claims offices, or independent agencies
Primary FocusAssessing medical necessity and appropriateness of servicesEvaluating insurance claims for coverage and settlement
Industry UsageCommon in health insurance and managed careCommon in property, casualty, and health insurance claims

Contractual Insurance Utilization Review focuses on evaluating medical necessity, while Insurance Claims Adjusters handle claims processing and settlement. Both roles require industry-specific certifications and are integral to insurance operations, but they serve different functions within the insurance process.

What cities are hiring for Contractual Insurance Utilization Review jobs? Cities with the most Contractual Insurance Utilization Review job openings:
What are the most commonly searched types of Insurance Utilization Review jobs? The most popular types of Insurance Utilization Review jobs are:
What states have the most Contractual Insurance Utilization Review jobs? States with the most job openings for Contractual Insurance Utilization Review jobs include:
Contractual Insurance Utilization Review jobs near you
Utilization Review Analyst

Utilization Review Analyst

EAGLEVILLE HOSPITAL

Eagleville, PA • On-site

Other

Posted 21 days ago

Job description

Eagleville Hospital, an independent substance use and behavioral health treatment and educational organization serving the community for more than a century, provides innovative compassionate care to those seeking treatment for stigmatized illnesses including substance use and mental health.
Position Summary
Review and abstract pertinent data from medical records and communicates information to all various insurance companies and/or their contractual agencies to guarantee continued financial coverage.
This position reports to the Utilization Review Director
Objectives / Responsibilities
  • Reviews admissions to determine medical necessity and appropriateness of treatment.
  • Reviews patient records to obtain justification of treatment.
  • Secures necessary data from the clinical team for extended stay reviews.
  • Presents abstracts (via telecon) of clinical course of treatment to all various insurance companies and/or their contractual agencies, to justify continued treatment.
  • Review, abstracts and assigns initial length of stay and extensions of treatment as appropriate for all payers as assigned
  • Communicates all extensions of treatment to clinical teams and Director, Utilization Review (UR)
  • Notify clinical teams of need for current documentation.
  • Refer cases to Director, UR when appropriateness of and necessity of extended stay is questionable.
  • Attend appropriate daily treatment team meeting
  • Salary Range: $50-$57/yr

Educational Requirements
  • Bachelor's Degree Preferred

Competencies
  • Patient-Centered Approach - Treat all individuals with dignity, empathy, and respect, recognizing that every role contributes to the patient experience.
  • Excellence & Accountability - Perform all duties with professionalism, following hospital policies to ensure safety, compliance, and efficiency.
  • Teamwork & Communication - Collaborate with colleagues across departments, maintaining a positive and solution-oriented attitude.
  • Commitment to Our Mission - Uphold the hospital's values and contribute to a culture of trust, inclusivity, and continuous improvement.

Qualifications
  • 3+ years of UR or case management experience in Substance Use /Behavioral Health
  • Good communication
  • Ability to work independently
  • Experience with Microsoft applications
  • Knowledge of pre-certification process and ASAM. Knowledge of DSM V, private care managers and county referral sources

Physical Requirements
  • Ability to sit for long periods
  • Ability to walk around campus if needed
  • Good dexterity, must be able to type
  • Use of telephone

Work Environment
  • Office setting

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