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Contractual Insurance Utilization Review Jobs (NOW HIRING)

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

$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 ...

Mindful Health

Utilization Review Specialist

$25 - $30/hr

Utilization Review Specialist Mindful Health is a fast-growing company with the goal of providing ... Comprehensive medical and supplemental health insurance, including vision, dental, life insurance ...

UHS

Utilization Review Coordinator

Augusta, GA

... insurance companies/authorizing entities to ensure initial precertification and continued ... utilization review. CERTIFICATIONS, LICENSES, REGISTRATION LMHC, LAPC, LPC, LMSW, LCSW, LPN or RN ...

UHS

Utilization Review Coordinator

Augusta, GA

... insurance companies/authorizing entities to ensure initial precertification and continued ... utilization review. CERTIFICATIONS, LICENSES, REGISTRATION LMHC, LAPC, LPC, LMSW, LCSW, LPN or RN ...

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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 Jul 11, 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 Nurse

Utilization Review Nurse

Health Business Solutions

Cooper City, FL • On-site

Other

Posted 2 days ago

New

Job description

Job Summary : We are seeking a highly motivated and experienced Utilization Review Nurse to join our team. The Utilization Review Nurse will play a crucial role in supporting our clients in the healthcare industry by providing expert clinical guidance, facilitating effective utilization management, and ensuring revenue cycle efficiency. This position offers a unique opportunity to combine clinical expertise with revenue cycle management knowledge.

Key Responsibilities:

· Clinical Assessment : Conduct comprehensive clinical assessments of medical records to ensure patients are receiving appropriate care at the correct level of service.

  • Care Coordination : Collaborate with interdisciplinary healthcare teams to coordinate patient care and treatment plans, ensuring the most cost-effective and clinically appropriate care is provided.

  • Revenue Cycle Management : Utilize clinical expertise to support revenue cycle processes, including accurate coding, documentation improvement, and compliance with healthcare regulations.

  • Utilization Review:

a) Apply medical necessity screening criteria and clinical knowledge to ensure appropriateness of admissions and length of stays

b) Conduct initial admission, continuing stay, and 23-hour observations reviews for all patients

c) Support Utilization Review Coordinator team members on cases escalated for level of care determinations

d) Screen cases for Physician Advisor review

e) Collaborate with insurance companies on concurrently denied and high risk for denial cases

  • Documentation Improvement : Identify opportunities for improving clinical documentation to support accurate coding and billing processes, ultimately improving reimbursement.

  • Data Analysis : Analyze clinical and financial data to identify trends, opportunities for improvement, and areas of potential cost savings for clients.

  • Compliance : Stay up-to-date with healthcare regulations, guidelines, and policies to ensure all patient care and revenue cycle processes are in compliance with industry standards and regulatory requirements to ensure appropriate reimbursement.

Qualifications:

· Registered Nurse (RN) licensure required; must hold a USRN multi-state/compact nursing license.

· Bachelor of Science in Nursing (BSN) preferred.

· Case Management Certification (e.g., CCM) is a plus.

· Minimum of 3 years of clinical nursing experience, preferably in a hospital or acute care setting.

· Minimum 2 years of work experience in Utilization Review

· Strong understanding of revenue cycle management and healthcare reimbursement.

· Proficiency in medical coding and clinical documentation improvement.

· Excellent communication, interpersonal, and teamwork skills.

· Ability to work independently and make sound clinical and financial decisions.

· Strong analytical and problem-solving skills.

· Proficient in using healthcare information systems and technology.

· Commitment to maintaining patient confidentiality and ethical standards.

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