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Contractual Insurance Utilization Review Jobs (NOW HIRING)

University of Utah

Utilization Review Nurse

... the payer per university contractual obligation. * Participant in UR Committee as needed ... One year Utilization Review or Case Management experience. Licenses Required * Current license to ...

Acrisure

Utilization Review Nurse

Bradenton, FL · On-site

... of insurance, reinsurance, payroll, benefits, cybersecurity, mortgage services, and more. In the ... Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure ...

Banyan

Utilization Review Specialist

Pompano Beach, FL · On-site

$50K - $65K/yr

Verify insurance benefits, coordinate authorizations, and communicate effectively with external case managers and managed care organizations * Establish and maintain contracts with managed care ...

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

As of Aug 21, 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 (Full-Time)

Greater Baltimore Medical Center Healthcare

Towson, MD • On-site

Full-time

Posted 8 days ago

Job description

Under general supervision, provides consultative support to the admitting teams concerning patient status determinations and utilization of hospital resources facilitating quality, cost-effective patient outcomes for patients requiring hospital services. Works collaboratively with interdisciplinary staff internal and external to the organization facilitating appropriate status determinations through the utilization review process supporting quality, cost-effective patient outcomes. Responsible for analyzing clinical information and performing timely initial and concurrent reviews using InterQual screening software to identify appropriate medical necessity, length of stay, and level of care based upon evidence based clinical guidelines
Education:
Bachelor of Science in Nursing (BSN) OR Associate of Science in Nursing and currently enrolled in a BSN program with an expected graduation date within three (3) years.
Licensure, Certifications:
  • Current state of Maryland Registered Nurse license
  • Bachelor of Science in Nursing (BSN)
  • Certification in Utilization Management and/or Care Management highly desired.

Experience:
Five (5) years diversified, progressive experience in acute care and/or other settings within the continuum required.
Two (2) years of Utilization Review and Case Management experience which includes utilization review processes and discharge planning, and working with Re-Admission Initiatives preferred.
Skills:
• Advanced knowledge of InterQual and/or MCG admission criteria
• Knowledge of healthcare regulatory standards
• Advanced skill in using computer software
• Advanced skill in oral and written communication
• Advanced skill in critical thinking
• Ability to work independently and resolve complex problems
• Ability to remain calm under pressure and intense time constraints
• Ability to assess discharge needs for patients
• Strong analytical and problem-solving skills
• Strong interpersonal communication and influencing skills necessary to interact effectively with physicians, payers, regulatory agencies, staff, and other health professional
• Strong organizational and time management skills
• Ability to operate independently and balance multiple priorities
• Proficiency in electronic medical record review
Principal Duties and Responsibilities:
  • Reviews available electronic medical records during the pre-admission process to determine appropriate patient status, optimizing correct patient classification and corresponding payer notifications.
  • Reviews the appropriateness of admission and continued stay criteria for a defined group of patients
  • Develops initial admission reviews for patients requiring hospital services and provides timely status recommendations to admitting providers a concurrent stay and/or discharge plan of care in accordance with departmental and payer clinical guidelines.
  • Maintains a working knowledge of contractual and clinical criteria guidelines. Coordinates services with managed care companies and other third party payers. Discusses on-site reviewer issues with payer, either via the telephone or in person
  • Assures timely utilization compliance with all payers who require authorizations and clinical submission. Demonstrates knowledge of reimbursement mechanisms. Considers patient's financial resources for meeting healthcare needs (insurance reimbursement, managed care plans, entitlement programs, and personal resources).
  • Participates as an active partner with physicians and interdisciplinary teams, providing education ancillary, and nursing staffregarding admission decisions including status determinations, financial and clinical outcomes, and documentation requirements and standards.
  • Maintains current knowledge on all regulatory changes that affect care delivery or reimbursement of acute care services. Uses
  • knowledge of national and local coverage determinations to appropriately advise physicians.
  • Identifies system obstacles that affect patient outcomes and participates in interdisciplinary decisions and care of the patient. consults with interdisciplinary team members to address problems, and makes recommendations to problem solve.
  • Assists with discharge planning, by preventing un-necessary hospital utilization, assist in the appropriate return of and placement of patients to post acute care, community based care and appropriate alternate levels of care.
  • Demonstrates mastery in InterQual level of care guidelines. Possesses proficiency in utilization review systems, clinical support systems, and business support applications.
  • Promotes use of evidence-based protocols to influence high quality and cost-effective care.
  • Escalates clinically and financially complex cases to leadership, offering possible solutions through discussion and feedback. Engages regularly in formal and informal dialogue about quality; directly addressing concerns and promoting continuous improvement.
  • Performs concurrent reviews and additional duties as assigned.

All roles must demonstrate GBMC Values:
Respect
I will treat everyone with courtesy. I will foster a healing environment.
  • Treats others with fairness, kindness, and respect for personal dignity and privacy
  • Listens and responds appropriately to others' needs, feelings, and capabilities

Excellence
I will strive for superior performance in every aspect of my work. I will recognize and celebrate the accomplishments of others.
  • Meets and/or exceeds customer expectations
  • Actively pursues learning and self-development
  • Pays attention to detail; follows through

Accountability
I will be professional in the way I act, look and speak. I will take ownership to solve problems.
  • Sets a positive, professional example for others
  • Takes ownership of problems and does what is needed to solve them
  • Appropriately plans and utilizes required resources for various job duties
  • Reports to work regularly and on time

Teamwork
I will be engaged and collaborative. I will keep people informed.
  • Works cooperatively and collaboratively with others for the success of the team
  • Addresses and resolves conflict in a positive way
  • Seeks out the ideas of others to reach the best solutions
  • Acknowledges and celebrates the contribution of others

Ethical Behavior
I will always act with honesty and integrity. I will protect the patient.
  • Demonstrates honesty, integrity and good judgment
  • Respects the cultural, psychosocial, and spiritual needs of patients/families/coworkers

Results
I will set goals and measure outcomes that support organizational goals. I will give and accept help to achieve goals.
  • Embraces change and improvement in the work environment
  • Continuously seeks to improve the quality of products/services
  • Displays flexibility in dealing with new situations or obstacles
  • Achieves results on time by focusing on priorities and manages time efficiently

Pay Range
$68,281.18 - $110,274.20
Final salary offer will be based on the candidate's qualifications, education, experience and alignment with our organizational needs.
Equal Employment Opportunity
GBMC HealthCare and its affiliates are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.

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