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Entry Level Utilization Review Jobs (NOW HIRING)

Arizona State Hospital

Job Page

Phoenix, AZ · On-site

$71K/yr

With career paths for seasoned professionals in a variety of fields, entry-level positions, and ... Experience in Prior Authorization, Utilization Management, claims review, auditing, or managed care ...

Froedtert South, Inc.

Pharmacist

Pleasant Prairie, WI · On-site

$51.50/hr

MINIMUM EXPERIENCE REQUIRED * Entry Level * LICENSES / CERTIFICATIONS REQUIRED * Wisconsin ... and drug utilization review. * Demonstrates the ability to access, enter and adjust patient ...

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How much do entry level utilization review jobs pay per hour?

As of Sep 14, 2026, the average hourly pay for entry level 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 Entry Level Utilization Review vs Medical Claims Processor?

AspectEntry Level Utilization ReviewMedical Claims Processor
Required CredentialsTypically a healthcare-related certification or degree, such as a nursing license or health administration degreeHigh school diploma or equivalent; certification may be preferred but not always required
Work EnvironmentHealthcare settings, insurance companies, or third-party review organizationsInsurance companies, healthcare providers, or billing offices
Job FocusAssessing medical necessity for treatments and services, reviewing patient recordsProcessing and reviewing insurance claims for accuracy and completeness

While both roles involve working within healthcare and insurance industries, Entry Level Utilization Review focuses on evaluating the necessity of medical services, often requiring healthcare credentials. Medical Claims Processors primarily handle insurance claims processing, with less emphasis on clinical review. Understanding these differences helps job seekers identify the right career path based on their skills and interests.

How to get started in entry level utilization review?

To start as an entry-level utilization review specialist, obtain a relevant healthcare or insurance-related degree such as nursing, health administration, or a related field. Gaining knowledge of medical terminology, insurance policies, and utilization review processes is essential, and some employers may require certification like the Certified Professional in Healthcare Quality (CPHQ). Entry-level roles often involve on-the-job training and may require strong communication skills and attention to detail.
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Entry Level Utilization Review jobs near you
Infographic showing various Entry Level Utilization Review job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 3% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Revenue Utilization Review (RUR) Nurse

Smyrna, TN • On-site

Veterans Health Administration
Health Care and Social Assistance • 10K+ employees
Learn more about Veterans Health Administrationexternal

$82K - $144K/yr

Full-time

This job post has expired today. Applications are no longer accepted.

Veterans Health Administration rating

8.1

Company rating: 8.1 out of 10

Based on 1,009 frontline employees who took The Breakroom Quiz

Job description


QualificationsBasic Requirements:
  • English Language Proficiency
  • In accordance with 38 U.S.C. 7403(f), no person shall serve in direct patient care positions unless they are proficient in basic written and spoken English
  • Graduate of a school of professional nursing approved by the appropriate accrediting agency and accredited by one of the following accrediting bodies at the time the program was completed by the applicant: The Accreditation Commission for Education in Nursing (ACEN) or The Commission on Collegiate Nursing Education (CCNE)
  • OR Individuals attending a master's level bridge program in nursing who have completed coursework equivalent to a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion of the bridge program
  • Upon achievement of a State license, the individual may be appointed on temporary basis and later converted to a permanent appointment upon successful completion and graduation from the bridge program
  • (Reference VA Handbook 5005, Appendix G6)
  • OR In cases of graduates of foreign schools of professional nursing, possession of a current, full, active, and unrestricted registration will meet the requirement for graduation from an approved school of professional nursing to warrant an appointment as a Nurse who has completed an associated degree/entry level Nursing education program
  • Credit for foreign nursing education higher that associate degree/entry level requires a formal degree equivalency validation from a recognized equivalency evaluation accepted by VA such as International Consultants of Delaware (ICD)
  • Current, full, active, and unrestricted registration as a graduate professional nurse in a State, Territory or Commonwealth (i.e., Puerto Rico) of the United States, or the District of Columbia
  • Graduate Nurse Technician (GNT) Exception: Candidates who otherwise meet the basic education requirements, but do not possess the required licensure, may be appointed at the entry step of the grade and level applicable to the completed nursing education as a GNT on a 120-day temporary appointment while actively pursuing licensure (may be extended up to two years on a case-by-case-basis.) NOTE: Grandfathering Provision - All persons currently employed in VHA in 0610 series and performing the duties as described in the qualification standard on the effective date of the standard (1/29/2024) are considered to have met all qualification requirements for the grade held including positive education and licensure/certification
  • Grade Determinations: The following Scope, Education and Dimension criteria must be met in determining the grade assignment of candidates, and if appropriate, the level within a grade
  • The Dimension requirements (Practice, Veteran/Patient Driven Care, Leadership, Professional Development and Evidence-Based Practice/Research) are detailed for each grade and level within the online assessment: https://apply.usastaffing.gov/ViewQuestionnaire/12998227
  • Grade/Level Scope Education Nurse I, Level I Delivers fundamental, knowledge-based care to assigned clients while developing technical competencies
  • An Associate Degree (ADN) or Diploma in Nursing, with no additional professional nursing required
  • Nurse I, Level II Demonstrates integration of biopsychosocial concepts, cognitive skills and technically competent practice in providing care to clients with basic or complex
  • An ADN or Diploma in Nursing AND 1 year of specialized nursing experience equivalent to Nurse I, Level 1 ;OR a Bachelor of Science in Nursing (BSN) with no additional professional nursing experience required
  • Nurse I, Level III Demonstrates proficiency in practice based on conscious and deliberate planning
  • Self-directed in goal setting for managing complex client situations
  • An ADN or Diploma in Nursing AND 2 years of professional nursing experience in which one year is equivalent to Nurse I, Level 2
  • OR a BSN and 1 year of professional nursing experience equivalent to the Nurse I, Level 2
  • OR a Master's degree in nursing (MSN) and no additional professional nursing experience
  • OR a Master's degree in a *related field with a BSN and no additional professional nursing experience
  • Nurse II Demonstrates leadership in delivering and improving holistic care through collaborative strategies with others
  • A BSN with 2 years of professional nursing equivalent to Nurse I, Level 3
  • OR an MSN with one year of specialized nursing experience equivalent to Nurse I, Level 3
  • OR a Master's degree in a *related field with a BSN and one year of specialized nursing experience equivalent to Nurse I, Level 3
  • OR a Doctoral degree in Nursing with no professional nursing experience
  • OR a Doctoral degree in a *related field with a BSN with no additional professional nursing experience
  • Nurse III Executes position responsibilities that demonstrate leadership, experience and creative approaches to management of complex client care beyond the immediate practice setting
  • MSN and 2 years of specialized nursing experience, one of which is equivalent to Nurse II and meets all dimension requirements for Nurse III
  • OR a Master's degree in *related field with BSN and two years of specialized nursing experience, one of which is equivalent to Nurse II and meets all dimension requirements for Nurse III
  • OR a Doctoral degree in Nursing with and one year of specialized nursing experience equivalent to Nurse II and meets all dimension requirements for Nurse III
  • OR a Doctoral degree in a *related field with a BSN and one year of specialized nursing experience equivalent to Nurse II and meets all dimension requirements for Nurse III
  • *Note: Foreign education programs/degrees are not creditable as related degrees
  • Reference: For more information on this qualification standard, please visit https://www.va.gov/ohrm/QualificationStandards/
  • Preferred Experience: Strong clinical background with 5 years nursing experience
  • 1-3 years of relevant case management or utilization review experience
  • Ability to collaborate effectively and communicate with all areas within the revenue cycle
  • Previous experience in CPAC Revenue Utilization Review
  • InterQual/Milliman experience
  • Utilization Review certification
  • Proficiency in applying CPT, ICD-10, and HCPCS coding
  • Proficiency in Microsoft Word, Microsoft Excel, and related computer applications, as well as the ability to accurately enter and manage information within designated online portals
  • Proficient in learning through diverse educational modalities, including virtual formats
  • Physical Requirements: This position requires visual acuity, keen hearing, clear distinctive speech, and manual dexterity
  • This position requires potentially long periods of continued sitting and computer use and typing
  • The RUR nurse must be a mature, flexible, sensible individual capable of working effectively in stressful situations, able to shift priorities based on organizational needs and solve problems independently while utilizing critical thinking skills
  • See VA Directive and Handbook 5019.

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About Veterans Health Administration

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The Veterans Health Administration (VHA) is the largest integrated health care system in the United States, serving millions of Veterans each year. Located in Phoenix, AZ, and many other parts of the US, the VHA operates under the Department of Veteran Affairs, as suggested by their official website va.gov. The VHA is dedicated to providing the highest level of comprehensive care to its veterans. The organization offers a broad spectrum of medical, surgical, and rehabilitative care, including mental health services, research, and pharmacy benefits.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Phoenix, AZ, US

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