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Full Time Anthem Utilization Review Jobs (NOW HIRING)

Midland Health

Nurse Utilization Review

Midland, TX

The utilization review (UR) nurse serves to maximize the quality and cost efficiency of health care ... SHIFT AND SCHEDULE Full Time, Monday - Friday; 8:00 AM - 5:00 PM ESSENTIAL FUNCTIONS/PERFORMANCE ...

Midland Health

Nurse Utilization Review

Midland, TX · On-site

The utilization review (UR) nurse serves to maximize the quality and cost efficiency of health care ... SHIFT AND SCHEDULE Full Time, Monday - Friday; 8:00 AM - 5:00 PM ESSENTIAL FUNCTIONS/PERFORMANCE ...

Midland Health

Nurse Utilization Review

Midland, TX

The utilization review (UR) nurse serves to maximize the quality and cost efficiency of health care ... SHIFT AND SCHEDULE Full Time, Monday - Friday; 8:00 AM - 5:00 PM ESSENTIAL FUNCTIONS/PERFORMANCE ...

VillageCare

Utilization Review Nurse

Manhattan, NY

VillageCare is looking for a self-motivated and passionate RN as Utilization Review Nurse for a Full-Time position. This is an exciting and dynamic position from the comfort of your own home as you ...

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How much do full time anthem utilization review jobs pay per hour?

As of Jun 16, 2026, the average hourly pay for full time 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 Full Time Anthem Utilization Review vs Full Time Medicaid Utilization Review?

AspectFull Time Anthem Utilization ReviewFull Time Medicaid Utilization Review
CertificationsTypically requires certifications like CCM or URAC accreditationOften requires similar certifications, with additional Medicaid-specific knowledge
Work EnvironmentCorporate healthcare setting, insurance company officesGovernment or Medicaid agency offices, healthcare providers
Employer & IndustryInsurance companies, healthcare payersState Medicaid agencies, government healthcare programs
Job FocusReviewing insurance claims for Anthem members, ensuring coverage complianceReviewing Medicaid claims, eligibility, and coverage for state programs

Full Time Anthem Utilization Review primarily involves insurance claim assessments within a corporate setting, focusing on Anthem members. In contrast, Full Time Medicaid Utilization Review centers on government-funded Medicaid programs, requiring knowledge of state-specific policies. Both roles require similar certifications but differ in employer type and scope of coverage.

What cities are hiring for Full Time Anthem Utilization Review jobs? Cities with the most Full Time 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 Full Time Anthem Utilization Review jobs? States with the most job openings for Full Time Anthem Utilization Review jobs include:
Full Time Anthem Utilization Review jobs near you
Utilization Review Specialist

Utilization Review Specialist

PRAESUM HEALTHCARE

West Palm Beach, FL • On-site

Full-time

Medical, Dental, Vision, Retirement, PTO

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

Job description

Praesum Healthcare:
Position Title: Utilization Review Specialist
Founded in 2003, Praesum Healthcare provides administrative services for healthcare providers in key geographical locations throughout the Northeast, mid-Atlantic, and Southeast regions. Praesum is an established leader in the healthcare industry. With a solid, growth-focused business model, strong finances, and expert management team, Praesum will continue to grow in the years to come. Praesum currently provides services to behavioral health facilities providing all levels of care from inpatient psychiatric and substance abuse detoxification, through SUD and mental health outpatient clinics.
Utilization Review Specialist Job description:
Perform duties to authorize and review utilization of mental health and substance abuse services provided in inpatient, outpatient and intermediate care settings.
Utilization Review Specialist Duties/Responsibilities:
• Initiate pre-certification and continued stay authorizations based on ASAM criteria
• Communicate directly with facility regarding patients' needs and symptomology
• Maintain daily census scheduling all new admissions and concurrent reviews
• Input of authorizations and appropriate demographic information to EHR for billing purposes
• Completing "peer to peer" reviews and scheduling "Doctor to Doctor" reviews when needed
• Confirm insurance coverage of each patient
• Organize weekend census of all detox and residential patients for all our impatient facilities
• Collect all appropriate clinical data for each patient that requires precertification
Utilization Review Specialist Requirements:
• High School Diploma
• A minimum of 3-5 years of utilization review experience.
• Individual must be computer literate with proficiency in Microsoft Office applications.
Utilization Review Specialist Schedule:
• Full Time, Friday - Monday (weekends) with potential for bonus
• 8:30am to 05:00pm
Utilization Review Specialist Compensation:
• Hourly rate competitive with experience and location
Full time employees may be eligible for the following:
• Insurance: Medical, Dental, Vision, and STD options
• Medical FSA and Dependent Care Account
• 401k with company match up to 5%
• Accrued Paid Time Off (PTO)
• Education reimbursement
• Career Advancement Opportunities
*** This job does NOT sponsor visa's and we are unable to consider out of country applicants ***
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