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Full Time Utilization Review Social Worker Jobs (NOW HIRING)

UHS

Utilization Review Coordinator

Champaign, IL · On-site

$61K - $71K/yr

Responsibilities Full-time Utilization Review Coordinator Opening The Pavilion Behavioral Health ... social work) or RN licensure within Illinois required. Previous professional experience in a ...

UHS

Utilization Review Coordinator

Champaign, IL · On-site

Responsibilities Full-time Utilization Review Coordinator Opening The Pavilion Behavioral Health ... Master's degree in the human services field (counseling, psychology, social work) or RN licensure ...

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

As of Sep 8, 2026, the average hourly pay for full time utilization review social worker 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 does a full time utilization review social worker do?

A Full Time Utilization Review Social Worker evaluates patients’ medical records to ensure that the care provided is necessary and appropriate, based on insurance guidelines and clinical standards. They work with healthcare teams, insurance companies, and patients to coordinate services, advocate for needed care, and help manage healthcare costs. Their role is crucial in ensuring that patients receive the right level of care without unnecessary treatments, while also supporting the hospital or healthcare facility's compliance and reimbursement processes.

How does a full time utilization review social worker typically collaborate with healthcare providers and insurance representatives?

A Full Time Utilization Review Social Worker regularly communicates with physicians, nurses, and insurance representatives to ensure that patients receive appropriate and cost-effective care. They review medical records, participate in interdisciplinary team meetings, and advocate for patients’ needs while adhering to insurance guidelines. This role requires balancing clinical judgment with policy requirements, and effective collaboration is essential to resolving care authorization issues and facilitating smooth discharge planning.

What are the key skills and qualifications needed to thrive as a full time utilization review social worker, and why are they important?

To thrive as a Full Time Utilization Review Social Worker, you need a solid background in social work, case management, and healthcare regulations, typically with a relevant degree and state licensure (e.g., LCSW or LMSW). Familiarity with utilization review software, electronic medical records (EMRs), and knowledge of insurance guidelines such as Medicare/Medicaid are essential. Strong analytical, communication, and advocacy skills help you effectively assess patient needs and interact with healthcare teams and payers. These skills ensure appropriate resource utilization, compliance with policies, and optimal patient care outcomes.

What is the difference between Full Time Utilization Review Social Worker vs Utilization Review Nurse?

AspectFull Time Utilization Review Social WorkerUtilization Review Nurse
CredentialsSocial Work degree, LCSW or equivalent, certification in utilization review often preferredNursing degree, RN license, certification in utilization review (e.g., URAC)
Work EnvironmentHealthcare facilities, insurance companies, government agenciesHospitals, insurance companies, healthcare organizations
Primary ResponsibilitiesAssess patient needs, coordinate care, review medical necessity from a social work perspectiveReview medical records, evaluate treatment plans, ensure appropriate resource utilization

While both roles focus on reviewing healthcare utilization, the Full Time Utilization Review Social Worker emphasizes social work assessments and care coordination, whereas the Utilization Review Nurse concentrates on medical record evaluation and clinical review. Both positions require relevant certifications and work within healthcare or insurance settings, but their core functions differ based on professional background and focus areas.

What cities are hiring for Full Time Utilization Review Social Worker jobs?

Cities with the most Full Time Utilization Review Social Worker job openings:

What are the most commonly searched types of Utilization Review Social Worker jobs?

The most popular types of Utilization Review Social Worker jobs are:

What states have the most Full Time Utilization Review Social Worker jobs?

States with the most job openings for Full Time Utilization Review Social Worker jobs include:

Full Time Utilization Review Social Worker jobs near you

Utilization Review Specialist

Parkside Hospital

Tulsa, OK • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 2 days ago

Job description

Parkside provides professional purpose, hope, and healing. As a member of our staff, you will be part of a mission-driven team, dedicated to changing lives and changing communities, one patient at a time. 

Parkside Psychiatric Hospital & Outpatient Clinic is a comprehensive mental healthcare system providing acute inpatient care, residential treatment, and outpatient therapy. With a focus on society’s most vulnerable population, Parkside provides world-class mental health services for youth and adults. For over 65 years, Parkside’s physicians, therapists, and staff have provided state of the art, patient-centered care that propels families from hopeful to hope-filled. As a center of excellence, we cultivate talent and provide professional purpose. Together we facilitate healing, one patient at a time. 

We are looking for a Full Time Utilization Review Specialist! The Utilization Review Specialist asses, plans, implements and evaluates the internal processes to limit possible recoupment from third party pay sources including Medicare, Medicaid, HMO or private insurance. Coordinates with clinicians, business office and medical records to achieve above goals.

Responsibilities:

• Prepares authorization paperwork, processes requests for authorizations, and reviews requests for accuracy.

• Communicates with clinicians regarding discharge issues relevant to patient’s pay source. Tracks due dates for authorization reviews and alerts clinicians.

• Communicates with clinicians regarding admissions and discharges to various units.

• Knowledgeable of criteria for Medicare, Medicaid, HMO and private insurance coverage. Maintains current knowledge of managed care requirements and accurately interprets these requirements to increase authorizations.

• Coordinates/completes the appeal process for authorization denials

• Performs audits of clinical services to ensure compliance with standards of third party pay sources and agency policies.

• Tracks unauthorized services and possible recoupment issues. Looks for possible corrections, trends.

 • Maintains a good working relationship within the department and with other departments.

• Documentation meets current standards and policies.

 • Maintains fit for duty. Acts in a professional manner and follows all Parkside policies and procedures.

• Orients new staff members to the unit

• Demonstrates the ability to be organized and flexible, acts appropriately in stressful/emergency situations. Able to provide Handle with Care when needed

• Performs other duties as assigned

  • Bachelor’s degree in related field from an accredited university required. Experience in lieu of Degree will be considered.
  • 2yrs minimal experience in health care, utilization review and business setting

Benefits include:

  • Medical, Dental, and Vision
  • Generous Paid Time Off and Holidays
  • 401K and match start immediately, and includes a generous match
  • Company Paid Life Insurance and Disability and more!

We are an Equal Opportunity Employer! 

Apply