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Healthcare Utilization Review Jobs (NOW HIRING)

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Utilization Review Specialist

Knoxville, TN · On-site

At Bradford Health Services, we are committed to providing exceptional care to our patients while ... The Utilization Review Specialist plays a critical role in ensuring that healthcare services ...

Merrimack Health

Utilization Review Nurse

Lawrence, MA · On-site

Utilization Review Nurse Responsible for determining the appropriateness of hospital admission ... Responsible for working with the Clinical Care Coordinator and Complex Care Manager to facilitate ...

Acrisure LLC

Utilization Review Nurse

Bradenton, FL · On-site

Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure ... Collaborate with physicians, healthcare providers, claims professionals, and internal team members ...

Merrimack Health

Utilization Review Nurse

Methuen, MA · On-site

Responsible for working with the Clinical Care Coordinator and Complex Care Manager to facilitate ... to utilization review and discharge planning and payer regulations. MINIMUM EDUCATION AND ...

UF Health

Manager, Utilization Review

Gainesville, FL · On-site

Overview The Manager of Utilization Review provides operational leadership and oversight for ... Master's degree in nursing, Healthcare Administration, Business Administration, or related field ...

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Healthcare Utilization Review information

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How much do healthcare utilization review jobs pay per hour?

As of Sep 11, 2026, the average hourly pay for healthcare 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 Healthcare Utilization Review vs Healthcare Claims Reviewer?

AspectHealthcare Utilization ReviewHealthcare Claims Reviewer
CredentialsCertifications like URAC, CCM often preferredCertifications like CPC, CCS beneficial
Work EnvironmentHospitals, insurance companies, healthcare facilitiesInsurance companies, third-party administrators
Job FocusAssessing necessity and appropriateness of servicesReviewing and processing insurance claims for accuracy
Common Search IntentDifferences, responsibilities, qualificationsComparison, roles, duties

Healthcare Utilization Review involves evaluating the necessity of medical services to ensure appropriate care, while Healthcare Claims Review focuses on verifying the accuracy and validity of insurance claims. Both roles require related certifications and are employed within healthcare and insurance settings, but they serve distinct functions in the patient care and billing process.

How do I get into a healthcare utilization review?

To become a healthcare utilization review specialist, typically a background in healthcare, nursing, or health administration is required. Relevant certifications such as the Certified Professional in Healthcare Quality (CPHQ) or Utilization Review Certification can improve job prospects. Experience with medical records, insurance processes, and strong analytical skills are also important for entry into this role.

Is healthcare utilization review a good job?

Healthcare utilization review is a professional role that involves evaluating medical services for insurance companies or healthcare providers to ensure appropriate and cost-effective care. It typically requires knowledge of healthcare policies, strong analytical skills, and sometimes certification, with job stability and demand generally considered favorable in the healthcare industry.

What does a healthcare utilization review specialist do in healthcare?

A healthcare utilization review specialist evaluates medical services to ensure they are necessary, appropriate, and cost-effective. They review patient records, insurance claims, and treatment plans, often using guidelines and criteria to approve or deny coverage, supporting efficient resource use and cost management in healthcare settings.
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What states have the most Healthcare Utilization Review jobs?

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Healthcare Utilization Review jobs near you
Infographic showing various Healthcare Utilization Review job openings in the United States as of August 2026, with employment types broken down into 2% As Needed, 67% Full Time, 14% Part Time, and 17% Contract. Highlights an 90% Physical, 1% Hybrid, and 9% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Liaison

Fremont, CA • On-site

Washington Hospital Healthcare System
Health Care and Social Assistance • 1 - 5K employees
Learn more about Washington Hospital Healthcare Systemexternal

$32.35 - $43.63/hr

Other

Posted 27 days ago

Job description

Utilization Review Liaison

Salary Range: $32.35 - $43.63 + applicable differentials

Under the general supervision of the Director of Case Management, the Utilization Review (UR) Liaison is responsible for assisting Utilization Review Case Managers. The UR Liaison is responsible for coordinating insurance reviews and issuance of authorization numbers through submission of required clinical information. The UR Liaison will work directly with all Case Management staff, Business Office, Patient Access, and along with the Hospital's Revenue Cycle to ensure quality and efficiency of certain elements of claims processing, denial prevention, and denial management.

Provides office and referral management support services; assists the Utilization Review Team in obtaining medical records, documenting case information in the system, performing data entry into appropriate databases for monitoring and tracking, and following up on phone calls as directed.

Continue to learn about clinical programs, processes, and changes

May also perform office support functions as required

In addition to performing the essential functions listed below, may also be assigned other duties as required.

Washington Hospital Health System does not utilize any form of electronic chatting, such as Google chat for the purposes of interviewing candidates for employment. If you are contacted by any entity or individual attempting to engage you in this format, do not disclose any personal information and contact Washington Hospital Healthcare System.

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