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Healthcare Utilization Review Jobs (NOW HIRING)

Pride Health

Utilization Review Nurse

Manhattan, NY · On-site

$60 - $61/hr

... ensuring appropriate utilization of healthcare services and improved member outcomes ... Perform utilization review and discharge planning. * Collaborate with providers and ...

Acrisure, LLC

Collaborate with physicians, healthcare providers, claims professionals, and internal team members ... Utilization review or case management experience highly beneficial* Clinical experience involving ...

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 ...

Randolph Health

Utilization Review Nurse

Asheboro, NC · On-site

$21.47 - $35/hr

... the Utilization Review Plan for Randolph Hospital. Review patient record and plan of care at ... Knowledge of treatment modalities and alternate healthcare delivery systems is preferred. Three ...

Umpqua Health

Utilization Review Clinician

Roseburg, OR · On-site

Utilization Review Clinician Remote Ability to travel on-site to 3031 NE STEPHENS ST. ROSEBURG, OR ... We provide integrated, whole-person care through primary care, specialty care, behavioral health ...

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 ...

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 ...

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 ...

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 ...

Orison

RN - Utilization Review

Elmhurst, NY · On-site

Communicate with physicians and other healthcare providers regarding clinical information and ... Non-acute utilization review. Skills: RN,REGISTERED NURSE

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Healthcare Utilization Review information

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$21

$42

$68

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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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 Nurse

Manhattan, NY • On-site

Pride Health
Recruiting and Staffing Services • 51 - 200 employees
Learn more about Pride Healthexternal

$60 - $61/hr

Other

Medical, Dental, Vision, Life, Retirement

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

Job description

Care Manager (RN) – Non-Patient-Facing - MLTC

Location: New York, NY 10004

Schedule: Monday–Friday | 9:00 AM – 5:00 PM (35 hours/week)

Job Start date: 09/28/2026

Duration: 8–13+ weeks (extension possible)

Pay Rate: $60–$61/hour


We are seeking an experienced Registered Nurse (RN) for a non-patient-facing Care Manager position in New York. This role is focused on care coordination, utilization management, discharge planning, and case management. The RN will collaborate with interdisciplinary teams, members, and caregivers to develop and manage individualized care plans while ensuring appropriate utilization of healthcare services and improved member outcomes.


Responsibilities:

  • Coordinate and manage member care plans.
  • Perform utilization review and discharge planning.
  • Collaborate with providers and interdisciplinary teams.
  • Assess member needs and coordinate appropriate services.
  • Maintain accurate documentation and ensure compliance with regulatory guidelines.
  • Support quality improvement and care management initiatives.


Qualifications:

  • Active New York RN License
  • BSN required
  • Minimum 5 years of clinical nursing experience
  • Experience in Care Coordination, Utilization Review, and Discharge Planning
  • MLTC experience required
  • Computer proficiency required
  • PRI and Screen Certification required within 3 months of hire


Benefits

Pride Global offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts with preferred vendors.


Equal Employment Opportunity

Pride Health is an equal opportunity employer. We do not discriminate on the basis of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, reproductive health decision making, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, veteran or military status, or any other characteristic protected by applicable federal, state, or local law.


Fair Chance Employment

Pride Health is a Fair Chance employer. We consider all qualified applicants, including those with criminal histories, in a manner consistent with applicable state and local Fair Chance laws and ordinances, including the California Fair Chance Act and all applicable local Fair Chance ordinances.


Accommodations

We are committed to providing reasonable accommodations to applicants and employees with disabilities. If you require a reasonable accommodation to participate in the application or interview process, or to perform the essential functions of this role, please contact us.

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About PRIDE Health

Sourced by ZipRecruiter

PRIDE Health is the minority-owned healthcare recruitment division of Pride Global--an integrated human capital solutions and advisory firm. With our robust and abundant travel nursing and allied health employment options across the U.S., PRIDE Health will allow you to help change the way the world lives and heals as it connects you with the industry's leading healthcare organizations.

Industry

Recruiting and staffing services

Company size

51 - 200 Employees

Headquarters location

New York, NY, US

Year founded

2010

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