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Insurance Utilization Review Jobs (NOW HIRING)

Enlyte

Utilization Reviewer 2

Tampa, FL

$59K - $76K/yr

Prior review experience in healthcare, insurance, utilization management, quality assurance, or other applicable capacity. * Prior experience in the workers' compensations field. Benefits We're ...

Discovery Institute

Utilization Review

Marlboro, NJ · On-site

Obtain initial and concurrent insurance authorizations for all levels of care. * Review clinical ... Participate in utilization review meetings and case conferences. * Generate reports on ...

Genex Services

Utilization Reviewer 2

Tampa, FL · On-site

$59K - $76K/yr

Prior review experience in healthcare, insurance, utilization management, quality assurance, or other applicable capacity. * Prior experience in the workers' compensations field. Benefits We're ...

Enlyte

Utilization Reviewer 2

Tampa, FL · On-site

$59K - $76K/yr

Prior review experience in healthcare, insurance, utilization management, quality assurance, or other applicable capacity. * Prior experience in the workers' compensations field. Benefits We're ...

Prime Time Healthcare

Utilization Review

Baltimore, MD · On-site

Now Hiring: RN Utilization Review - Baltimore, MD Are you a passionate RN professional looking for ... Medical, vision & dental insurance * 401(k) matching program * Flexible schedules * Travel ...

Ova Technologies

Utilization Review Nurse

Alpharetta, GA · On-site

Utilization Review Nurse Location: [City, State / Remote] Employment Type: Full-Time Experience: 2 ... Communicate with insurance companies, managed care organizations, and third-party payers regarding ...

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How much do insurance utilization review jobs pay per hour?

As of Aug 10, 2026, the average hourly pay for insurance 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 are the most common challenges faced by insurance utilization review professionals?

One common challenge in Insurance Utilization Review is balancing the need for cost-effective care with the clinical needs of patients, which often requires careful analysis and decision-making. Professionals in this role frequently navigate complex medical records, strict policy guidelines, and collaborate with healthcare providers who may advocate strongly for particular treatments. Managing challenging conversations while maintaining professionalism and ensuring timely determinations are also a regular part of the role. Developing expertise in these areas can make the job both demanding and rewarding, while building a strong foundation for career growth within healthcare administration.

What are the key skills and qualifications needed to thrive in insurance utilization review?

To thrive in Insurance Utilization Review, you generally need a strong background in healthcare or nursing, an understanding of medical terminology, and analytical thinking skills, often supported by an RN license or relevant clinical experience. Familiarity with utilization management software, coding systems like ICD-10, and knowledge of regulatory requirements (such as Medicare or Medicaid) are important. Strong communication, attention to detail, and problem-solving abilities help professionals excel when interacting with providers and insurers. These skills are essential to ensure appropriate care is authorized while maintaining regulatory compliance and cost-effectiveness.

What is an insurance utilization review?

An Insurance Utilization Review job involves evaluating medical treatments and services to determine if they are necessary, appropriate, and covered by a patient's insurance plan. Professionals in this role review medical records, treatment plans, and insurance policies to ensure compliance with guidelines and cost-effectiveness. They work closely with healthcare providers, insurance companies, and patients to facilitate approvals or appeals. The goal is to balance quality patient care with cost containment in the healthcare system.

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What cities are hiring for Insurance Utilization Review jobs? Cities with the most Insurance Utilization Review job openings:
What are the most commonly searched types of Insurance Utilization Review jobs? The most popular types of Insurance Utilization Review jobs are:
What states have the most Insurance Utilization Review jobs? States with the most job openings for Insurance Utilization Review jobs include:
What job categories do people searching Insurance Utilization Review jobs look for? The top searched job categories for Insurance Utilization Review jobs are:
Insurance Utilization Review jobs near you
Infographic showing various Insurance Utilization Review job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 73% Full Time, 21% Part Time, and 5% Contract. Highlights an 91% Physical, 1% Hybrid, and 8% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

UTILIZATION REV SPEC I

Aspire Health Partners

Orlando, FL

Full-time

Re-posted 23 days ago

Aspire Health Partners rating

4.8

Company rating: 4.8 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

Job description

Behavioral Health Utilization Review Specialist I

Aspire Health Partners, Inc.

Make a Difference in Behavioral Health Care

At Aspire Health Partners, we are dedicated to transforming lives through compassionate, high-quality behavioral healthcare. As Florida’s largest nonprofit behavioral health provider, we serve diverse populations across Central Florida and are committed to clinical excellence and meaningful impact.

We are currently seeking a Utilization Review Specialist to join our team and play a key role in ensuring our clients receive the care they need while supporting effective coordination with insurance providers.

Position Summary

In this role, you will coordinate and manage insurance utilization review activities for hospitalized clients. You’ll work closely with clinical teams, insurance representatives, and internal departments to ensure timely authorizations, support treatment planning, and contribute to high-quality patient outcomes.

Key Responsibilities

  • Partner daily with the Access Center and/or Crisis Response Center (CRC) to identify clients needing utilization review
  • Communicate clinical information to insurance reviewers to secure authorizations and extended lengths of stay
  • Collaborate with attending psychiatrists on clinical assessments and treatment recommendations
  • Participate in interdisciplinary treatment team meetings to support care for managed care clients
  • Provide constructive clinical feedback to enhance service delivery and patient care
  • Ensure accurate authorization details are submitted to Patient Accounts for billing
  • Review client charts for potential denial issues and support appeal processes when needed
  • Maintain strict adherence to ethical standards, confidentiality, and organizational policies

Qualifications

Required:

  • High School Diploma or equivalent
  • Level II Background clearance- All Aspire Health Partners Internships and Careers require Level 2 clearance, with Aspire covering fingerprinting costs. Click https://info.flclearinghouse.c... to learn more.
  • Valid driver’s license with an acceptable driving record per organizational guidelines

Preferred:

  • Experience in behavioral health, utilization review, or managed care environments
  • LPN or RN experience
  • Strong communication, documentation, and organizational skills

Why Join Aspire?

  • Mission-driven organization making a real impact in your community
  • Collaborative, team-focused work environment
  • Opportunities for growth and professional development
  • A role where your work directly supports quality care and patient outcomes

Equal Opportunity Employer

Aspire Health Partners is a drug-free workplace and an Equal Opportunity Employer. We value diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will be considered without regard to race, color, religion, national origin, sex, age, disability, or veteran status.


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