Rx Claims SME
Eden Prairie, MN · Hybrid
... Utilization Review (DUR) 3. Knowledge on business & plan configuration and plan option knowledge. 4. Facilitate discussion with Product Owners, Business and clarify business requirements 5. High ...
New
Rx Claims SME
Eden Prairie, MN · Hybrid
... Utilization Review (DUR) 3. Knowledge on business & plan configuration and plan option knowledge. 4. Facilitate discussion with Product Owners, Business and clarify business requirements 5. High ...
New
... reviews insurance appeals, and prospective and retrospective claims. The Physician Reviewer will ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... reviews insurance appeals, and prospective and retrospective claims. The Physician Reviewer will ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... reviews insurance appeals, and prospective and retrospective claims. The Physician Reviewer will ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... reviews insurance appeals, and prospective and retrospective claims. The Physician Reviewer will ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Travel Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location ... Benefits: * Day 1 Insurance * Cigna medical, MetLife dental and vision insurance * License ...
Travel Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location ... Benefits: * Day 1 Insurance * Cigna medical, MetLife dental and vision insurance * License ...
... Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ... insurance benefits) to qualifying employees. All compensation determinations are based on the ...
... Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ... insurance benefits) to qualifying employees. All compensation determinations are based on the ...
Board-Certified Pain Medicine
Minneapolis, MN · On-site
$18 - $23/hr
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Quick apply
Board-Certified Pain Medicine
Minneapolis, MN · On-site
$18 - $23/hr
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Board-Certified Pain Medicine
Minneapolis, MN · On-site
$18 - $23/hr
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Board-Certified Pain Medicine
Minneapolis, MN · On-site
$18 - $23/hr
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Quick apply
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Quick apply
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Board-Certified Pain Medicine
$18 - $23/hr
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Board-Certified Pain Medicine
$18 - $23/hr
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Quick apply
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... peer review services, trusted by insurance carriers and organizations across the country for ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Insurance Utilization Review information
See Minnesota salary details
$20.95 - $25.19
2% of jobs
$25.19 - $29.43
9% of jobs
$32.33 is the 25th percentile. Wages below this are outliers.
$29.43 - $33.67
21% of jobs
The median wage is $37.10 / hr.
$33.67 - $37.91
23% of jobs
$37.91 - $42.14
13% of jobs
$45.44 is the 75th percentile. Wages above this are outliers.
$42.14 - $46.38
10% of jobs
$46.38 - $50.62
8% of jobs
$50.62 - $54.86
5% of jobs
$54.86 - $59.09
5% of jobs
$59.09 - $63.33
2% of jobs
$63.33 - $67.57
2% of jobs
$20
$41
$67
How much do insurance utilization review jobs pay per hour?
As of Jun 12, 2026, the average hourly pay for insurance utilization review in Minnesota is $41.41, according to ZipRecruiter salary data. Most workers in this role earn between $32.74 and $47.55 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 the Insurance Utilization Review position, and why are they important?
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 job?
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.
What are the most commonly searched types of Insurance Utilization Review jobs in Minnesota? The most popular types of Insurance Utilization Review jobs in Minnesota are:
What are popular job titles related to Insurance Utilization Review jobs in Minnesota? For Insurance Utilization Review jobs in Minnesota, the most frequently searched job titles are:
- Temporary Utilization Review Nurse
- Remote Utilization Management
- Non Exempt No Experience Utilization Management Nurse
- Utilization Review Physician
- Remote Cvs Utilization Management Nurse
- Contract Hedis Review Nurse
- No Experience Utilization Review Nurse
- Contract Utilization Review Nurse
- Remote Utilization Review Rn
- Overnight Utilization Review Nurse
What job categories do people searching Insurance Utilization Review jobs in Minnesota look for? The top searched job categories for Insurance Utilization Review jobs in Minnesota are:
- Volunteer Aetna Utilization Review Nurse
- Remote International Utilization Review Nurse
- Remote Optum Utilization Review
- Temporary Aetna Utilization Review Nurse
- Remote Anthem Utilization Review Nurse
- Part Time Optum Utilization Review
- Dental Utilization Review
- Utilization Case Manager
- Optum Utilization Review Nurse
- Cigna Utilization Review Nurse
What cities in Minnesota are hiring for Insurance Utilization Review jobs? Cities in Minnesota with the most Insurance Utilization Review job openings:
Job description
W2 and locals only
Rx Claims SME
Eden Prairie - MN; hybrid
Experience : 12+ years
JD:
1. In depth knowledge on RxClaim Adjudication, claims processing, MedD claims
2. Deep knowledge of PBM concepts, including drug pricing, copays, accumulators, and Drug Utilization Review (DUR)
3. Knowledge on business & plan configuration and plan option knowledge.
4. Facilitate discussion with Product Owners, Business and clarify business requirements
5. High level knowledge in executing root cause analysis, managing data validation, and navigating automated database systems/reporting tools.
About Net2Source
Sourced by ZipRecruiter
Net2Source is an employer-of-choice for over 2200+ consultants across the globe. We recruit top-notch talent for over 40 Fortune and Government clients coast-to-coast across the U.S. We are one of the fastest-growing companies in the U.S. and this may be your opportunity to join us!
Industry
Recruiting and staffing services
Company size
1,001 - 5,000 Employees
Headquarters location
New Brunswick, NJ, US
Year founded
2007