... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
UTILIZATION SPECIALIST
North Olmsted, OH · On-site
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
UTILIZATION SPECIALIST
North Olmsted, OH · On-site
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
UTILIZATION SPECIALIST
Hudson, OH · On-site
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
UTILIZATION SPECIALIST
Hudson, OH · On-site
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The ...
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. Utilization ...
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. Utilization ...
UTILIZATION SPECIALIST-E.D.
Hudson, OH · On-site
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. Utilization ...
UTILIZATION SPECIALIST-E.D.
Hudson, OH · On-site
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. Utilization ...
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. Utilization ...
... review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. Utilization ...
RN Utilization Review in Middleburg Heights, OH
Middleburg Heights, OH · On-site
$1.9K - $2.1K/wk
Now Hiring: RN Utilization Review - Middleburg Heights, OH Job ID: JOB-414060 Weekly Pay Range ... Medical, Vision & Dental insurance * 401(k) Matching Program * Flexible Schedules * Travel ...
RN Utilization Review in Middleburg Heights, OH
Middleburg Heights, OH · On-site
$1.9K - $2.1K/wk
Now Hiring: RN Utilization Review - Middleburg Heights, OH Job ID: JOB-414060 Weekly Pay Range ... Medical, Vision & Dental insurance * 401(k) Matching Program * Flexible Schedules * Travel ...
This role will review patient medical records to ensure accurate documentation, proper level of ... Strong verbal and written communication skills to interact with physicians and insurance payers.
This role will review patient medical records to ensure accurate documentation, proper level of ... Strong verbal and written communication skills to interact with physicians and insurance payers.
This role will review patient medical records to ensure accurate documentation, proper level of ... Strong verbal and written communication skills to interact with physicians and insurance payers.
This role will review patient medical records to ensure accurate documentation, proper level of ... Strong verbal and written communication skills to interact with physicians and insurance payers.
This role will review patient medical records to ensure accurate documentation, proper level of ... Strong verbal and written communication skills to interact with physicians and insurance payers.
This role will review patient medical records to ensure accurate documentation, proper level of ... Strong verbal and written communication skills to interact with physicians and insurance payers.
Utilization Review Director Shift: M-F Hours: 8-4:30 9-5 The Role Itself * Oversees service ... Life Insurance Options * Accidental Insurances * Paid Time Off + Paid Holidays * Employee ...
Utilization Review Director Shift: M-F Hours: 8-4:30 9-5 The Role Itself * Oversees service ... Life Insurance Options * Accidental Insurances * Paid Time Off + Paid Holidays * Employee ...
Insurance Utilization Review information
See Ohio salary details
$20.34 - $24.45
2% of jobs
$24.45 - $28.57
9% of jobs
$31.38 is the 25th percentile. Wages below this are outliers.
$28.57 - $32.68
21% of jobs
The median wage is $36.01 / hr.
$32.68 - $36.79
23% of jobs
$36.79 - $40.91
13% of jobs
$44.11 is the 75th percentile. Wages above this are outliers.
$40.91 - $45.02
10% of jobs
$45.02 - $49.13
8% of jobs
$49.13 - $53.25
5% of jobs
$53.25 - $57.36
5% of jobs
$57.36 - $61.48
2% of jobs
$61.48 - $65.59
2% of jobs
$20
$40
$65
How much do insurance utilization review jobs pay per hour?
As of Aug 8, 2026, the average hourly pay for insurance utilization review in Ohio is $40.20, according to ZipRecruiter salary data. Most workers in this role earn between $31.78 and $46.15 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.
What are the most commonly searched types of Insurance Utilization Review jobs in Ohio? The most popular types of Insurance Utilization Review jobs in Ohio are:
What are popular job titles related to Insurance Utilization Review jobs in Ohio? For Insurance Utilization Review jobs in Ohio, the most frequently searched job titles are:
- Senior Behavioral Health Utilization Review
- Part Time Utilization Review Nurse
- Freelance Utilization Review Nurse
- Non Exempt No Experience Utilization Management Nurse
- Utilization Management
- No Experience Hedis Review Nurse
- Flex Schedule Remote Utilization Review Nurse
- Night Shift Remote Utilization Review Nurse
- Utilization Review Nurse
- Behavioral Health Utilization Review
What job categories do people searching Insurance Utilization Review jobs in Ohio look for? The top searched job categories for Insurance Utilization Review jobs in Ohio are:
- Per Diem Remote Occupational Therapy Utilization Review
- Medical Utilization Review Physician
- Therapy Utilization Review
- Utilization Review Nurse Compact License
- Utilization Review Coordinator Remote
- Remote Dental Utilization Review
- Utilization Review Clinician
- Utilization Review Salary
- Utilization Review
- Temporary Aetna Utilization Review Nurse
What cities in Ohio are hiring for Insurance Utilization Review jobs? Cities in Ohio with the most Insurance Utilization Review job openings:
Southwest General Health Center rating
6.9
Based on 46 frontline employees who took The Breakroom Quiz
549th of 1,055 rated hospitals
Job description
Summary
-
POSITION INFORMATION
-
Position summary:
-
The Utilization Specialist is responsible for carrying out admission and concurrent stay screening reviews of the assigned patient population during the episode of care under defined guidelines for acute care case management to ensure the appropriateness of services, utilization of hospital resources, and quality of care rendered. Accurate and efficient application of screening criteria will be applied to identify and support patients being placed in the appropriate hospital level of care via emergency, scheduled, or direct admission processes. Combines clinical, business, and regulatory knowledge and skill to reduce significant financial risk and exposure caused by concurrent and retrospective denial of payments for services provided. Through continuous assessments, problem identification, and education, the Utilization Specialist facilitates the quality of health care delivery in the most cost-effective manner. The Utilization Specialist must be able to demonstrate the knowledge and skills necessary to provide services appropriate to age groups according to specific chronological age, developmental age, and/or psycho-social maturity. The Utilization Specialist will work collaboratively with management, staff, and departments involved in the patients plan of care. The Utilization Specialists responsibility is to collect data and clinical review summaries on patients concurrently for both utilization review and quality assessment. The utilization data and clinical summaries are shared with insurance companies to obtain certification of days and prevent denial of payment for services. The Utilization Specialist will communicate with physicians, hospital staff, outside agencies such as insurance companies, and patients regarding the assigned level of care and associated resource utilization.
-
-
-
MINIMUM QUALIFICATIONS
-
Education:
-
Graduation from an accredited School of Nursing. BSN graduate preferred.
-
-
Required length and type of experience:-
Minimum of five (5) years recent experience in clinical nursing or related nursing field. (e.g. Utilization Review or Case Management)
-
Previous Care Management, Case Management or Utilization Management Experience preferred
-
Previous experience with screening criteria (i.e. Interqual, MCG) preferred
-
Excellent critical thinking and communication skills
-
Strong computer skills
-
-
Required licensure, certification or registry:-
Current licensure by Ohio State Board of Nursing.
-
ACM/CCM Certification helpful
-
-
What Southwest General Health Center employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About Southwest General
Sourced by ZipRecruiter
Industry
Hospitals
Company size
1,001 - 5,000 Employees
Headquarters location
Middleburg Heights, OH, US
Year founded
1920