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Insurance Utilization Review Jobs in Pennsylvania

National Medical Reviews

Review Coordinator

Warminster, PA · On-site

$65K - $70K/yr

Experience in health insurance, utilization review, quality management and/or managed care * Pursues excellence while achieving results within defined parameters * Listens effectively and expresses ...

National Medical Reviews

Review Coordinator

Warminster, PA · On-site

$65K - $70K/yr

Experience in health insurance, utilization review, quality management and/or managed care * Pursues excellence while achieving results within defined parameters * Listens effectively and expresses ...

Wellpath

Director Utilization Mgmt

Lemoyne, PA · On-site

$199K - $249K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... insurance • Tax free Health Spending Accounts (HSA) • Wellness program featuring fitness ... Manage UM staff including performance reviews, employee development, hiring, coaching, counseling ...

Acadia Healthcare

Utilization Specialist

Moosic, PA · On-site

Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...

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All JobsInsurance Utilization Review JobsInsurance Utilization Review Jobs in Pennsylvania

Insurance Utilization Review information

See Pennsylvania salary details

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$42

$69

How much do insurance utilization review jobs pay per hour?

As of Aug 18, 2026, the average hourly pay for insurance utilization review in Pennsylvania is $42.38, according to ZipRecruiter salary data. Most workers in this role earn between $33.51 and $48.65 per hour, depending on experience, location, and employer.

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 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 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.

How do I get into an insurance utilization review?

To become an insurance utilization review specialist, candidates typically need a background in healthcare, nursing, or a related field, along with knowledge of insurance policies and medical terminology. Certification such as the Certified Professional in Healthcare Quality (CPHQ) or similar credentials can enhance job prospects. Relevant skills include attention to detail, analytical thinking, and familiarity with medical records and insurance software systems.

Is insurance utilization review a stressful job?

Insurance utilization review can be stressful due to the need for accuracy, attention to detail, and meeting strict deadlines. Reviewers often handle complex cases and must balance policy guidelines with patient needs, which can contribute to job pressure. However, the level of stress varies depending on workload, work environment, and individual coping skills.

What are the most commonly searched types of Insurance Utilization Review jobs in Pennsylvania?

The most popular types of Insurance Utilization Review jobs in Pennsylvania are:

What are popular job titles related to Insurance Utilization Review jobs in Pennsylvania?

For Insurance Utilization Review jobs in Pennsylvania, the most frequently searched job titles are:

What job categories do people searching Insurance Utilization Review jobs in Pennsylvania look for?

The top searched job categories for Insurance Utilization Review jobs in Pennsylvania are:

What cities in Pennsylvania are hiring for Insurance Utilization Review jobs?

Cities in Pennsylvania with the most Insurance Utilization Review job openings:

Insurance Utilization Review jobs near you
Infographic showing various Insurance Utilization Review job openings in Pennsylvania as of August 2026, with employment types broken down into 1% As Needed, 70% Full Time, 25% Part Time, and 4% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution, with an average salary of $88,158 per year, or $42.4 per hour.

Utilization Review Specialist

Diversified Treatment Alternative Centers

Chadds Ford, PA • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 15 days ago

Job description

Utilization Review (UR) Specialist

Location: Chadds Ford, Pennsylvania (Hybrid / Remote Eligible)
Job Type: Full-Time
Schedule: Monday – Friday


Overview

Diversified Treatment Alternative Centers (DTAC) is seeking a detail-oriented and experienced Utilization Review (UR) Specialist to support our behavioral health programs.

This role plays a critical part in ensuring services are medically necessary, appropriately authorized, and compliant with payer, state, and regulatory requirements while supporting timely reimbursement and quality care delivery.


Why Join DTAC

  • Flexible hybrid or remote work options
  • Collaborative, cross-functional team environment
  • Meaningful work supporting behavioral health services
  • Stable organization focused on quality and growth
  • Opportunities for professional development


Position Summary

The Utilization Review Specialist manages the full lifecycle of authorizations and eligibility verification. This role collaborates closely with Clinical, Admissions, and Revenue Cycle teams to ensure compliance, minimize denials, and support accurate billing and reimbursement.


Key Responsibilities

  • Conduct initial, concurrent, and continued stay utilization reviews
  • Submit, track, and manage authorizations and reauthorizations
  • Communicate authorization updates with clinical and admissions teams
  • Maintain accurate documentation in EHR and billing systems
  • Perform ongoing eligibility verification for active clients
  • Identify coverage changes and communicate impacts to appropriate teams
  • Review clinical documentation for medical necessity and compliance
  • Collaborate with clinicians to address documentation gaps
  • Support denial prevention and revenue cycle optimization
  • Assist with appeals and utilization-related inquiries
  • Participate in audits, quality improvement initiatives, and compliance reviews
  • Stay current with payer requirements and regulatory updates


Qualifications

Required:

  • Bachelor’s degree in Healthcare Administration, Nursing, Social Work, Psychology, or related field
  • Minimum of 1–3 years of experience in utilization review, case management, or behavioral health revenue cycle
  • Strong understanding of medical necessity and authorization processes
  • Excellent attention to detail and analytical skills
  • Strong written and verbal communication skills

Preferred:

  • Experience with Pennsylvania and Ohio behavioral health payers
  • Familiarity with EHR systems and billing workflows
  • Experience supporting audits, compliance reviews, or appeals


Requirements

  • Ability to manage multiple priorities and deadlines
  • Strong collaboration across clinical, billing, and administrative teams
  • Commitment to compliance with regulatory and payer requirements
  • Ability to work hybrid or remotely depending on organizational needs


Benefits

  • 401(k)
  • Health, Dental, and Vision Insurance
  • Health Savings Account
  • Paid Time Off
  • Life and Disability Insurance
  • Employee Assistance Program
  • Referral Program


Work Location

This position is based in Chadds Ford, PA (19317) with hybrid or remote work options available based on business needs.


Apply Today

If you are a detail-driven professional with experience in utilization review or behavioral health operations, we encourage you to apply and join DTAC’s team.


Equal Opportunity Employer

Diversified Treatment Alternative Centers is committed to providing equal employment opportunities and maintaining an inclusive workplace in accordance with all applicable laws.