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Insurance Utilization Review Jobs in Pennsylvania

emergiTEL HR Solutions

RN - Case Manager

Honesdale, PA · On-site

$75 - $110/hr

Responsibilities Conduct utilization review for patient admissions and continued stays. Collaborate ... Facilitate communication among providers, patients, and insurance companies. Coordinate discharge ...

Commonwealth Health

RN Case Manager

Scranton, PA

... insurance information k)identifying and documenting potentially avoidable days l) identifying and ... Current Acute Care Case Management and/or Utilization Review experience required. Minimum of one ...

Commonwealth Health

RN Case Manager

Scranton, PA · On-site

... insurance information k)identifying and documenting potentially avoidable days l) identifying and ... Current Acute Care Case Management and/or Utilization Review experience required. Minimum of one ...

Commonwealth Health

RN Case Manager

Scranton, PA · On-site

... insurance information k)identifying and documenting potentially avoidable days l) identifying and ... Current Acute Care Case Management and/or Utilization Review experience required. Minimum of one ...

Commonwealth Health

RN Case Manager

Scranton, PA · On-site

... insurance information k)identifying and documenting potentially avoidable days l) identifying and ... Current Acute Care Case Management and/or Utilization Review experience required. Minimum of one ...

Pyramid Healthcare

Counselor / Therapist

Langhorne, PA · On-site

$50K - $55K/yr

Train in utilization review processes and perform insurance reviews as needed. * Maintain caseload as required. * Support the Director in providing necessary services for the facility. * Perform ...

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All JobsInsurance Utilization Review JobsInsurance Utilization Review Jobs in Pennsylvania

Insurance Utilization Review information

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$42

$69

How much do insurance utilization review jobs pay per hour?

As of Aug 19, 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.

Physician Family Practice-Without OB - Competitive Salary

Enterprise Medical Recruiting

Philadelphia, PA • On-site, Remote

$250K/yr

Other

Medical, Life, Retirement

Re-posted 4 days ago

Job description

A highly awarded health system located north of Philadelphia, Pennsylvania, is seeking a Family Medicine physician to work in a non-clinical utilization review setting.

Opportunity Highlights

  • Daytime Monday through Friday position. Potential to work remotely part of the time.
  • Strong CDI Program
  • Salary and incentive $250K+ depending upon background and experience level
  • Health, life, and disability insurance
  • 403-B Retirement Saving Plan with Employer match
  • Medical malpractice insurance and tail coverage
  • American Board of Quality Assurance and Utilization Review certification is a plus.

About Philadelphia, Pennsylvania

Famous as the birthplace of life, liberty, and the pursuit of happiness, Philadelphia delivers one destination, five counties, and countless things to do: fascinating museums, vibrant parks, national historic sites, and famous (and delicious) food.

GB-2401-97742

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