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Insurance Utilization Review Jobs in Tennessee (NOW HIRING)

Charlie Health

Utilization Review Specialist

Nashville, TN · Remote

$62K - $70K/yr

Given the complex nature of insurance these days, it is crucial to have timely communication with ... Knowledge of utilization review processes, medical necessity criteria, and healthcare regulations

Covenant Health

RN UTILIZATION MGMT I

Knoxville, TN · On-site

Prepares and reviews necessary documentation for insurance utilization management processes and coordinates communication between members of the UM team to ensure timely follow through for status ...

Covenant Health

RN UTILIZATION MGMT I

Knoxville, TN

Prepares and reviews necessary documentation for insurance utilization management processes and coordinates communication between members of the UM team to ensure timely follow through for status ...

Summit BHC

Assigns all clients to Utilization Review staff and supervises staff to ensure staff are completing insurance verifications on time and compliant with regulatory standards and requirements. * Ensures ...

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Insurance Utilization Review information

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$38

$62

How much do insurance utilization review jobs pay per hour?

As of Aug 30, 2026, the average hourly pay for insurance utilization review in Tennessee is $38.38, according to ZipRecruiter salary data. Most workers in this role earn between $30.34 and $44.09 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 Tennessee?

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

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

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

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

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

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

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

Insurance Utilization Review jobs near you
Infographic showing various Insurance Utilization Review job openings in Tennessee as of August 2026, with employment types broken down into 100% Full Time. Highlights an 67% In-person, and 33% Remote job distribution, with an average salary of $79,822 per year, or $38.4 per hour.

Manager of Utilization Review

ODYSSEY BEHAVIORAL GROUP

Franklin, TN • On-site, Remote

Full-time

Re-posted 9 days ago

Job description

Position Summary
The Manager of Utilization Review (UR) manages the daily operations of the UR practices for an assigned division. Leads This position ensures timely initial, concurrent, and retrospective reviews are conducted efficiently with a high degree of accuracy. The Manager of Utilization Review collaborates with leaders throughout the company to support denial prevention strategies, regulatory compliance and process optimization. This position serves as an internal subject matter expert and frontline people leader guiding and educating team members on UR functions, tracking and maintaining performance metrics, managing workflows and cross functional collaboration in support of organizational goals.
Relationships and Contacts
Within the organization: Maintains frequent and close working relationships with the Director of Utilization Review, Utilization Review Coordinators, Revenue Cycle team members, Admissions team members, Nursing leadership, milieu leadership, and all clinical team members.
Outside the organization: Initiates and maintains strong professional relationships with clients and families, insurance carrier contacts, referral partners and vendors, as needed.
Position Responsibilities
Essential Responsibilities
  1. Communicates professionally and effectively with multidisciplinary team members, insurance organizations and business offices, providing needed information in a logical, concise manner using technical language that accurately describes clients' condition(s) and treatment needs.
  2. Manages hiring and selection, onboarding training, regular coaching and supervision of Utilization Review Coordinators.
    1. Provides fair and consistent leadership and communication with team members.
    2. Promotes effective team dynamics within and between departments, facilitates team building and professional development for Utilization Review Coordinators.
  3. Assists team members with challenging cases, removing barriers and increasing access to care.
  4. Performs medical records reviews and ongoing training with clinical/medical team members within the assigned division.
  5. Performs regular audits of Utilization Review Coordinator's work to ensure quality and performance.
  6. Maintains current knowledge of Utilization Review process and trends, including denials and concurrent reviews.
  7. Revises processes in collaboration with the Director of Utilization Review to meet organizational goals, as needed.
  8. Utilizes effective documentation standards that support a strong historical record of actions taken on each account.
  9. Maintains a strict level of confidentiality for all client, company, departmental, and healthcare provider information.
  10. Escalates challenges and/or roadblocks to Director of Utilization Review for resolution, as needed.

Additional Responsibilities
  1. Maintains current knowledge of Utilization Review process, including denials and concurrent reviews.
  2. Functions within the guidelines of the corporate Code of Ethics and in accordance with Corporate Compliance standards.
  3. Reads, understands, adheres to, and models all company policy statements on ethics, conduct, and conflict of interests.
  4. Attends and completes all training within assigned time frames.
  5. Performs other duties as assigned.

Education and Experience
Position requires a bachelor's degree or equivalent in combined education and experience, and a minimum of three (3) years' experience with external review organizations or comparable entities doing pre-certification and concurrent reviews in mental health, substance abuse, and/or eating disorder facilities. Requires a comprehensive understanding of the admission, concurrent, continued stay, and retrospective reviews using established facility criteria.
Physical Requirements
  • While performing the duties of this job, the employee will be required to communicate with peers/public, clients and/or vendors.
  • Tolerant to various noise levels: noise level in the work environment varies - may be very quiet to moderate.
  • Job performance will require the ability to sit or remain stationary for extended periods of time.
  • While performing the duties of this job, the employee may be required to talk or hear, sit, and stand.

Additional Requirements
  • Clearance of pre-employment tests, and any other mandatory state/federal requirements.

Skill Competencies
  • Demonstrates a proficient knowledge of medical and behavioral health terminology, and techniques used to diagnose and treat various medical conditions; including practices, standards of care, symptoms, treatment alternatives, medications used for treatment, and preventative healthcare measures.
  • Demonstrated ability to successfully function under pressure in critical situations.
  • Demonstrated ability to effectively manage conflict and crisis situations.
  • Demonstrates strong problem solving and analytical skills.
  • Demonstrates the ability to consistently exercise sound judgment and a high level of discretion.
  • Demonstrates excellent organizational and time management skills.
  • Demonstrates a high level of collaborative skills working with a variety of groups.
  • Demonstrates excellent interpersonal and relationship building skills.
  • Demonstrates a high level of follow-through and attention to detail.
  • Demonstrates excellent verbal and written communication skills.
  • Consistently demonstrates and models alignment with company core values and mission.
  • Demonstrate proficiency with technology resources to include Microsoft Office programs.

Odyssey Behavioral Healthcare, LLC and its subsidiaries provide equal employment opportunities without regard to race, color, creed, ancestry, national origin, ethnicity, sex, gender, sexual orientation, marital status, religion, age, disability, gender identity, genetic information, service in the military, or any other characteristic protected under applicable federal, state, or local law. Equal employment opportunities apply to all terms and conditions of employment. Odyssey reserves the rights to modify, interpret, or apply this job description in any way the organization desires. This job description in no way implies that these are the only duties, including essential duties, to be performed by the employee occupying this position. Reasonable accommodations may be made to reasonably accommodate qualified individuals with disabilities. This job description is not an employment contract, implied or otherwise. The employment relationship remains "At-Will."

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