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Insurance Utilization Review Jobs in West Virginia

Dane Street

Board-Certified Neurologist

Chapmanville, WV · On-site

$284K - $355K/yr

... 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 ...

Dane Street, LLC

Board-Certified Neurologist

Chapmanville, WV · On-site

$284K - $355K/yr

... 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 ...

Dane Street, LLC

Board-Certified Neurologist

Chapmanville, WV · On-site

$284K - $355K/yr

... 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 ...

Ourhrconnect

Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...

Ourhrconnect

Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...

Ourhrconnect

Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...

Ourhrconnect

Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...

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All JobsInsurance Utilization Review JobsInsurance Utilization Review Jobs in West Virginia

Insurance Utilization Review information

See West Virginia salary details

$16

$32

$53

How much do insurance utilization review jobs pay per hour?

As of Aug 17, 2026, the average hourly pay for insurance utilization review in West Virginia is $32.73, according to ZipRecruiter salary data. Most workers in this role earn between $25.87 and $37.60 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 popular job titles related to Insurance Utilization Review jobs in West Virginia?

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

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

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

Insurance Utilization Review jobs near you
Infographic showing various Insurance Utilization Review job openings in West Virginia as of August 2026, with employment types broken down into 1% As Needed, 73% Full Time, 22% Part Time, and 4% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution, with an average salary of $68,085 per year, or $32.7 per hour.

Healthcare Staffing Sales

Anderson Recruiting & Consulting

Charleston, WV • Remote

$49K - $64K/yr

Full-time, Contractor

Re-posted 17 days ago

Job description

healthcare Staffing Sales - Remote US

Our client is expanding their Science and Healthcare Practice and is looking for proven sales talent with experience selling RN Case Managers and Utilization Review RN's. They focus solely on Contract and Contract to Hire business nationally. They sell to Hospitals, Health Insurance Companies, Home Health, Nursing Facilities, along with many other Providers and Programs. Target is to average over 30% GM per placement on $1M+ in GM per year.

Offering a solid base salary + uncapped commissions, excellent benefits package with a lot of additional perks. Excellent leadership/training and growth opportunities.

For additional information/consideration, please apply.

#LI - CA1