Charleston, WV · Remote
$49K - $64K/yr
... N 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 ...
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Charleston, WV · Remote
$49K - $64K/yr
... N 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 ...
Morgantown, WV · On-site
$60 - $72/hr
Check out retirement health insurance benefits, retirement income, and FAQ's * Wellness programs ... Review individual prior authorization, drug utilization review, and billing inquiries and use ...
Morgantown, WV · On-site
$60 - $72/hr
Check out retirement health insurance benefits, retirement income, and FAQ's * Wellness programs ... Review individual prior authorization, drug utilization review, and billing inquiries and use ...
Morgantown, WV · On-site
$60 - $72/hr
Check out retirement health insurance benefits, retirement income, and FAQ's * Wellness programs ... Review individual prior authorization, drug utilization review, and billing inquiries and use ...
Morgantown, WV · On-site
$60 - $72/hr
Check out retirement health insurance benefits, retirement income, and FAQ's * Wellness programs ... Review individual prior authorization, drug utilization review, and billing inquiries and use ...
Morgantown, WV · On-site
$60 - $72/hr
Check out retirement health insurance benefits, retirement income, and FAQ's * Wellness programs ... Review individual prior authorization, drug utilization review, and billing inquiries and use ...
Morgantown, WV · On-site
$60 - $72/hr
Check out retirement health insurance benefits, retirement income, and FAQ's * Wellness programs ... Review individual prior authorization, drug utilization review, and billing inquiries and use ...
Morgantown, WV · On-site
WVU offers a range of health insurance and other benefits * 401(a) retirement savings with 6% ... Review individual prior authorization, drug utilization review, and billing inquiries and use ...
Morgantown, WV · On-site
WVU offers a range of health insurance and other benefits * 401(a) retirement savings with 6% ... Review individual prior authorization, drug utilization review, and billing inquiries and use ...
Morgantown, WV · On-site
WVU offers a range of health insurance and other benefits * 401(a) retirement savings with 6% ... Review individual prior authorization, drug utilization review, and billing inquiries and use ...
Morgantown, WV · On-site
WVU offers a range of health insurance and other benefits * 401(a) retirement savings with 6% ... Review individual prior authorization, drug utilization review, and billing inquiries and use ...
Morgantown, WV · On-site
Check out retirement health insurance benefits, retirement income, and FAQ's. • Wellness program ... Review individual prior authorization, drug utilization review, and billing inquiries and use ...
Morgantown, WV · On-site
Check out retirement health insurance benefits, retirement income, and FAQ's. • Wellness program ... Review individual prior authorization, drug utilization review, and billing inquiries and use ...
Charleston, WV · On-site
$95 - $100/hr
... Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ... insurance benefits) to qualifying employees. All compensation determinations are based on the ...
Charleston, WV · On-site
$95 - $100/hr
... Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ... insurance benefits) to qualifying employees. All compensation determinations are based on the ...
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 ...
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 ...
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 ...
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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 ...
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 ...
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 ...
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 ...
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 ...
... reviews insurance appeals, and prospective and retrospective claims. The Physician Reviewer will ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
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... reviews insurance appeals, and prospective and retrospective claims. The Physician Reviewer will ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... reviews insurance appeals, and prospective and retrospective claims. The Physician Reviewer will ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... reviews insurance appeals, and prospective and retrospective claims. The Physician Reviewer will ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... reviews insurance appeals, and prospective and retrospective claims. The Physician Reviewer will ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
... reviews insurance appeals, and prospective and retrospective claims. The Physician Reviewer will ... and utilization review/management expertise * Expanded credentials as an expert in Independent ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Charleston, WV · On-site
$130 - $140/hr
... Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ... insurance benefits) to qualifying employees. All compensation determinations are based on the ...
Charleston, WV · On-site
$130 - $140/hr
... Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance ... insurance benefits) to qualifying employees. All compensation determinations are based on the ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
$16.56 - $19.91
2% of jobs
$19.91 - $23.26
9% of jobs
$25.55 is the 25th percentile. Wages below this are outliers.
$23.26 - $26.61
21% of jobs
The median wage is $29.32 / hr.
$26.61 - $29.96
23% of jobs
$29.96 - $33.31
13% of jobs
$35.92 is the 75th percentile. Wages above this are outliers.
$33.31 - $36.66
10% of jobs
$36.66 - $40.01
8% of jobs
$40.01 - $43.36
5% of jobs
$43.36 - $46.71
5% of jobs
$46.71 - $50.06
2% of jobs
$50.06 - $53.41
2% of jobs
$16
$32
$53
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.
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.
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.
$49K - $64K/yr
Full-time, Contractor
Re-posted 9 days ago
Sourced by ZipRecruiter
Recruiting and staffing services
11 - 50 Employees
Atlanta, GA, US
2006
