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Insurance Utilization Review Jobs (NOW HIRING)

Midland Health

Nurse Utilization Review

Midland, TX

The utilization review (UR) nurse serves to maximize the quality and cost efficiency of health care ... insurance information, provide clinical updates to 3rd Party payors, place accounts on hold and ...

Midland Health

Nurse Utilization Review

Midland, TX · On-site

The utilization review (UR) nurse serves to maximize the quality and cost efficiency of health care ... insurance information, provide clinical updates to 3rd Party payors, place accounts on hold and ...

Mindful Health

Utilization Review Specialist

$25 - $30/hr

Utilization Review Specialist Mindful Health is a fast-growing company with the goal of providing ... Comprehensive medical and supplemental health insurance, including vision, dental, life insurance ...

Midland Health

Nurse Utilization Review

Midland, TX

The utilization review (UR) nurse serves to maximize the quality and cost efficiency of health care ... Communicates and works closely with insurance companies to ensure that the organization will be ...

PARKSIDE INC

Utilization Review Specialist

Tulsa, OK · On-site

The Utilization Review Specialist asses, plans, implements and evaluates the internal processes to ... Company Paid Life Insurance and Disability and more! We are an Equal Opportunity Employer!

Dane Street, LLC

Utilization Review Physician

Perform utilization review for: * Preauthorization requests * Appeals (first and second level ... Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We ...

Genesis HealthCare

Works with insurance verification associates, billers, physicians, and patients to analyze and resolve payor authorization problems in order to assure timely reimbursement. Works with Utilization ...

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How much do insurance utilization review jobs pay per hour?

As of Jun 8, 2026, the average hourly pay for insurance utilization review in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

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.

What are the key skills and qualifications needed to thrive in the Insurance Utilization Review position, and why are they important?

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 is an Insurance Utilization Review job?

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.

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What cities are hiring for Insurance Utilization Review jobs? Cities with the most Insurance Utilization Review job openings:
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What states have the most Insurance Utilization Review jobs? States with the most job openings for Insurance Utilization Review jobs include:
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Insurance Utilization Review jobs near you
Infographic showing various Insurance Utilization Review job openings in the United States as of May 2026, with employment types broken down into 1% Locum Tenens, 54% Full Time, 42% Part Time, 2% Contract, and 1% Nights. Highlights an 89% Physical, 2% Hybrid, and 9% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.
Nurse Utilization Review

Nurse Utilization Review

Midland Health

Midland, TX

Full-time

Medical

Posted 24 days ago

Job description

The utilization review (UR) nurse serves to maximize the quality and cost efficiency of health care services. Through regular utilization reviews and audits, the UR nurse ensures that patients receive the care they need without unnecessary diagnostic procedures, ineffective treatments or extended hospital stays. The utilization review examines how health care services are being utilized. The UR nurse requires extensive knowledge of patient care, medical treatments and hospital procedures. The UR nurse will rely on their clinical judgment, honed over years in acute care settings, to make responsible decisions that promote patient health and well-being while keeping resources available to those most in need. The UR nurse will also assist Registered Nurse (RN) Case Managers and Social Workers with helping patients make informed decisions about their health care by educating them on the benefits and limitations of their Medicare, Medicaid or private health care coverage.

SHIFT AND SCHEDULE

Full Time, Monday - Friday; 8:00 AM - 5:00 PM

ESSENTIAL FUNCTIONS/PERFORMANCE EXPECTATIONS

• Able to utilize electronic healthcare record (EHR) and billing systems, filter and prioritize UM Worklist, document Utilization Management (UM) reviews of various types, enter notes, locate insurance information, provide clinical updates to 3rd Party payors, place accounts on hold and release, and manage concurrent denials.

• Proficiently navigate within the EHR and the UM platform to gather documented information concerning the patient to establish appropriate utilization of hospital services.

• Conducts and documents an UM Review at time of admission or the next working day.

• Conducts and documents concurrent UM reviews no more than 3 days after admission review has been completed. Refers to Physican Advisor appropriately.

• Performs an in-depth Extended Stay review on patients with a stay greater than 5 days and refers to Physician Advisor appropriately.

• Utilizes and applies UM platform Care Level Scores along with clinical expertise, to validate medical necessity of the ordered admission status, appropriateness of treatment, and ordered level of care.

• Confers with attending physician or Physician Advisor when appropriate to make a determination about medical necessity.

• Communicates and works closely with insurance companies to ensure that the organization will be reimbursed for services rendered. Providing supporting documentation to justify medical necessity of the admission or continuation of stay.

• Assists and educates Medical Staff and other members of the healthcare team with regards to utilization issues such as, but not limited to:

     Admission Status

     Level of Care

     Medical Necessity

     Costs and best practices of treatment

     Expected Length of Stay (LOS)

• Functions as a resource to the healthcare team regarding approved criteria, practice guidelines, and alternative treatment options.

• Provides monthly reporting to the Utilization Management/Case Management Committee regarding inappropriate admissions.

• Assists with ensuring compliance with CMS Conditions of Participation for Utilization Review, Appendix A/§42 CFR 482.30

EDUCATION AND EXPERIENCE

Current State of Texas License as a Registered Nurse.

5 years of nursing experience (preferably in utilization management or hospital/acute care).

Computer proficiency in Microsoft Office

PHYSICAL REQUIREMENTS

· To perform this job successfully, an individual must be able to perform each essential responsibility satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The individual must be able to: Ø Stand, walk, sit, stoop, reach, lift, see, speak and hear. Lifting is limited to 35 lbs. for clinical staff and to 50 lbs. for non-clinical staff. The individual must use an assisted-lift device or get another individual(s) to assist with the lift that is over these maximum limits.

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