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Insurance Utilization Review Jobs (NOW HIRING)

Prime Time Healthcare

Utilization Review

Baltimore, MD · On-site

Now Hiring: RN Utilization Review - Baltimore, MD Are you a passionate RN professional looking for ... Medical, vision & dental insurance * 401(k) matching program * Flexible schedules * Travel ...

Enlyte

Utilization Reviewer 2

Wayne, PA · On-site

$52K - $76K/yr

Prior review experience in healthcare, insurance, utilization management, quality assurance, or other applicable capacity. * Prior experience in the workers' compensations field. Benefits We're ...

Ova Technologies

Utilization Review Nurse

Alpharetta, GA · On-site

Utilization Review Nurse Location: [City, State / Remote] Employment Type: Full-Time Experience: 2 ... Communicate with insurance companies, managed care organizations, and third-party payers regarding ...

ADP, Inc.

Utilization Review Specialist

Knoxville, TN · On-site

Voluntary Coverages - Pet insurance, home and auto insurance, family legal services, and more ... The Utilization Review Specialist plays a critical role in ensuring that healthcare services ...

UHS

PR · On-site

Leads the utilization review procedures in accordance with the standards set by all relevant accrediting and regulatory agencies, including URAC, CMS, NCQA, PR Insurance Commissioner's Office, and ...

Acrisure, LLC

... of insurance, reinsurance, payroll, benefits, cybersecurity, mortgage services, and more.In the ... Utilization Review Nurse, LPN** to evaluate treatment requests and help ensure injured workers ...

Acrisure

Utilization Review Nurse

Bradenton, FL · On-site

... of insurance, reinsurance, payroll, benefits, cybersecurity, mortgage services, and more. In the ... Acrisure is seeking a Utilization Review Nurse, LPN to evaluate treatment requests and help ensure ...

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Insurance Utilization Review information

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How much do insurance utilization review jobs pay per hour?

As of Sep 13, 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 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.
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Insurance Utilization Review jobs near you
Infographic showing various Insurance Utilization Review job openings in the United States as of September 2026, with employment types broken down into 1% As Needed, 74% Full Time, 19% Part Time, and 6% Contract. Highlights an 88% Physical, 1% Hybrid, and 11% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Assistant

Odessa, TX • On-site

Medical Center Hospital
Health Care and Social Assistance • 1 - 5K employees
Learn more about Medical Center Hospitalexternal

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Re-posted 26 days ago

Medical Center Health System rating

8.4

Company rating: 8.4 out of 10

Based on 34 frontline employees who took The Breakroom Quiz

Job description

Position Summary:
Assists UM Department with utilization review processes, including the collection and analysis of various computer-based data related to Utilization Review, Care Coordination, and Commercial Insurance.
Qualifications:
A. Education:
Must have a high school diploma or equivalent.
B. Training and Experience:
Must have a minimum of one-year work experience in an acute care medical facility.
C. Job Knowledge:
Familiar with medical terminology, utilization review, community resource a plus. Basic computer skills required. Be able to communicate effectively verbally and in writing.
Unusual Physical Demands and Working Conditions:
Should be familiar with healthcare operations. Experience with the collection and management of data preferred. Familiar with medical terminology, utilization review, and/or medical insurance preferred.
Ability to communicate effectively and professionally, both verbally and in writing.

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