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Insurance Utilization Review Jobs (NOW HIRING)

HHC

UTILIZATION REVIEW SPECIALIST

Indianapolis, IN

FLSA Status Non-Exempt Job Role Summary The Utilization Review Specialist interacts with customers ... and Insurance terminology Ability to prioritize workload/schedules and perform duties without ...

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How much do insurance utilization review jobs pay per hour?

As of Jun 9, 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.
Utilization Review Analyst

Utilization Review Analyst

EAGLEVILLE HOSPITAL

Eagleville, PA • On-site

Other

Posted 10 days ago

Job description

Eagleville Hospital, an independent substance use and behavioral health treatment and educational organization serving the community for more than a century, provides innovative compassionate care to those seeking treatment for stigmatized illnesses including substance use and mental health.
Position Summary
Review and abstract pertinent data from medical records and communicates information to all various insurance companies and/or their contractual agencies to guarantee continued financial coverage.
This position reports to the Utilization Review Director
Objectives / Responsibilities
  • Reviews admissions to determine medical necessity and appropriateness of treatment.
  • Reviews patient records to obtain justification of treatment.
  • Secures necessary data from the clinical team for extended stay reviews.
  • Presents abstracts (via telecon) of clinical course of treatment to all various insurance companies and/or their contractual agencies, to justify continued treatment.
  • Review, abstracts and assigns initial length of stay and extensions of treatment as appropriate for all payers as assigned
  • Communicates all extensions of treatment to clinical teams and Director, Utilization Review (UR)
  • Notify clinical teams of need for current documentation.
  • Refer cases to Director, UR when appropriateness of and necessity of extended stay is questionable.
  • Attend appropriate daily treatment team meeting
  • Salary Range: $50-$57/yr

Educational Requirements
  • Bachelor's Degree Preferred

Competencies
  • Patient-Centered Approach - Treat all individuals with dignity, empathy, and respect, recognizing that every role contributes to the patient experience.
  • Excellence & Accountability - Perform all duties with professionalism, following hospital policies to ensure safety, compliance, and efficiency.
  • Teamwork & Communication - Collaborate with colleagues across departments, maintaining a positive and solution-oriented attitude.
  • Commitment to Our Mission - Uphold the hospital's values and contribute to a culture of trust, inclusivity, and continuous improvement.

Qualifications
  • 3+ years of UR or case management experience in Substance Use /Behavioral Health
  • Good communication
  • Ability to work independently
  • Experience with Microsoft applications
  • Knowledge of pre-certification process and ASAM. Knowledge of DSM V, private care managers and county referral sources

Physical Requirements
  • Ability to sit for long periods
  • Ability to walk around campus if needed
  • Good dexterity, must be able to type
  • Use of telephone

Work Environment
  • Office setting

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