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Insurance Utilization Review Jobs (NOW HIRING)

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 ...

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!

ARcare

Utilization Review Associate

Augusta, AR · On-site

Utilization Review Associate Job Type: Full-time, 40 hours per week required (hourly POSITION ... That mission drives everything we do, from accepting every patient, regardless of insurance status ...

UHS

Utilization Review Clinician

Augusta, GA

... insurance companies/authorizing entities to ensure initial precertification and continued ... utilization review. CERTIFICATIONS, LICENSES, REGISTRATION LMHC, LMFT, LAPC, LPC, LMSW, LCSW, LPN ...

Oscar Health

Utilization Review Nurse

Atlanta, GA · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI ...

UHS

Utilization Review Clinician

Augusta, GA · On-site

... insurance companies/authorizing entities to ensure initial precertification and continued ... utilization review. CERTIFICATIONS, LICENSES, REGISTRATION LMHC, LMFT, LAPC, LPC, LMSW, LCSW, LPN ...

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI ...

UHS

Utilization Review Coordinator

Brookline, MA

Responsibilities Utilization Review Coordinator Opportunity - HRI Hospital is seeking a Full-time ... insurance offering, a physician network and various related services located in 40 U.S. states ...

UHS

Utilization Review Coordinator

Brookline, MA · On-site

Responsibilities Utilization Review Coordinator Opportunity - HRI Hospital is seeking a Full-time ... insurance offering, a physician network and various related services located in 40 U.S. states ...

UHS

Utilization Review Coordinator

Brookline, MA

Responsibilities Utilization Review Coordinator Opportunity - HRI Hospital is seeking a Full-time ... insurance offering, a physician network and various related services located in 40 U.S. states ...

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How much do insurance utilization review jobs pay per hour?

As of Jul 29, 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:
What are the most commonly searched types of Insurance Utilization Review jobs? The most popular types of Insurance Utilization Review jobs are:
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 July 2026, with employment types broken down into 1% As Needed, 70% Full Time, 23% Part Time, and 6% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Utilization Review Physician

Dane Street, LLC

Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 17 days ago

Job description

Overview
We are seeking a high-performing Physician Reviewer to join our Group Health division. The role is responsible for delivering timely, defensible utilization review determinations across a high-volume, fast-paced environment. Reviews span multiple case types, including preauthorization, appeals, DRG clinical validation, benefit review, and experimental/investigational determinations.
Key Responsibilities
  • Perform utilization review for:
    • Preauthorization requests
    • Appeals (first and second level)
    • Independent external reviews
    • DRG validation and clinical review
    • Benefit and coverage determinations
    • Experimental/Investigational (E/I) review
  • Apply evidence-based criteria and guidelines, including:
    • InterQual
    • MCG
    • CMS guidelines (including 2-Midnight Rule)
    • LCD/NCD
    • Client-specific policies
  • Produce clear, concise, and defensible clinical rationales
  • Maintain high accuracy and consistency across determinations
  • Meet or exceed turnaround time (TAT) expectations, including urgent cases
  • Participate in peer-to-peer discussions as needed
  • Collaborate with QA and operational teams to ensure quality and compliance
  • Reviews may be conducted within internal systems or client-specific platforms, depending on assignment and client requirements

Performance Metrics
  • High daily review volume with strong accuracy
  • Consistent adherence to client-specific requirements
  • Ability to manage short-TAT and urgent cases efficiently
  • Clear, audit-ready documentation

Required Qualifications
  • MD or DO, board-certified in Internal Medicine, Family Medicine, or similar
  • Active, unrestricted medical license
  • Prior utilization review experience, preferably in a health plan or IRO environment
  • Familiarity with InterQual, MCG, and CMS guidelines
  • Strong clinical judgment and documentation skills
  • Ability to work independently in a high-throughput environment

Technical Skills
  • Proficiency with standard business tools (e.g., Google Workspace, Microsoft Office)
  • Comfortable working across multiple systems, including internal platforms and client-specific portals
  • Strong navigation and documentation skills within web-based applications
  • Ability to manage multiple systems/screens simultaneously in a high-throughput environment
  • Familiarity with Mac operating systems

Work Environment
  • Remote work from home
  • Full-time, Monday-Friday
  • Availability for occasional weekends and holiday coverage for urgent reviews

Benefits
Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind. We offer a range of benefits including medical, dental, and vision coverage for you and your family. Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. Apple equipment and a media stipend are provided for remote workspace.
ABOUT DANE STREET:
A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers' Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.

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